What is plantar flexion

An injury to any of the muscles that support plantar flexion can limit your ability to flex your foot or stand on tiptoe. Ankle injuries, including sprains and fractures, are one of the most common causes of plantar flexion problems. These can happen in sports where you have to change direction very quickly — such as basketball — or in activities that involve jumping. When you injure the muscles or bones of your ankles, the area swells up and becomes inflamed.

The swelling limits movement. Depending on how severe the injury is, you might not be able to point your toe or stand on your tiptoes until it heals. Mild ankle sprains are usually treated with the RICE method :. Sprains usually heal within a few days or weeks. If the ankle is fractured, you may need to wear a cast. More serious fractures could require surgery to reposition the broken bone. Surgeons sometimes use a plate or screws to hold the bone in place while it heals. Strengthening the muscles in your ankle, leg, and foot that support plantar flexion will keep your foot flexible, protect your ankle, and prevent future injuries.

A physical therapist can teach you how to do these exercises correctly. Wearing proper footwear can also help you avoid injuries. Get fitted each time you buy a new pair of shoes. See a podiatrist or orthopedic surgeon for advice on how to keep your feet and ankles healthy and prevent any plantar flexion problems before they can start. Keeping your feet strong and flexible can help reduce pain and muscle soreness, improve your overall foot health, and more.

Here's how. Working on your feet all day can do a number on your feet, legs, and back. Learn tips for choosing the right shoes, stretching, and home care. Treating pain with hot and cold can be extremely effective for a number of different conditions and injuries. The tricky part is knowing which…. The traditional prescription for sprains and strains, known as RICE—rest, ice, compression. Looking for flip-flops on a budget, for arch support, or bunions?

It starts along the back of the fibula and goes through the ankle, running along the sole of the foot to attach to the big toe. The flexis hallucis longus helps plantar flexion of the ankle, and plays a large role in curling the toes. It is very important for walking and balancing, especially while on tiptoe. This is another deep muscle in the leg. The flexor digitorium longus starts on the back of the tibia near the soleus muscle.

The muscle fibers end in a tendon that travels through the ankle and runs along the bottom of the foot. The flexor digitorium longus attaches to every toe except the big toe. It is this muscle that provides the power to flex the toes themselves. It helps to support the arch of the foot and is used in plantar flexion. The tibialis posterior is the third deep muscle in the leg. It is the most central leg muscle and is vital in keeping the lower leg stable.

It is attached to interosseous membrane which separates all bones in the leg and is connected to the tibia and fibula. The tendon of the tibialis posterior spreads out to attach to the metatarsals, which are the five long bones in the top of the foot.

The tibialis posterior is also attached to other bones in the foot — the medial cuneiform, middle and lateral cuneiform, and navicular bones. The peroneus longus muscle starts at the upper section of the fibula. The tibialis posterior and the peroneus longus work together in the middle foot to create support for the weight-bearing arches of the foot.

These two muscles help keep the ankle stable when standing or rising onto the toes. The peroneus brevis lies just underneath the peroneus longus. It starts in the shaft of the fibula, and the tendon stretches to the foot, where it attaches to the metatarsal of the little toe. The peroneus longus and peroneus brevis help keep the foot stable.

All these muscles and tendons work together in plantar flexion to help the body stay balanced and stable. When there is a problem with even one of these muscles or tendons, the whole system is weakened, causing injury and a reduced range of motion.

An injury to any one of the muscles supporting the act of plantar flexion will limit the range of motion of the foot. Ankle injuries are one of the most common ways to severely limit plantar flexion. The ankle is a very complex joint. It is capable of a wide range of movement to stabilize the body in the most difficult situations, such as hiking or jumping on uneven surfaces.

It does this while also protecting key ligaments, arteries, and nerves. When the ankle is injured, inflammation helps prevent additional injury by reducing the range of motion of the foot.

This can drastically reduce plantar flexion, sometimes to the degree where a person cannot move their foot. Ankle injuries can range in severity from mild sprains to severe fractures. The severity of the injury will determine the treatment. Treating injuries depends on the type of injury that the person has sustained. Mild ankle sprains do not require casts or splints.

Instead, they can be treated with rest, ice, compression, and elevation, known as the RICE method. Nine patients with calpainopathy performed ankle strength measurements. One patient was not able to perform ankle plantar-flexion measurements. Values as low as 1. The mean SD z-scores were For ankle plantar-flexion, the mean SD z-scores were Ankle strength is an important factor for ambulation and balance [ 1 , 2 ] and should therefore be closely monitored.

A novel dynamometer has been developed in order to accurately measure both ankle dorsi-flexion and plantar-flexion strength in children and adults with neuromuscular disorders. Normative data were established and predictive models computed for both children and adults. The device was shown to have a good level of reliability with low relative standard errors of measurement between test and retest sessions.

The feasibility to use this novel dynamometer on patients was confirmed on a small sample of patients affected with calpainopathy. The device was both easy to use and transport. Its size makes it usable for children, as young as five years old, as well as for elderly people as old as eighty years of age. A few subjects complained of discomforts but none refused to perform the measurements. The reluctance of some to perform at their maximal strength on the first trial may be partly explained by the apprehension of the subjects to hurt themselves.

We found that the right side was significantly stronger than the left side independently of the laterality determined by hand dominance. The hand dominance does not seem to be a good indicator for leg dominance.

Indeed the recommendation given in the literature is to establish foot preference by asking the subject which leg he or she would choose to kick a ball [ 31 ]. This method was applied by several authors who found that there was no significant differences in force between the dominant and the non-dominant side in dorsi-flexion strength [ 20 , 32 ] or between the left and right leg [ 20 ]. However we found that the right side was significantly stronger than the left side; this result is comparable to that obtained by other authors [ 25 , 33 ].

These differences observed between different studies may be attributed to differences in the population tested and to the test protocol itself especially the positioning of the subject.

In children, results for dorsi-flexion and plantar-flexion torque values in our study differ slightly from other studies [ 12 , 24 ] probably due to discrepancies in test protocols already mentioned above and due to difference in stature that can have a great impact on strength.

Torque values found in our study are therefore probably lower than the maximum value possible when both the ankle and knee position are optimized.

However, the seated position was chosen over other positions in order to minimize the possibilities of co-contractions and to enable as many subjects as possible to perform the measurements even in the presence of contractures. Most authors have used age, weight, sex and sometimes height as predictive variables for ankle strength [ 12 , 32 , 34 , 35 ]. In this study we found that height was the best predictor of strength for both children and adults and that other variables added little to the model.

Using height to predict strength in children may enable one to assess muscle weakness in children with muscle disabilities associated with growth disorders. If a child is small for his age, prediction will make it possible to establish the part of muscle weakness that is due to disease and not growth retardation.

Eek et al. They indicated that sex was included in the model when the age was over As Hogrel et al. In adults, the model predicting dorsi-flexion torque in our study has similar determination coefficients compared to other models [ 32 , 34 , 35 ].

The quality of our plantar flexion model could not be assessed either in children or adults as no other study computing this model could be found. The difference in determination coefficients between dorsi-flexion and plantar-flexion models found in our study can be interpreted as a higher variability in plantar-flexion strength rather than dorsi-flexion strength among adults. Even though our model only explains a small amount of plantar-flexion variability, it may be useful in evaluating strength deficit for this function as, to our knowledge, no other model has been established.

The significant positive differences between retest and test sessions suggest that there might be a minor learning effect in performing maximal voluntary contractions for ankle movements. This phenomenon may also be explained by the apprehension of the subject to hurt himself during the first trial as was previously mentioned or by the fact that this function is not performed isometrically in everyday life and can therefore be difficult to perform at first.

This increase in strength during the retest session on plantar-flexion strength measurements has been observed by several authors [ 14 , 15 ]. Standard error of measurements and ICCs found in our study are similar or higher to those found in other studies assessing reliability in dorsi-flexion or plantar-flexion strength [ 14 , 25 , 34 ].

Due to the possible learning effect in assessing ankle strength, a training session should be recommended in clinical trials where there is a follow up of patient strength over time. A training session would also be useful in evaluating the smallest detectable differences that is relevant to the patient population studied. Moreover, the variations in subsequent measurements depend on motivation, skill, learning effect and several individual variables that are complex to analyse.

This can affect estimates of reliability. The dynamometer was applied without particular difficulties to nine patients with limb girdle muscular dystrophy. Values of maximal torque as low as 1. Using the predictive equations established in this study, all subjects were shown to have a significant strength deficit compared to the normal population.

Therefore these quantitative strength measurements relative to the normal population highlight the strength deficit of these patients in a quantitative way.

The device could therefore be used in clinical trials for the follow up of different pathologies in which leg muscles are affected, even severely. Note that most of the patients present a strength that lies under the smallest detectable difference, which may be of limited pertinence in this case.

Not all subjects had a retest session, meaning that norms and predictive equations were established on test values which might not be representative of the maximum values as a learning effect was demonstrated on a subgroup of patients. The device we have developed shows a good level of reliability and accuracy in assessing ankle dorsi-flexion and plantar-flexion torque measurements from weak patients to strong healthy adults. The size of the device makes it useable for both children and adults.

This device overcomes the drawbacks of other measuring methods such as sensitivity to low values of strength and joint stabilization. Guillebastre B, Calmels P, Rougier P: Effects of muscular deficiency on postural and gait capacities in patients with charcot-marie-tooth disease.

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CAS Google Scholar. Qual Life Res. PubMed Google Scholar. Clin Rheumatol. BMC Musculoskel Dis. Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Jean-Yves Hogrel.