The Foot and Ankle: A Foundation for Movement and a Source of Common Issues

The human foot and ankle complex, a marvel of biomechanical engineering, serves as the foundation for movement, bearing the brunt of ground reaction forces, momentum, and gravity with each step. This intricate network of bones, muscles, tendons, and ligaments plays a crucial role in gait, balance, and overall kinetic chain function. However, due to the repetitive stress and impact it endures daily, the foot and ankle are uniquely susceptible to a variety of overuse and impact-related injuries. Understanding these common issues and their influence on movement is essential for fitness professionals to effectively assess clients and modify exercise programs. While diagnosis and treatment remain the purview of healthcare professionals, a sound understanding of these conditions empowers Coaches to better manage clients and contribute to their well-being. This understanding is particularly crucial for stretching and flexibility coaches, as targeted work on the intrinsic foot muscles, such as those involved in the "short foot" exercise, the rear foot, and the short and long toe extensors, combined with fascial manipulation techniques, can significantly mitigate issues along the entire kinetic chain.

One of the most frequently encountered foot conditions is plantar fasciitis. This painful ailment stems from inflammation of the plantar fascia, a thick band of connective tissue that spans the bottom of the foot, supporting the medial longitudinal arch. The plantar fascia acts as a shock absorber, lengthening and recoiling with each step. However, when this tissue lacks sufficient elasticity or is subjected to excessive strain, micro-tears can occur, leading to pain and inflammation. This pain is often most pronounced with the first steps in the morning or after periods of rest, a phenomenon known as poststatic dyskinesia. Prolonged standing or walking can also exacerbate the discomfort. Risk factors for plantar fasciitis include limited mobility in the plantar fascia and Achilles tendon, repetitive high-impact activities, an everted foot type (where the foot rolls inward excessively), increased body mass index in non-athletic populations, and insufficient ankle mobility. Notably, decreased plantar flexor and Achilles tendon length can restrict ankle joint motion, leading to compensatory excessive pronation, which further stresses the plantar fascia. Individuals exhibiting feet turn out, excessive pronation, or excessive forward trunk lean during overhead squat assessments may be at an elevated risk. For clients with active plantar fasciitis, the Coach should prioritize increasing foot and ankle mobility through myofascial release of the plantar foot and posterior muscle group (soleus and gastrocnemius).1 As a stretching and flexibility coach, I emphasize activating and strengthening the intrinsic foot muscles through exercises like the "short foot" exercise. This exercise helps restore proper arch support and reduce strain on the plantar fascia, addressing a key underlying factor. Furthermore, addressing rear foot mobility and the function of the short and long toe extensors improves overall foot mechanics and reduces compensatory strain further up the kinetic chain. I also utilize fascial manipulation techniques to release restrictions within the plantar fascia itself and address fascial connections to the calf muscles and even the posterior chain, to further alleviate pain and improve tissue extensibility.

Another common overuse injury affecting the posterior aspect of the lower leg is Achilles tendinopathy. The Achilles tendon, formed by the soleus and gastrocnemius muscles, is the largest and strongest tendon in the body, crucial for elastic recoil and energy return during dynamic movement. Achilles tendinopathy, encompassing a spectrum from reactive tendinopathy to degenerative tendinopathy, is often linked to limited ankle mobility or a tight Achilles tendon. Similar to plantar fasciitis, individuals with feet turn out, excessive pronation, or excessive forward trunk lean may be predisposed to this condition. Pain associated with Achilles tendinopathy can manifest either at the tendon’s insertion on the calcaneus or along the mid-portion of the tendon. Insertional pain is often associated with uncontrolled impact absorption, while mid-tendon pain is more commonly linked to insufficient elasticity and subsequent micro-tearing. As with plantar fasciitis, the Coach should avoid impact activities and focus on improving foot and ankle mobility through myofascial release. Furthermore, eccentric training, such as negative heel raises, has proven highly effective in managing Achilles tendinopathy by promoting tendon healing and strength. From a stretching and flexibility perspective, ensuring proper function of the rear foot and toe extensors is crucial for optimal Achilles tendon loading and reducing the risk of injury. The short foot exercise also plays a role by improving overall foot stability and reducing stress on the tendon. In addition to these exercises, I incorporate fascial manipulation to address restrictions not only within the Achilles tendon itself, but also in the surrounding fascia of the calf and lower leg, significantly impacting tendon function and recovery.

Medial tibial stress syndrome (MTSS), commonly known as shin splints, is another overuse injury frequently encountered in fitness settings. MTSS is thought to arise from improper loading of impact forces, particularly in individuals with a more rigid foot type. During impact, the body utilizes a stiffening response within the myofascial system to absorb vibrations and protect the bones. However, when this system is overloaded or functions inefficiently, it can lead to pain and tenderness along the lower third of the medial tibia, especially during activities like running and jumping. Risk factors for MTSS include improper footwear, overpronation, a rigid (supinated) foot type, gluteal weakness, and delayed stabilization on impact. For clients experiencing MTSS, the Coach should avoid impact activities and concentrate on improving foot mobilization, strengthening intrinsic foot muscles, and promoting foot-to-core integration to enhance gluteal strength and overall stability. Orthotics may be considered for individuals with overpronation to optimize muscle stabilization timing. As a stretching and flexibility coach, I emphasize addressing foot mechanics through exercises like the short foot exercise, working on rear foot mobility, and toe extensor function. These interventions improve force distribution during impact and reduce stress on the tibia. I also use fascial manipulation to address restrictions in the deep fascia of the lower leg, contributing to the pain and discomfort associated with MTSS.

While not a direct injury, understanding bone adaptation and stress fractures is crucial for fitness professionals. Stress fractures occur not from a single traumatic event, but rather from repetitive submaximal loading that exceeds the bone’s capacity to repair itself. This repetitive stress acts as a mechanical stimulus, triggering bone formation and repair. However, when the rate of loading exceeds the rate of repair, micro-fractures can accumulate, eventually leading to a stress fracture. This highlights the importance of progressive training programs that allow for adequate bone adaptation and prevent overloading. Even in the context of bone adaptation, the proper function of the foot and ankle, facilitated by exercises like the short foot and attention to rear foot and toe extensor function, is essential for optimal load distribution and injury prevention. Maintaining fascial integrity through manipulation techniques also supports healthy bone loading and adaptation.

Finally, ankle sprains and subsequent chronic ankle instability are common, especially in sports involving lateral movements and jumping. Lateral ankle sprains, resulting from excessive ankle inversion, are particularly prevalent. Individuals who experience an ankle sprain are at risk of developing chronic ankle instability, characterized by recurrent episodes of “giving way” and a feeling of instability. Risk factors include previous sprains, increased arch height or a supinated foot type, improper footwear, intrinsic muscle weakness, and even gluteal weakness. For clients with a history of ankle sprains or chronic ankle instability, the Coach should emphasize proprioceptive training, foot strengthening, and gluteal strengthening to enhance ankle joint stability and position sense. From a stretching and flexibility standpoint, focusing on the short foot exercise, rear foot mobility, and toe extensor function is crucial for restoring proprioception and improving dynamic stability in the ankle joint. Furthermore, I apply fascial manipulation to address any residual restrictions in the ligaments and surrounding soft tissues of the ankle, which can contribute to instability.

In conclusion, the foot and ankle complex, while vital for movement, is susceptible to various issues due to the high demands placed upon it. By understanding these common conditions—including plantar fasciitis, Achilles tendinopathy, MTSS, and the implications of bone adaptation and ankle sprains—fitness professionals can better assess clients, modify exercise programs, and contribute to their overall health and well-being. As a stretching and flexibility coach, I firmly believe that addressing the intrinsic foot muscles, rear foot mobility, and the function of the short and long toe extensors through targeted exercises like the short foot exercise, combined with fascial manipulation techniques, is paramount for optimizing foot and ankle mechanics and mitigating issues along the entire kinetic chain. This integrated approach not only aids in the management of existing conditions but also plays a crucial role in injury prevention, promoting optimal movement and performance.