ADVERTISEMENT
Using Heel Lifts To Combat Limited Ankle Joint Range Of Motion
I recently discussed the effects of limitation of ankle joint dorsiflexion range of motion (ROM) on the medial column, the function of the peroneals and on gait overall.1,2 I talked about the use of ankle joint manipulation in a previous DPM Blog and how that can often increase ankle ROM for patients.3 But what if the manipulation does not work and what if stretching exercises don’t work either? Then what can you do to combat the evils of ankle joint equinus?
Your conservative options for treating limited ankle dorsiflexion range of motion range from manipulation to stretching or the use of heel lifts. Manipulation can work but the effects of manipulation often will not last and manipulation is not guaranteed to provide all the dorsiflexion ROM necessary.
Stretching exercises to increase ankle ROM range from the traditional gastrocnemius and soleus wall stretches to lunges and Mulligan concept stretches.4 Stretches have had somewhat successful testing in the literature but are no cure-all.
Ultimately, if you can’t get the increase in ankle dorsiflexion range of motion that you want through traditional options, you are left with using heel lifts. Physicians often use heel lifts unilaterally for patients with limb length issues.5 Those practitioners who evaluate for limb length discrepancies regularly will use heel lifts to help bring symmetry to the patient’s gait.
Heel lifts may have some use for treatment of low back pain with orthotics. The reasoning behind this is not completely known. I think it has to do with relaxing the posterior leg flexors, like the Achilles and hamstrings. I think this will allow for relaxation of the low back musculature as well.
From a gait perspective, research has shown that heel lifts increase the available ankle joint range of excursion and they also delay the time for the heel to lift off.6 Increased excursion or range of motion, combined with a delay in heel off, can increase hip extension range of motion in gait. This also can decrease back issues by keeping the trunk upright. Dananberg talks about this in his functional hallux limitus papers.7 Finally, as we have all learned, right or wrong, eliminating ankle equinus can decrease subtalar joint pronation. This is another good reason to use heel lifts on your patients who need them.
Regardless of whether your patients have back pain or not, if you have measured their ankle range of motion and find it to be lacking, and if stretching or manipulation have failed to remedy this, add a heel lift to their devices. It will help them overall.
Thank you for reading!
References
1. Williams B. Pertinent considerations with using the ankle joint lunge test to assess ankle joint ROM. Podiatry Today DPM Blog. Published July 3, 2018. Available at https://www.podiatrytoday.com/blogged/pertinent-considerations-using-ankle-joint-lunge-test-assess-ankle-joint-rom .
2. Williams B. Peroneal function and fibular translation: assessing their impact on the first ray and ankle range of motion. Podiatry Today DPM Blog. Published May 2, 2018. Available at https://www.podiatrytoday.com/blogged/peroneal-function-and-fibular-translation-assessing-their-impact-first-ray-and-ankle-range .
3. Williams B. How ankle joint manipulation affects the peroneal tendons and ankle range of motion. Podiatry Today DPM Blog. Published June 1, 2018. Available at https://www.podiatrytoday.com/blogged/how-ankle-joint-manipulation-affects-peroneal-tendons-and-ankle-range-motion .
4. Young R, Nix S, Wholohan A, et al. Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis. J Foot Ankle Res. 2013; 6(1):46.
5. Barton CJ, Coyle JA, Tinley P. The effect of heel lifts on trunk muscle activation during gait: a study of young healthy females. J Electromyogr Kinesiol. 2009;19(4):598-606.
6. Johanson MA, Cooksey A, Hillier C, et al. Heel lifts and the stance phase of gait in subjects with limited ankle dorsiflexion. J Athl Train. 2006;41(2):159–165.
7. Dananberg HJ, Guiliano M. Chronic low back pain and Its response to custom-made foot orthotics. J Am Podiatr Med Assoc. 1989; 89(3):109–17.
