Why Ankle Mobility Matters
The Role of Ankle Dorsiflexion in Pain, Performance and Movement
What Is Ankle Dorsiflexion?
Ankle mobility is a common movement we assess in musculoskeletal practice, yet it's often one of the most overlooked by patients. Whether you're walking, running, squatting in the gym, climbing stairs or simply getting up from a chair, your ankle needs to move through an adequate range of motion to allow the rest of your body to function efficiently.
One of the more important movements at the ankle is dorsiflexion. In simple terms, dorsiflexion is the movement that allows your knee to travel forwards over your foot while your heel stays firmly planted on the ground. Although it sounds technical, it's a movement you perform hundreds, if not thousands, of times every day without even thinking about it.
A healthy amount of ankle dorsiflexion is essential for normal walking, running, jumping, lunging and squatting. During these activities, your shin bone (tibia) needs to move smoothly forwards over your foot. This phase of movement is often referred to as the ankle rocker, and it represents one of the body's most important mechanisms for absorbing force before transitioning into propulsion.
Reduced ankle dorsiflexion is very common. Previous ankle sprains, fractures, surgery, prolonged immobilisation, calf tightness, joint stiffness or even your natural anatomy can all contribute to a restriction in this movement. Many people don't realise their ankle mobility is limited until they begin noticing difficulty with activities such as deep squats, running, climbing stairs or certain exercisies done in the gym.
Why Is Ankle Dorsiflexion So Important?
To understand why ankle mobility matters, it helps to think of the body as a chain of connected links rather than a collection of individual joints. Every movement you perform requires multiple joints to share the workload. If one joint contributes less movement, another usually has to contribute more.
The ankle plays a particularly important role because it acts as one of the body's primary shock absorbers. As your foot contacts the ground, the ankle gradually allows the tibia to move forwards while the surrounding muscles control this motion. This smooth progression helps distribute forces efficiently throughout the entire lower limb before your body generates the force needed to walk, run or jump again.
When ankle dorsiflexion is restricted, the body adapts. It finds another way to achieve the same task. This might involve lifting the heel earlier during walking, turning the foot out during a squat, flattening the arch to gain extra movement, or changing how the knee, hip or trunk move. These compensations aren't necessarily "bad"—they're simply the body's way of finding movement when one joint isn't contributing as much as it should.
Research has found that reduced ankle dorsiflexion is associated with a range of lower limb conditions, including recurrent ankle sprains, Achilles tendinopathy, plantar heel pain and patellofemoral pain. However, this doesn't mean limited ankle mobility directly causes these conditions. Rather, it may change how movement and force are distributed throughout the lower limb, potentially increasing the demands placed on other tissues over time.
What Happens When You Don't Have Enough Ankle Mobility?
The body is remarkably good at finding alternative ways to complete a movement. If one joint can't contribute enough motion, another joint or tissue often steps in to compensate. This isn't necessarily a bad thing—in fact, it's one of the reasons we're so adaptable. However, if these compensations are repeated thousands of times during walking, running or sport, they may gradually increase the demands placed on other parts of the body.
Think of movement like a group lifting a heavy table. If one person suddenly lets go, the table doesn't immediately fall to the ground. Instead, everyone else has to work a little harder to keep carrying the load. Our joints behave in much the same way. When the ankle contributes less movement, the rest of the body often has to pick up the slack.
Early Heel Lift
One of the most common compensations for limited dorsiflexion is an early heel lift.
Normally, as you walk or squat, your tibia progresses forwards over your foot while your heel remains on the ground. If the ankle runs out of movement too early, the heel may lift sooner than it should. This allows the body to continue moving forwards, but it also means the calf muscles and Achilles tendon begin doing more of the work.
Over time, this may increase repetitive loading through the Achilles tendon, which helps explain why reduced ankle dorsiflexion has been associated with Achilles tendinopathy in the research. This doesn't mean every person with a stiff ankle will develop Achilles pain, but it provides a plausible mechanical explanation for why the two are often linked.
Increased Foot Pronation
Sometimes when the body doesn't lift the heel—it uses movement from the foot instead.
Rather than moving primarily through the ankle joint, the foot may roll inwards slightly more (pronation) to create the extra movement required for walking or squatting. This involves a combination of movements through the rearfoot, midfoot and forefoot, allowing the leg to continue progressing forwards.
Pronation itself is not a bad thing. In fact, it's an essential part of normal walking and running. Problems generally arise when the foot is repeatedly required to contribute more movement than it has the capacity to tolerate. This may increase the demands placed on structures such as the plantar fascia, tibialis posterior and the smaller stabilising muscles of the foot.
Changes at the Knee
The knee may also adapt when ankle mobility is limited.
During movements such as squatting, lunging and landing from a jump, adequate ankle dorsiflexion allows the knee to travel forwards while maintaining good control of the lower limb. When the ankle contributes less movement, people often adopt alternative strategies. Some turn their feet outwards, some lean their trunk forwards, while others allow the knee to drift further inwards—a movement commonly referred to as dynamic knee valgus.
Reduced ankle dorsiflexion can be associated with increased knee valgus and altered landing mechanics during tasks such as squatting and jumping. These changes may increase loading around the patellofemoral joint in some individuals, which is one reason ankle mobility is often assessed in people presenting with anterior knee pain. Again, this relationship is not one of direct cause and effect, but rather a change in how forces are distributed throughout the lower limb.
The Body Simply Shares the Load Differently
The most important concept to understand is that limited ankle mobility doesn't automatically mean you'll develop pain or an injury. Many people have reduced dorsiflexion and function perfectly well.
What matters is whether the body can successfully adapt without overloading another structure. Every muscle, tendon and joint has a certain capacity to tolerate load. If the ankle contributes less movement, another tissue often contributes more. If that tissue has sufficient capacity, you may never notice a problem. If it doesn't, symptoms may eventually develop.
Rather than thinking that "poor ankle mobility causes injuries," it's more accurate to think of ankle dorsiflexion as one part of the body's overall load-sharing system. The ankle doesn't work in isolation, it works alongside the foot, knee, hip and trunk to distribute forces efficiently. When one part of the system contributes less, the rest of the chain simply has to work a little harder.
How Do We Measure Ankle Mobility?
One of the simplest and most reliable ways to assess ankle dorsiflexion is with the Knee-to-Wall Test (also known as the Weight-Bearing Lunge Test). This test is widely used by physiotherapists, osteopaths and sports medicine clinicians because it closely reflects how the ankle functions during everyday activities such as walking, running and squatting.
The test itself is straightforward. Standing facing a wall, you place one foot in front of the other and slowly drive your front knee towards the wall while keeping your heel firmly on the ground. The goal is to find the furthest distance your foot can be from the wall while still allowing your knee to make contact without the heel lifting.
Most healthy adults are able to achieve approximately 9-10 cm, although small variations between individuals are completely normal. Equally important is comparing one side to the other, with differences greater than around 1.5 cm often warranting further assessment. While these measurements provide a useful starting point, they are only one piece of the puzzle.
Perhaps the biggest mistake clinicians can make is focusing purely on the number. Two people may both achieve exactly the same Knee-to-Wall score, yet have completely different reasons for their restriction. Understanding why the movement is limited is often far more valuable than simply knowing how much movement is available.
Where You Feel the Restriction Can Provide Valuable Clues
One of the most interesting concepts to emerge from recent research is that the location of discomfort or restriction during the Knee-to-Wall Test may provide valuable clues about which structures could be contributing to limited ankle dorsiflexion. Rather than simply recording a measurement and prescribing the same stretch for everyone, clinicians can use the patient's symptoms to generate more specific clinical hypotheses.
For example, a person who experiences a pinching sensation at the front of the ankle may have a restriction involving the talocrural joint or surrounding joints of the midfoot. Someone who feels discomfort towards the front and outside of the ankle may instead have stiffness involving the distal tibiofibular joint, particularly following a previous high ankle (syndesmosis) sprain. Pain behind the inside of the ankle may suggest involvement of the flexor hallucis longus tendon or subtalar joint, while discomfort behind the outside of the ankle may point towards the peroneal tendons or, again, the distal tibiofibular joint. Finally, if the restriction is felt at the back of the ankle, the calf muscles, Achilles tendon or even increased sensitivity of the tibial nerve may all be contributing factors.
It's important to emphasise that these locations are not diagnoses. They are simply clinical clues that help guide further assessment. Much like detective work, they provide a starting point rather than the final answer.
Why Stretching Isn't Always the Answer
If you've ever searched "how to improve ankle mobility" online, you've probably been shown a calf stretch. While stretching can be an excellent intervention when calf muscle tightness is genuinely limiting movement, it isn't always the solution.
Imagine two people who both have limited ankle dorsiflexion. The first has genuinely shortened calf muscles following several weeks in a moon boot. The second has adequate calf flexibility but a stiff ankle joint following a previous ankle sprain. Although their Knee-to-Wall scores may look almost identical, treating them with exactly the same exercise is unlikely to produce the same result.
This is where individual assessment becomes so important. The goal shouldn't simply be to create more movement—it should be to understand what is preventing the movement in the first place. Sometimes that may involve improving joint mobility. Other times it may involve addressing muscle flexibility, tendon stiffness, neural sensitivity or even improving how the body coordinates movement during functional tasks.
Looking Beyond the Ankle
One of the biggest lessons I've learnt in clinical practice is that ankle dorsiflexion isn't just an ankle movement. Achieving good dorsiflexion requires a coordinated contribution from multiple structures, including the ankle joint itself, the foot, the surrounding muscles and the way the lower limb moves as a whole. The body doesn't think in isolated joints, and neither should we.
Rather than asking, "How do I force more ankle movement?", a better question is often, "What is stopping this movement from occurring naturally?" The answer is different for every individual, which is why assessment and treatment should never follow a one-size-fits-all approach.
Limited ankle dorsiflexion isn't automatically a problem, and it certainly doesn't guarantee you'll develop pain. What matters is whether it's changing the way you move or increasing the demands placed on other tissues over time. Understanding why your ankle mobility is limited is often far more valuable than simply trying to force more movement through stretching alone.
If you've been dealing with recurring ankle sprains, persistent calf tightness, difficulty squatting or ongoing lower limb pain, assessing your ankle dorsiflexion may provide an important piece of the puzzle. By identifying not only how much movement is available, but also why that movement is restricted, treatment can become far more specific, individualised and ultimately more effective.
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Written By Dr. Matthew Keys (B.Sci(Osteo), M.H.S (Osteopathy)) - Associate Osteopath, Osteopathic Movement, South Yarra.