By Philip J Stotter, CEP
The question is, where does it all begin? Our body’s biomechanical function starts at the foot level and as we age, if ignored, this relationship typically takes a turn for the worst. Foot and ankle training is perhaps the single most neglected component of strength and performance, especially in older adults. If the feet and ankles are not functioning properly, which those of most older adults are not, it’s clinically proven that these individuals are at higher risk for chronic injuries, decreased balance, and more injurious falls. The feet and ankles are extremely important to the overall function of the human body especially in terms of one’s balance, since it is the only part of the body that interacts with the ground while in an upright position. The feet and ankles are directly responsible for the distribution of weight and pressure throughout the body when the forces of kinetic energy, gravity, and the ground collide. Therefore, it is imperative that the feet and ankles are fully functional and doing their job correctly to ensure that the force of gravity is well opposed, keeping an older adult upright and functional.
Building a strong connection with the ground is the first step in improving one’s balance. Studies show the two greatest predictors of declining balance and increasing falls in the older adult is biomechanical restriction in the ankle or, more specifically, loss of ankle dorsiflexion as well as decreased sensory interaction for postural control. Let’s start with dorsiflexion, an action where the toes draw close to the shin bone. Weight-bearing ankle dorsiflexion range of motion has been proven to be a predictor of a person’s dynamic balance as well as general mobility and stability. More importantly, lack of dorsiflexion has a strong association with postural control (balance) and is a predictor of fall risk. Besides increasing the likelihood of a fall, loss of dorsiflexion lessens the effectiveness of one’s ability to perform daily functions such as getting up and down from a chair, walking efficiently, and walking without pain, as well as many activities an older adult faces every day. Postural control, or what is referred to as good balance, depends on correct sensory information from one’s eyes (visual system), muscles, tendons, and joints (proprioceptive input), and the balance organs in the inner ear (vestibular system). With that said, the feet serve as the base for all this sensory information and must be free and strong enough to control this input. I compare this to living one’s life in ski boots. Ski boots limit a person’s ability to move from their ankles especially through dorsiflexion. Imagine walking, squatting, or going downstairs in ski boots. Trust me, it’s not easy. So even with all of a person’s sensory information controlling their posture, all is lost if there is restriction or weakness in their feet and ankles.
A Word About Ski Boots
Ski boots are engineered to transfer a skier’s bodily movements into the skier’s skis. The boots are designed to be stiff, to restrict ankle motion, and to support and protect feet, ankles, and lower legs. To successfully transfer forces well, the boots have to be stiff and restrict ankle movement. The soles on ski boots are designed to attach to ski bindings so that the boots can be held firmly to the skis. All ski boots tilt the lower leg forward, so that ankles and knees are bent when standing. Forward lean is normally set at about 14° but can often be adjusted as far as 17°. The cuff of the boot will not let the ankle move sideways, or let the ankle straighten, but the flex of the boot will enable the shin to move further forwards by a few more degrees.
–Information used with permission from MechanicsofSport.com, a website that explains the mechanics involved in skiing and skateboarding and offers online skiing lessons.
The first step is to assess an individual’s weight-bearing dorsiflexion range of motion. In order to gain range of motion and strength in dorsiflexion, just stretching exercises are not enough. To truly improve overall function in the foot and ankle when targeting dorsiflexion, an individual must perform everyday movements, slowly increasing the range of motion in the ankle while performing them. Even static positions, such as standing still, require a certain degree of dorsiflexion to ensure body weight is over the heels, centering the force of gravity throughout the entire body. To improve overall foot and ankle function, perform basic movements such as walking, squatting, and bending while increasing the angle of the foot and the load of weight into the proper segments of the foot. This will help increase the strength and flexibility of the feet and ankles and, more importantly, the control an individual will have over the rest of his/her body. Examples of these exercises would be bending forward while the balls of one’s feet are elevated or squatting down while their feet are in this same elevated position.
Foot and ankle training should be first on the list for improving overall physical function, balance, and preventing falls for the older adult. Remember, the feet and ankles won’t improve enough with just stretching and, if ignored, they will lose strength and flexibility. A strong focus on training the feet and ankles is essential to a functional quality of life for the older adult. Making sure the biomechanical system is unrestricted, especially in the feet and ankles, allows the sensory system to freely communicate its message to the postural muscles. In the end, foot and ankle training for the older adult should be a priority – and it all starts with loosening the boot.
Philip Stotter, CEP, is a veteran clinical exercise physiologist turned inventor/business developer, and the Visionary and Founder behind Stotter Technologies, Moflex foot/ankle training device, AA360, and others. As a practitioner, researcher, and educator, Philip has over 25 years of experience in performance, corrective and preventative clinical, and sports settings. He is currently one of the top human biomechanics and ground force experts in the world. Philip focuses his work on ground mechanics and how to use technology to augment the test/treat or test/train intervention process. His most recent venture is as Director of Sports Science for V1 Sports, the leader in video analysis and ground pressure software to capture, review, and analyze athletic movement.