Normal gait requires at least 5 degrees of ankle dorsiflexion, with maximum dorsiflexion occurring closed chain during late mid stance when the subtalar joint is passing through neutral.   Limited ankle joint dorsiflexion can result in a myriad of compensations both proximally and distally.

From knee hyperextension to midfoot over-pronation (calcaneal eversion), the deforming forces caused by tight calves is enough to make any Movement Specialist cringe.  I refer to this lack of ankle joint dorsiflexion as a “Podiatric Epidemic” as a majority of people assessed lack adequate ankle joint range of motion.

I often reference the correlation between proximal pelvic influences on ankle joint range of motion and calf flexibility.   In the case of a client or athlete with an anterior pelvic tilt position and over-active hip flexors, integrating hip flexors stretches or myofascial release will often relax the tight calves and increase ankle joint mobility.  

However for those clients or athletes who have adequate pelvic flexiblity but demonstrate decreased ankle range of motion, we want to integrated posterior group stretches.

When recommending posterior group stretches some of the classic stretches include the wall stretch, downward facing dog and dropping a heel off of the step. When performing theses stretches have you ever considered the role rearfoot position may have on the effectiveness of that stretch?  

A 2009 study by Jung et al. evaluated the impact of rearfoot position on the effectiveness of gastrocnemius stretching. Due to the prevalence of tight gastrocs in an over-pronated (everted) foot type, Jung et al. wanted to determine if the everted calcaneal position altered the effectiveness of the stretch.

Jung et al. evaluated 30 patients with both a neutral foot type and an over-pronated foot type with increased calcaneal eversion (average 4 degrees). Subjects performed a gastrocnemius wall stretch both in their relaxed calcaneal stance position and while wearing orthotics which placed the calcaneus in a neutral position.

Ultrasound technology was used to evaluate the degree of stretch as determined by the change in myotendinous length.   It was observed that rearfoot position had a significant impact on the effectiveness of posterior group stretching with a 3mm increase in gastroc length when the rearfoot was held in a neutral position.

Considerations for the Movement Specialist

When considering articles to review and share on the EBFA Blog, I like this study for several reasons:

1. It emphasizes the impact subtle adjustments in body positioning can have on stretching effectiveness.   As evidence-based professionals, if we can apply research studies such as this into our client’s programming we may begin to see better results.

2. It re-emphasizes the concept of foot-specific programming I integrate into my Barefoot Training Specialist workshops. In an over-pronated foot type with increased calcaneal eversion and decreased medial arch you want to be careful with the impact ankle stretching may have on the weakened posterior tibialis tendon.

When the calcaneus is brought out of the excessive eversion the stretch becomes more isolated to the Achilles tendon and gastrocnemius with little stress to the posterior tibialis tendon.   I have had many patients return to me after doing physical therapy and calf stretching through an everted or pronated foot.  

 How can the fitness professional integrate this evidence into their programming?

1. For any clients with an over-pronated foot type, isolated gastroc stretching should be performed preferably non-weight bearing to minimize the impact of rearfoot position on the stretch.
2. If the clients have orthotics that control rearfoot motion, perform closed chain gastroc stretches with the orthotics and then remove the shoes and orthotics for any barefoot training exercises.
3. For any clients with an over-pronated foot type who wear Vibrams or minimal footwear for daily use and training, frequent evaluation of posterior tibial tendon condition should be performed.

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To learn more about foot-specific programming and the integration of barefoot training into your client programming please visit www.ebfafitness.com

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