a community of practitioners

Are we effectively the foot and ankle?!

The calcaneus is both a commonly overlooked and rarely treated area of the body in massage and bodywork settings, but one that can have far reaching implications when it comes to athletic performance, injury prevention and pain management.

Poor motion of the foot can have wide ranging on effects on the muscular system especially the stirup spring system, which Erik talks about in great detail on his website and during his seminars

I would like to hear how most of us go about assessing and treating poor foot range of motion

Replies to This Discussion

Permalink Reply by Donna C. Agrinsonis, LMT on January 8, 2010 at 8:06am

Speaking of that - I have an issue with my own ankle. I broke it in 3 places 2 years ago. Every massage therapist who has worked on it here locally has not done a thing to help it to get better. The only relief I have gotten is from deep massage around the ankle using cross-friction techniques. I have pins in there now. The ankle is very strong and it is totally healed. I do strengthening exercises and range of motion exercises. Also since I am overweight my other ankle hurts a lot also and each time a massage therapist works on it they use all this light pressure. I am working on losing weight but in the interim, I am wanting to know if I should look for a massage therapist with particular credentials or modalities to get help with this issue. I am new to massage and still learning deep tissue so in dealing with my own infirmity, I suppose I will learn more. But this is very frustrating since I do a lot of massage at times and I end up having to use Biofreeze on my ankles in order to alleviate the pain enough so I am not distracted when I am working on clients.

Permalink Reply by Mike Hinkle on January 8, 2010 at 11:38am

Hi Donna,

This sounds like a breakdown in communication with you and the therapist. (*Probably the number one reason clients move onto the next therapist) Make sure they understand what you want in that specific area and don't let them move on until they have addressed it.

We say our clients need to let us know. Sometimes we need to train therapists ourselves and be able to accept these requests to have happy customers. I think it will make us more understanding towards clients as well. How many therapists have they been to already trying to solve this?

Speak up. Isn't that what we tell our clients? We need to repeat that to them twice, when we say it and with emphasis.

And when someone says, "My major situation is with my ankle", therapists need to hear that and address that ankle, not break into their famous repertoire of techniques.

Donna C. Agrinsonis, LMT said:

Speaking of that - I have an issue with my own ankle. I broke it in 3 places 2 years ago. Every massage therapist who has worked on it here locally has not done a thing to help it to get better. The only relief I have gotten is from deep massage around the ankle using cross-friction techniques. I have pins in there now. The ankle is very strong and it is totally healed. I do strengthening exercises and range of motion exercises. Also since I am overweight my other ankle hurts a lot also and each time a massage therapist works on it they use all this light pressure. I am working on losing weight but in the interim, I am wanting to know if I should look for a massage therapist with particular credentials or modalities to get help with this issue. I am new to massage and still learning deep tissue so in dealing with my own infirmity, I suppose I will learn more. But this is very frustrating since I do a lot of massage at times and I end up having to use Biofreeze on my ankles in order to alleviate the pain enough so I am not distracted when I am working on clients.

Permalink Reply by Mike Hinkle on January 8, 2010 at 12:03pm

Hi Danny,

Well you are already on the right path, if you are attending Erik's classes and following his work.

Our lack of effective basic foot and ankle work in school is another reason, I think. My massage instructor taught very little foot and ankle work, never allowed the thumbs to do anywork and involked "endangerment zone" in every other sentence. It is a precaution and understood in school, but look outside school. How many advanced instructors are there out there teaching these classes? Not many. Hence little attention is paid to these areas.

More attention needs to be paid to these areas. Gait is so important to overall health. So Danny, Erik is planning on retirement soon, are you going to be "The Gait Man"? Sounds like a niche to me. Great discussion question.

Permalink Reply by Danny Christie on January 8, 2010 at 5:17pm

Hello Mike,

I agree that the foot and ankle a grossly misunderstand and under studied area.

Gait is a huge field and a specialty in itself; I will be posting a more in depth post shortly regarding the mechanics of the foot and how faulty movement can manifest in wide reaching aches and pains
Erik teaches a great workshop on lower limb and foot mechanics which is a must for all LMT whom deal muscle pain clients.

Permalink Reply by Danny Christie on January 9, 2010 at 9:48am

The foot and ankle region is a hugely complex area of the body. The foot is comprised of 26 bones accounting for 33 joints. There are 20 muscles involved in movement of the foot. The ankle and foot move in a tri-planar fashion. The complex movement of the foot and ankle is a fully integrated motion involving multiple joints and muscles, both locally and globally.
The foot is the first area of contact during the gait cycle. A fully functional foot and ankle will move through a tri-planar motion in order to dissipate ground reaction forces.2
At foot strike, the calcaneus moves into eversion in tail leading to internal tibia rotation and dorsi flexion of the talocrural joint. As the gait cycle moves to the phases of stance and toe off, the mechanics change. The calcaneus inverts, the tibia externally rotates and the talocrural joint moves into plantar flexion. These complex motions are extremely important in reducing musculoskeletal stress in the foot and ankle.

Determining faulty movement of the subtalar joint

Immobility of the subtalar joint can manifest pain and dysfunction in many different ways. But firstly it is important to determine if we are dealing with a flexibility or mobility issue, as illustrated in Figure 3. There many ways to establish this, but the easiest way is to utilize the classic soleus stretch position.3
If a deep stretch is felt in the achilles and soleus complex, we have a flexibility issue. If pinching and discomfort is felt in the anterior retinaculum and or around the medial malleolus, we are dealing with an impingement and/or mobility issue.1

We also need to determine the amount of calcaneal inversion, and more importantly, eversion. Calcaneal inversion is normally 20 degrees compared with 10 degrees of eversion. Therefore eversion is an extremely important motion of which we have only a little.