4.3 The Foot and Ankle Complex

Beginner Section: The Only Part of You That Touches the Ground

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The short version

Unless you are swimming or cycling, every bit of force you produce leaves your body through your feet, and every bit the ground sends back arrives the same way. If that connection is sloppy, everything above it is working off a bad platform and bad information. Which makes it a slightly odd thing to spend zero minutes a week thinking about.

This article covers what your foot and ankle are actually doing during a step, the neat mechanism that lets a foot switch between soft and rigid, why an ankle you sprained years ago is probably still costing you something, and what to do about all of it.

First, a party trick

Put your foot flat on the floor. Now reach down and pull your big toe upward with your hand.

Watch what happens: your arch rises, all on its own. You didn’t tense a single muscle. It just appeared.

That tiny trick is the secret to how your whole foot works — and by the end of this section you’ll know what it has to do with your squat, your sprint, and that ankle you rolled years ago.

The rope and the drum

Here’s what you just did. A thick band of tissue runs along the sole of your foot and wraps around the base of your big toe, like a rope around a drum.

Lift the toe and you wind the rope. The winding pulls your heel and your forefoot closer together, the arch lifts, and the whole foot locks up into a solid lever (Hicks, 1954).

You never have to think about it. It happens automatically every single time you walk or run — which means your big toe is doing far more work than you ever gave it credit for.

And the band is not just a strap. It stores and returns elastic energy with every stride, so the foot behaves like a spring — and small muscles inside the foot actively tune how stiff that spring is. The advanced section treats them as the foot’s forgotten core, and yes, they’re trainable.

Two things can break the trick

The mechanism only asks for two things. Your big toe has to be able to bend upward far enough. And the band has to be stiff enough to pass the tension along.

Stiff, restricted big toes are extremely common. Somebody who can’t extend theirs properly never fully winds the rope — the foot stays soft when it should be firm, and every stride pushes off a platform that’s quietly collapsing.

In the gym: this is why the exercise library later pairs a great toe extension mobilisation with the calf and arch work. The logic runs in a straight line: no toe extension means no winding, no winding means no lock, and no lock means no lever.

One foot, two contradictory jobs

Your foot has to be two opposite things within a few hundredths of a second.

The instant it lands, it needs to be soft — spreading out, rolling in, soaking up the impact, moulding itself to whatever the ground is doing.

By the time you push off, it needs to be rigid: a stiff lever that can shove an entire body forward without folding up.

So think beanbag on landing, diving board at push-off — with the rope-and-drum trick doing the switching in mid-step.

Getting stuck at either end

A foot that is always soft cannot push. A foot that is always rigid cannot absorb. Both are common, and they go wrong in different directions.

Perpetually soft feet tend toward arch and inner-shin complaints. Perpetually rigid feet tend toward outer-ankle trouble and bone stress issues.

Neither is a moral failing. They’re just two different ways of getting stuck.

In the gym: this is also a speed story. Sprinting and bounding give the foot only the briefest contact with the ground, and a foot that stays soft bleeds energy into the floor instead of getting it back. The stiff-lever state isn’t just injury insurance — it’s where your bounce comes from.

One-line recap: soft to land, stiff to push, and the switch has to happen every single step.

That ankle you rolled years ago is still on the payroll

Rolled ankles get waved away. They shouldn’t be.

A sprained ankle is one of the most common injuries in sport and one of the most casually dismissed (Bahr et al., 2018). And a large share of the people who sprain one don’t simply heal up and move on.

They end up with symptoms that hang around, an ankle that keeps giving way, or measurable long-term losses in range, strength and balance (Doherty et al., 2017; Hertel & Corbett, 2019). Very often, it does not just get better on its own.

In the gym: this is why single-leg balance work belongs in your programme even when the ankle feels fine. As the advanced section explains, a sprain damages the ankle’s sense of where it is — and balance training rebuilds that more effectively than a brace ever will.

One caveat before any of that. This article is performance coaching, not rehabilitation. An ankle that is still swelling, still painful weeks after the event, still giving way, or that has been operated on needs assessing by a qualified clinician, and the loading plan should come from them rather than from here.

The souvenir nobody notices

The most reliable leftover from a sprain is a loss of forward bend (Hertel & Corbett, 2019). The ability to drive your shin forward over a planted foot shrinks — and it stays shrunk.

When athletes get screened, this is the single most common restriction that shows up. It’s usually years old and completely forgotten about.

The bill goes upstairs

Here’s the nasty part: the cost does not stay at the ankle.

If the shin can’t travel forward, squat depth has to be found somewhere else — usually the lower back. Landings get absorbed with a stiffer knee, because the ankle won’t give. And under load, the knee is more likely to drift inward.

So an ankle you sprained playing netball at seventeen can still be shaping how your knee behaves a decade later.

Worked example: your squat depth has stalled and your lower back keeps finishing the job. Before you blame your hips, measure the ankle — the knee-to-wall test in the practical section exists for exactly this, and it takes about a minute per side.

Why feet earn the time

Not because feet are fascinating. Most people will never find them fascinating, and that’s fine.

They earn the time because they sit upstream of almost everything, and problems that start there tend to get reported somewhere else entirely.

One-line recap: the foot is the only part of you that touches the ground. If it isn’t doing its two jobs, something above it is doing them badly on its behalf.

Want the mechanism? Keep reading

The rest of the article gets properly into the detail: the individual joints that matter, what the foot actually does through the stance phase of a step, the windlass mechanism explained in full, how foot structure adapts to training, and specific assessment and loading strategies.

Those sections are more technical, so treat them as the mechanism rather than the map. Come back to them whenever you want to know exactly why.

Advanced Section: Structure, Mechanics and Adaptation

The joints that matter

The windlass in detail

The plantar fascia is not merely a passive strap. It stores and returns elastic energy, contributing meaningfully to the economy of running along with the Achilles tendon (Ker et al., 1987). The foot behaves as a spring, and the stiffness of that spring is partly structural and partly actively regulated by the intrinsic musculature (Kelly et al., 2014).

Intrinsic foot muscles: The forgotten core

The four layers of intrinsic muscles running within the foot itself act as local stabilisers of the arch, in a role directly analogous to the deep trunk musculature at the spine (McKeon et al., 2015). They contribute to arch control during stance and appear to modulate foot stiffness dynamically. Training them — via short-foot exercises and progressive barefoot loading — has been shown to improve measures of dynamic balance and arch control (Ridge et al., 2019).

The extrinsic muscles (tibialis posterior, peroneals, tibialis anterior, triceps surae) provide the larger forces and cross the ankle. Tibialis posterior in particular is the primary dynamic supporter of the medial longitudinal arch; posterior tibial insufficiency produces progressive arch collapse.

Why dorsiflexion is lost and why calf stretching often fails

Functional dorsiflexion requires posterior glide of the talus within the mortise. After sprain, capsular scarring, effusion and an anteriorly positioned talus can all restrict that glide (Vicenzino et al., 2006). In this scenario the limiting structure is articular, not muscular, and no amount of gastrocnemius or soleus stretching will restore it — which is exactly why a joint mobilisation with movement often produces more change in one session than six weeks of stretching.

Distinguishing the two is straightforward in practice. Perform the knee-to-wall test with the knee bent (soleus and joint) and then with the knee straight (gastrocnemius included). If the bent-knee version is limited and the end-feel is hard and abrupt, suspect a joint restriction. If the straight-knee version is disproportionately limited with an elastic end-feel, suspect gastrocnemius length.

Ankle stiffness as a performance quality

Range is only half the story. In sprinting and jumping the ankle must behave as a stiff spring: Ground contact times in maximum-velocity sprinting are brief, and a compliant ankle bleeds energy into the ground rather than returning it. Achilles tendon stiffness and the ability to pre-activate the triceps surae before contact are major determinants of running economy and of reactive strength.

This creates an apparent tension that confuses many athletes. They need more available dorsiflexion range for squatting, landing and change of direction, and higher stiffness within a small range for sprinting and bounding. These are not contradictory: Range is a passive and active availability question, stiffness is a regulation question. Both are trainable, and they are trained differently. Article 3.9 covers reactive strength in depth.

Tendon adaptation timelines

Tendon responds more slowly than muscle. Meaningful change in Achilles tendon stiffness and cross-sectional area requires months of consistent high-load exposure, typically heavy slow resistance or loaded isometrics held for extended durations (Bohm et al., 2015). This has two practical consequences: Progress in a rehabilitation plan should be judged over weeks rather than sessions, and rapid increases in plyometric volume in an athlete whose tendon has not been prepared are a well-recognised route to tendinopathy.

Chronic ankle instability

Recurrent giving-way after sprain is not simply ligament laxity. It involves altered proprioceptive input from damaged mechanoreceptors, delayed peroneal reflex responses, impaired postural control, and central changes in how movement is planned (Hertel & Corbett, 2019). This is why balance and neuromuscular training programmes reduce recurrence more effectively than bracing alone, and why single-leg balance work belongs in the programme even when the ankle "feels fine" (Doherty et al., 2017).

Practical Section: Testing, Progression and Programming

Where coaching stops. What follows is written for healthy athletes building foot and ankle capacity, and for people well past the acute stage of an old injury. It is not a rehabilitation protocol. Pain that does not settle, swelling, giving way, an inability to weight-bear, a post-operative ankle, a suspected fracture or failed hop and strength testing all belong with a clinician, and impact and plyometric work in particular should be reintroduced against criteria a clinician sets rather than against a week number (Chmielewski et al., 2006).

The assessment battery

The progression map

Programming variables

Sample week — returning from a lateral ankle sprain (weeks 4 to 8)

Read this as an illustration of how the pieces fit together in a straightforward case, not as a plan to self-apply. Anyone rehabilitating an actual sprain should be working to criteria agreed with the clinician managing it, and should stop and be reassessed if pain, swelling or giving-way returns.

What each element in the week is doing

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• Banded talar glide, 2 x 10 (daily). Targets the posterior glide of the talus that is often the actual restriction behind limited dorsiflexion, rather than stretching a calf that may not be the problem.
• End-range dorsiflexion isometric, 3 x 15 s. Turns newly available range into range the athlete can control, which is what makes a mobility gain persist.
• Short-foot, 3 x 20 s. Trains the intrinsic foot muscles that support the arch and contribute to force transfer at push-off.
• Single-leg balance, 3 x 30 s progressing to eyes closed. Rebuilds the ankle proprioception that is reliably impaired after a sprain and is one of the strongest predictors of recurrence (Hertel & Corbett, 2019).
• Heavy calf raises, 4 x 8 with a slow eccentric (Monday). Restores plantarflexor strength and Achilles capacity, which absorb a large share of landing and push-off force.
• Split-squat isometrics, 3 x 20 s. Load the whole limb in a lunge position without requiring the ankle to move through range under speed.
• Y-balance reaches, 3 x 6 each direction. Train controlled reaching at end range in three directions, and double as the measurement used to decide progression.
• Peroneal strength with a band, 3 x 15 (Wednesday). The peroneals are the primary dynamic defence against the inversion mechanism that caused the original sprain.
• Step-downs, 3 x 8. Train eccentric control down the whole chain, with the ankle managing dorsiflexion under load.
• Lateral bounds to a stick landing, 4 x 4 each side. Reintroduce frontal-plane force at speed, with the stick landing forcing the athlete to demonstrate control rather than absorb and move on.
• Pogo hops, 4 x 15 low amplitude (Friday). Restore ankle stiffness and short ground-contact elasticity, which is the quality most degraded by a period of reduced loading.
• Single-leg heel raises to near failure. Build plantarflexor endurance, which fatigues faster than strength does and is what fails late in a match.
• Unstable-surface balance with a ball catch. Adds a divided-attention demand, so ankle control is trained under the cognitive load that sport actually imposes.
• The progression rule. Advancing only when the previous level is symptom-free the next morning, with knee-to-wall asymmetry under 1.5 cm, keeps the progression governed by tissue response rather than by the calendar (Powden et al., 2015). Where the ankle is genuinely under rehabilitation, those thresholds sit alongside the hop and strength criteria the treating clinician sets, and returning pain, swelling or giving way is a reason to step back and be reassessed rather than to hold the line.

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Fatigue and monitoring

Dorsiflexion range and single-leg balance both degrade with fatigue and with accumulated training load. Test at a consistent point in the week. Morning Achilles stiffness lasting more than about thirty minutes after a session is a practical early warning that plyometric or running volume has outpaced tendon capacity. Article 1.7 covers the broader recovery framework.

Footwear, surfaces and a note on minimalism

Footwear changes the demand placed on the foot but does not train it by itself. Highly cushioned, motion-controlled shoes reduce the work required of the intrinsic musculature; minimal shoes increase it (Ridge et al., 2019). Neither is universally correct. The defensible position is that transitions should be gradual and progressive — abrupt shifts to minimal footwear are a well-documented route to metatarsal bone stress injury (Ridge et al., 2013) — and that some barefoot exposure during warm-up, balance and low-intensity work is a reasonable way to load the foot without changing everything at once.

Sport Applications

Exercise Library

Short Foot (Arch Doming)

Banded Talar Glide Mobilisation with Movement

Loaded End-Range Dorsiflexion Isometric

Heavy Slow Calf Raise (Straight and Bent Knee)

Single-Leg Balance Progression

Pogo Hops

Great Toe Extension Mobilisation

Banded Peroneal (Eversion) Strengthening

Common Mistakes

Coaching Cues

FAQs

How much dorsiflexion do I actually need? Roughly 35 to 40 degrees supports a full-depth squat with an upright torso; a knee-to-wall distance of 10 to 12 cm is a reasonable working target. Beyond that, additional range brings diminishing returns for most sports — control and strength through the range matter more.

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Is pronation bad? No. Pronation is a normal and necessary shock-absorbing motion. The problem is only ever timing and amount — pronating when the foot should be re-supinating for push-off, or pronating so far that the arch collapses under load.

Do I have flat feet, and does it matter? A low arch in standing that rises with the short-foot exercise or with the windlass is a control issue and is very trainable. A rigid arch that does not change is structural. Structure alone predicts performance and injury poorly; function predicts both better.

Should I train barefoot? Some barefoot exposure during warm-up, balance and low-intensity strength work is a reasonable way to load the foot. Progress gradually and keep high-impact volume in shoes until the foot has adapted.

My ankle clicks. Should I worry? Painless clicking without swelling or giving-way is generally not concerning. Clicking with pain, swelling or instability warrants assessment.

How long does it take to restore dorsiflexion? If the restriction is articular, meaningful change often appears within one to two sessions of correct mobilisation and can be consolidated within two to four weeks with daily work plus loading. If nothing has changed in three weeks, the working hypothesis is wrong.

Can I train around an old ankle that never got better? You can, and many athletes do for years. But the compensation does not stay local — it commonly shows up at the knee, the hip and the lumbar spine. It is usually cheaper to fix it than to keep paying for it, and if the ankle still swells, gives way or hurts, fixing it starts with an assessment by a qualified clinician rather than with a training block.

Recommended Viewing

The channels below are the sources this series draws on. Rather than link individual videos that may be renamed or removed, each entry names the topic to search for within that channel.

Key Takeaways

References

Bahr, R., Clarsen, B., & Ekstrand, J. (2018). Why we should focus on the burden of injuries and illnesses, not just their incidence. British Journal of Sports Medicine, 52(16), 1018–1021. https://doi.org/10.1136/bjsports-2017-098160

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Bohm, S., Mersmann, F., & Arampatzis, A. (2015). Human tendon adaptation in response to mechanical loading: A systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Medicine – Open, 1(1), 7. https://doi.org/10.1186/s40798-015-0009-9

Chmielewski, T. L., Myer, G. D., Kauffman, D., & Tillman, S. M. (2006). Plyometric exercise in the rehabilitation of athletes: Physiological responses and clinical application. Journal of Orthopaedic & Sports Physical Therapy, 36(5), 308–319. Read on PubMed

Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2017). Treatment and prevention of acute and recurrent ankle sprain: An overview of systematic reviews with meta-analysis. British Journal of Sports Medicine, 51(2), 113–125. https://doi.org/10.1136/bjsports-2016-096178

Hertel, J., & Corbett, R. O. (2019). An updated model of chronic ankle instability. Journal of Athletic Training, 54(6), 572–588. https://doi.org/10.4085/1062-6050-344-18

Hicks, J. H. (1954). The mechanics of the foot. II. The plantar aponeurosis and the arch. Journal of Anatomy, 88(1), 25–30.

Kelly, L. A., Cresswell, A. G., Racinais, S., Whiteley, R., & Lichtwark, G. (2014). Intrinsic foot muscles have the capacity to control deformation of the longitudinal arch. Journal of the Royal Society Interface, 11(93), 20131188. https://doi.org/10.1098/rsif.2013.1188

Ker, R. F., Bennett, M. B., Bibby, S. R., Kester, R. C., & Alexander, R. M. (1987). The spring in the arch of the human foot. Nature, 325(6100), 147–149. https://doi.org/10.1038/325147a0

McKeon, P. O., Hertel, J., Bramble, D., & Davis, I. (2015). The foot core system: A new paradigm for understanding intrinsic foot muscle function. British Journal of Sports Medicine, 49(5), 290. https://doi.org/10.1136/bjsports-2013-092690

Ridge, S. T., Olsen, M. T., Bruening, D. A., Jurgensmeier, K., Griffin, D., Davis, I. S., & Johnson, A. W. (2019). Walking in minimalist shoes is effective for strengthening foot muscles. Medicine & Science in Sports & Exercise, 51(1), 104–113. https://doi.org/10.1249/MSS.0000000000001751

Ridge, S. T., Johnson, A. W., Mitchell, U. H., Hunter, I., Robinson, E., Rich, B. S. E., & Brown, S. D. (2013). Foot bone marrow edema after a 10-week transition to minimalist running shoes. Medicine & Science in Sports & Exercise, 45(7), 1363–1368. https://doi.org/10.1249/MSS.0b013e3182874769

Powden, C. J., Hoch, J. M., & Hoch, M. C. (2015). Reliability and minimal detectable change of the weight-bearing lunge test: A systematic review. Manual Therapy, 20(4), 524–532. https://doi.org/10.1016/j.math.2015.01.004

Vicenzino, B., Branjerdporn, M., Teys, P., & Jordan, K. (2006). Initial changes in posterior talar glide and dorsiflexion of the ankle after mobilization with movement in individuals with recurrent ankle sprain. Journal of Orthopaedic & Sports Physical Therapy, 36(7), 464–471. https://doi.org/10.2519/jospt.2006.2265

Willy, R. W., Hoglund, L. T., Barton, C. J., Bolgla, L. A., Scalzitti, D. A., Logerstedt, D. S., Lynch, A. D., Snyder-Mackler, L., & McDonough, C. M. (2019). Patellofemoral pain: Clinical practice guidelines. Journal of Orthopaedic & Sports Physical Therapy, 49(9), CPG1–CPG95. https://doi.org/10.2519/jospt.2019.0302