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The ankle and foot are two of the most important structures in the body and are, in fact, biological masterpieces, considering that the average person takes between 8000 and 10,000 steps per day, walking places one and a half times the body’s weight on the feet, and running can place up to four times the body’s weight on the feet. Given these facts, it’s easy to understand how the ankle and foot are both highly susceptible to injury. Approximately 75% of Americans will experience some sort of foot or ankle problem in their lifetime; moreover, ankle injuries are the most common type of injury to the region and are among the most common joint injuries seen by physicians.

The ankle and foot are intricate structures, containing 26 bones, 107 ligaments, and 19 muscles and tendons that hold them together and allow them to function. They are formed by the piecing together of numerous individual bones, much like a three-dimensional puzzle. Because of the numerous structures involved, true one-on-one articulations between bones are rare in this region. Instead, most bones have several articulations between surrounding structures. Even though these bones and their articulations are often discussed separately, they have a unique relationship with each other and come together to function as a unit. They form the terminal portion of the kinetic chain of the lower extremity and are essential in all locomotive activities.

The lower leg, ankle, and foot have two principal functions:

Support: The foot provides a base that acts as a rigid structure; it supports the entire body and facilitates upright posture with minimal effort during standing.

Locomotion: The ankle and foot act like a flexible lever that provides adaptability to the environment, accommodates shock absorption, and offers a base from which the foot can push off.

These functions distribute and dissipate the forces acting on the body when the feet make contact with the ground. Any change in structure or mobility of the ankle and/or foot can lead to the transmission of abnormal stresses through the body and ultimately lead to the dysfunction of those structures.

An in-depth study of the biomechanics and dysfunction of the ankle and foot is beyond the scope of this text. This chapter provides a clear, basic understanding of this region of the body and how its functions relate to the rest of the body. Because of its significance, the therapist must be able to properly assess this region of the body. In addition to reviewing the structures, this chapter discusses:

  • Specific bony landmarks for palpation
  • Soft tissue structures, including the muscles of the region
  • The movements of the region, and the basic biomechanics of the ankle and foot
  • Manual muscle tests for the ankle and foot
  • Dermatome and trigger-point referral patterns for the involved muscles
  • Some common causes of dysfunction and how to assess and treat them using soft tissue therapy







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