01:49
Julie Pitois LMT, CAMTC
Hi guys. Welcome. Today we’re going to talk about all things, foot and ankle, because you can’t have one thing without the other.
We’re going to go into depth of the foot bones and all the bones that make up the foot and all that cool stuff next week.
Today we need to know about what makes up this cool ankle joint. So the bones are still in there. Okay.
02:11
Mike Julian LMT, CAMTC
What’s amazing to me, as you can see, just take a quick look at that.
How much goes into this, the structure right here and what, how much it has to do and just to keep us upright and stable.
And when it works properly, it’s great. We don’t even think about it.
The Foot And Ankle Structure
02:25
Julie Pitois LMT, CAMTC
How much everything moves together, but then separately as well.
02:29
Mike Julian LMT, CAMTC
Absolutely. So all has to work just right. We’re all, we’re good if it doesn’t we find out quick,
02:37
Julie Pitois LMT, CAMTC
We’ll find out quick guys. Alright, let’s talk to the ankle.
The ankle joint is actually formed by three bones. You got this big tibia, which is your shinbone. You got the little fibula, which is the side of the bone that comes off of this other bone. Right?
You’ve got your tailless and the tailless is actually this bone that’s actually sitting in the foot right underneath the tibia. If you notice this fibula comes all the way down and comes past the actual ankle joint and actually puts that.
That is the outside of your ankle bone. It’s called your lateral malleolus, but it’s your ankle bone, the inside forms, the inside of your ankle bone. We have two bones in here that are really important for ankle movement and stability.
The ankle itself is a mobile joint. We, it goes up, it goes down, it goes in and it goes out.
03:32
Julie Pitois LMT, CAMTC
This would be dorsal flection because it brings it up like a dorsal fin. It goes into plantar flexion, like planting your foot into the floor.
It goes into inversion in the E version, which is in and out. So it goes up, down in out. The reason why we have to have that much movement in this ankle joint is because it’s got to move the rest of our body because we wouldn’t walk very well.
If all we did was just move up and down, it would be kind of a Frankensteiny in our walk, I would guess.
04:04
Mike Julian LMT, CAMTC
If you didn’t need to have that dorsiflexion, plantar flection is just as stiff walking pipes, pounding into the ground rather than having a nice, smooth, rotate, circular motion.
04:12
Julie Pitois LMT, CAMTC
Right. Right. Remember, human beings were made to move. We have to have joints that support it. Why do we talk about this ankle joint so much?
Because this ankle joint doesn’t move very well for a lot of people. It’s the cause of a lot of pain. Remember, we’ve got these two big bones, well, one big tip, one little fibula.
We’ve got the two ankle bones that go to the bottom, right? The malleoli. You’ve got this tailless, which is underneath. Now, the way that the ankle actually works is if you think that this bone glides back and forward as we plant and dorsiflex so as we plant our foot and as we flex our ankle, it moves up and back.
If you think of, I was always taught that this is a coin slot, and it sounds really funny, but as you push your foot down in the ankle, down this slides out, and then when you pull this up, this is supposed to slide back.
05:21
Julie Pitois LMT, CAMTC
What happens if you ever have a coin that you try to put in the coin slot and it gets stuck in the coin slot, you don’t have any more movement. The movement stops with the coin.
05:31
Mike Julian LMT, CAMTC
Deals or whatever you’re trying to get home. What kind of coin slot I got like snack machine,
05:37
Julie Pitois LMT, CAMTC
Totally different type of coin slot, like, okay, whatever. Let’s talk here, the tibia and fibula, it’s not just bones that we’re working with, right?
Because if we just had bones down here, then sprained ankles and strained ankles, wouldn’t be an issue. We’ve got these really strong ligaments that are there to stabilize and help with movement to stabilize the movement.
Because remember, this is a big movable joint down here. We’ve got big ligaments that attach from the bones to the feet and from the bones to the feet.
We have these four big ligaments in the inside of our ankle, that are attached from the bottom of our tibia down into the bones.
They’re called your deltoid ligaments mainly because they go into a full, they fan out into the foot and then they converge at the top. So they’re called your deltoid ligaments.
Now, the thing about these guys is these are very strong because we have a tendency to drop in to our ankle, way more than we tend to drop out.
06:41
Julie Pitois LMT, CAMTC
Even though this is the side that we tend to roll more. This is the side that gets a lot more attention based on all of the pressure that we’re putting on into our foot.
When you pronate, when you drop into your toe, when you bring your ankle in these take a lot. Now, if you guys remember from our older talks or other talks, I guess what ligaments do is they attach bone to bone and ligaments.
They help with stabilization. There, they get pulled from all different directions. If you think of a hammock and as a hammock kind of sits there and it kind of holds everything together.
When you put pressure on it pulls from all areas and it goes taught, and it allows for pressure and strength to hit it.
The ligaments are kind of crossed that fibers like this, and they’re being pulled all the way so that we can keep these bones hopefully all together, because we need that right now.
07:41
Julie Pitois LMT, CAMTC
On the lateral side, we have ligaments that also attach from this fibula to the heel, from the fibula to the midfoot and from the fibula all the way over to the front of the foot of the four foot .
Because if you also know if something about the lower leg, it’s a lot of smaller muscles and a lot of long tendons.
We want to make sure that we are, we’re working within all of those areas too, because we got attendance polling all over the place with our.
08:10
Mike Julian LMT, CAMTC
Legs, shearing forces going through onto the lower leg as well.
08:14
Julie Pitois LMT, CAMTC
Now, when we get to the bottom of this, and we look at this, if you notice the bottom of the Tibia hits into the tailless in between this tailless and the tibia it’s, what’s called this joint is called your mortise joint or your mortis joint,
08:31
Mike Julian LMT, CAMTC
Your mortise.
08:32
Julie Pitois LMT, CAMTC
Aura. Wow.
08:34
Mike Julian LMT, CAMTC
Anybody get that reference? Anyone Martin,
08:36
Julie Pitois LMT, CAMTC
Steve Miller band, were just talking about.
08:38
Mike Julian LMT, CAMTC
It. He thinks.
08:39
Julie Pitois LMT, CAMTC
It’s so funny anyway.
08:42
Mike Julian LMT, CAMTC
So.
Dorsiflexion And Plantar Flexion
08:42
Julie Pitois LMT, CAMTC
The reason why it’s called a mortise joint is because it’s like a mortis muscle, a PESTEL and mortis where you’re moving it in and out, it’s grinding and moving and grinding.
If you’ve ever, if you’ve ever, if you ever been yeah. Guacamole or making mojitos where you’re grinding and pummeling the leaf, whatever it’s called.
Anyway, the bowl is like this. It moves in this way kind of how your ankle joint works. It’s called a mortise joint and it feels fits very snug inside there, or it should. Again, the movements that we have, Dorsiflection, the ankle comes up, plantar flection.
The ankle goes down, right? This is when we’re jumping. This is when we’re attempting to run side note. In order for us to actually run, we need at least 18 degrees of dorsiflexion, which means if this is zero, you got to come up pretty far in order for your foot and your toes to clear the concrete and the ground.
09:51
Julie Pitois LMT, CAMTC
Otherwise you drag your feet around and you’re going to fall over and it’s going to make running challenging.
09:56
Mike Julian LMT, CAMTC
This is something that one of the things we look out all the time to see what kind of doors selection somebody has, if they’re having knee problems, ankle problems, hip problems, even neck problems, we’ll come and see, where does this door’s reflection going? Yeah.
10:05
Julie Pitois LMT, CAMTC
I will say a lot of times when there is an overuse injury, when we’re getting into sprains and strains, the lack of dorsal flection can actually lead into potential injury in and of itself.
If you’re not getting the doors of flection, it’s got to come from somewhere, which means now your foot is doing a lot of this or the legs doing a lot of this to make up for the fact that you can’t get the ankle to actually come up.
What happens there, let’s go into sprains and strains. Let’s go into what symptoms these are, right? If you guys have been with us before, you’ll know that a strain refers to tendon, right? So strain with the T.
10:50
Mike Julian LMT, CAMTC
Muscle.
10:50
Julie Pitois LMT, CAMTC
Muscle and tendon where the muscle belly comes in and then it pulls into a tendon at the bottom.
The tendon attaches to so that it can pull the joint because that’s how we make Joe bones move.
The strain would be a strain to the fibers where some of the fibers have been torn into the tendon.
11:10
Mike Julian LMT, CAMTC
Well, quite often to sit that where the muscles bellies becoming the 10 in the muscular myotendinous junction is where it happens a lot, but it can happen anywhere along.
It can happen at the attachment point or anywhere in the muscle belly itself.
11:21
Julie Pitois LMT, CAMTC
Yeah. So let’s talk about ankle strain. What actually happens when we strain the ankle,
11:26
Mike Julian LMT, CAMTC
You put too much load on that 10 and that it cannot handle. The fibers are gonna start to free up,
11:32
Julie Pitois LMT, CAMTC
Right? Does this happen at once overnight or is it acute?
11:35
Mike Julian LMT, CAMTC
It can be very much a cute, what I mean? You can’t have it once or can come over time.
11:39
Julie Pitois LMT, CAMTC
Right? Most of the time, it’s an, it’s a overused thing. Most of the time it’s been ongoing and it’s layering.
Where it may be acute, it’s been happening for a while. This also happens a lot with runners. This happens ballet. This happens with anybody who is on their toes all the time basketball.
It happens with a lot of people who do a lot of sports that got, are requiring for you to be on your toes, off your toes, on your toes, off your toes, all the time over use injury.
What are some of the symptoms that come up with a strain,
12:15
Mike Julian LMT, CAMTC
The civil strain that you get you’ll get acute, or you’ll get some acute pain. You’re getting maybe a mild amount of swelling or inflammation.
That’s why the inflammation. Sure. You will get you. What else are we gonna get? We’re gonna get.
12:28
Julie Pitois LMT, CAMTC
Inflammation. You can get a little heat. You can get swelling. You can get limited range of motion,
Strains and Sprains In Foot And Ankle
12:35
Mike Julian LMT, CAMTC
Pain with resisted resistance.
12:38
Julie Pitois LMT, CAMTC
And, and sometimes pain.
When movement, if you’re going into a drawing to go into dorsiflexion and plantar flexion, and you’re actively trying to recruit the muscle fibers, those muscle fibers are strained.
They’re like, no, we’re not doing it. They’re on strike. What’ll happen is sometimes it’ll appear warm and will get flushed with blood because you’ve injured the tissue.
Where the tissue of the muscle fibers, like we said, run like this. It may be just a couple of ’em that are torn, but it’s a strain that is actually injuring those tissues. It’s going to take awhile for us to get it back.
So let’s talk about a sprain now. The difference between a muscle strain and a muscle sprain is that P stands for pain in a passive movement. That is where we work with ligaments.
Now, a ligament, like we said, attaches to the bone, attaches to the bone.
13:35
Julie Pitois LMT, CAMTC
It’s there to stabilize that big range of motion and movement and to provide mobility, but stability to a mobile joint. Right? And so let’s say Mike’s running.
All of a sudden, he’s got of an acorn that he steps on and re there goes his ankle. He takes it down and it is an acute pain. What I mean by acute is it’s not cute. There’s nothing cute about that pain.
It is out there sharpness, there’s tenderness, there’s swelling instantly. There’s heat. The difference, a lot of difference between a tendon strain and a sprain is bruising. You may hear a pop too.
You may hear a pop. That’s when, instead of over use where it’s like, eh, and they start to get a little frayed. It’s like, oh, not worked on or not. We’re gone.
There’s only a few tendons left, but a bunch of them left the scene at the same time.
14:32
Mike Julian LMT, CAMTC
Yeah. It’s still being overused. It can be an overused. That’s what finally a final that final roll or that final pressure is what gateway and in the ligament now ruptured,
14:42
Julie Pitois LMT, CAMTC
Right? There’s going to be swelling at the side of the ankle.
There’s going to be pain. There’s going to be weakness. You could potentially have not a lot of movement at all because of pain. It’s more called pain inhibition where your brain is just like, no, we’re done with that.
Or now you’re going to also potentially have muscle cramps and weakness because of secondary muscle guarding and splinting in the area. Putting your foot completely down will be a bad idea.
And it’s just pain with passive movement. When the, when in somebody else’s trying to move, you hurts like crazy.
If it’s a strain, when they’re doing it, initially it may hurt when they’re swelling, but unless there’s resistance placed, it’s not going to hurt as much.
There’s a difference between a muscle strain and a muscle sprain. One of the other things in a sprain is the bruising over the side of the spring.
15:38
Julie Pitois LMT, CAMTC
In addition to swelling, you’re going to know blue, red purple skin discolorations.
A lot of times, if you’re got a sprain here, it’s going to be down in here where the attaches, because it’s the ligaments that are being potentially torn as well.
Instead of the tendon, just the fibers of the tendon, kind of getting frayed and torn those ligaments now, which are like, this are like, and so you are tearing some of the ligaments and that’s more traumatic.
You’re going to have the inability to bend, turn flex the foot. You just can’t move it any other way. Walking is just not going to be a no-go. It’s going to be like difficult or impossible for a while.
Remember too ligaments take a long time to heal because they don’t have a lot of blood flow freely, like a tendon pumps blood in and out with the muscle.
16:33
Julie Pitois LMT, CAMTC
The ligaments are not supposed to have a lot of blood flow in them because they’re just there to stabilize.
This is your cable. Your cable and your hammock are just going to be sitting there and it’s going to take you awhile to get those things to feel better.
Unfortunately, when we have anything like that, any ankle trauma to the ankle in the list, soft tissue department is going put injury into or changes into the bone department.
Because remember you can’t have just soft tissue injury at the joint without potentially moving the joint. Now this joint that was really mobile is now not moving at all. Now, even if we do get our soft tissue to start feeling better, moving better and healing.
Now we might have a secondary injury in here where we’ve had changes to the joint of the ankle in and of itself.
17:31
Julie Pitois LMT, CAMTC
And it’s stuck. Remember this bone needs to glide forward and needs a glide back.
And he needs to glide forward. It needs a glide back, but now we’ve been sitting like this for so long because we can’t put pressure on the ankle.
We can’t put weight into the angle and or the foot we’re not walking. We’re just leaving like this. Probably the majority of us, or if we are walking, we’re walking with one big club foot, and we’re just doing this a lot.
If we’re doing that, this is now getting stuck, or this is getting stuck. Even this big fibula that big long bone gets stuck down there. Now you can’t move in and out.
18:09
Mike Julian LMT, CAMTC
To glide up and down and it was not gliding. Yeah.
18:12
Julie Pitois LMT, CAMTC
We’re now missing the ability to do this and to do this with the ankle, which then what happens in.
18:19
Mike Julian LMT, CAMTC
It’s going to create all different kinds of movement patterns, even down further down the foot or all the way up the chain to the neck.
18:25
Julie Pitois LMT, CAMTC
Yeah, absolutely.
Here’s the thing that sprain that we had remember an acute injury, it takes up to three months or to six months, depending on how severe the trauma is to the ankle for the tissue to fully heal, depending on what it is.
Now the tissue is healing, but now the joint is not working correctly. Do you think that’s going to give more or less opportunity for the body to have another secondary injury?
They always say, and they, by they, I mean, they, cause we know they are correct. The best indicator of an injury is.
19:05
Mike Julian LMT, CAMTC
Previous is.
19:06
Julie Pitois LMT, CAMTC
A previous injury. Because every time you injure yourself, your body changes.
19:11
Mike Julian LMT, CAMTC
For a roll that ankle chances are unless you had proper therapy and gone through the healing process and allowed it to heal, probably going to get that ankle roll again sooner. It could be more severe than the first time.
19:22
Julie Pitois LMT, CAMTC
Right? Not only that, but when we’re talking about ligaments, remember ligaments, they don’t have a lot of contractile property, meaning they’re not shortening and lengthening a Bustle’s job is to shorten and lengthen, right?
The S the ligaments job is to stabilize. Now all of a sudden you’ve done this right into your ligaments. Now your ligaments have a lot more laxity, which means they got a lot more play in them.
Now a muscle, a joint that normally would have movement in a normal range of motion is now all of a sudden, it’s like, oh yeah. Now where you’re not stable as much as you should be.
You have the ability to give yourself even more of an injury, because those are the people who ever sprain your ankle. You literally just roll your ankles.
Like every time you’re like, I just looked at the rock and boom, my ankle rolled over, I just looked at this, I could wear 18 inch heels and then take my shoes off and go into flats and roll myself down the hill.
20:25
Julie Pitois LMT, CAMTC
And that happens all the time. It did it,
20:29
Mike Julian LMT, CAMTC
My heels off. And,
20:30
Julie Pitois LMT, CAMTC
Oh my God, I hate when that happens every time, all the time. Here’s the other thing that we need to talk about with the ankle.
Can we mobilize the joint back to where it needs to be once it’s stuck?
20:46
Mike Julian LMT, CAMTC
Can we move, but are we gonna be holding stable in that area once it’s moving again? Can we hold stability right with that? Because that’s the big question.
20:53
Julie Pitois LMT, CAMTC
Yeah. We’ve gotten a lot of people who have come to us with previous ankle injuries.
Remember you guys, if you’re holding in your foot is like this, and it’s not doing flexing. Plantar flexing and dorsal flexing, right? It’s not moving into inversion E version. It’s not rolling this way, and it’s not moving this way.
What else? Isn’t working them, big muscles that are actually controlling the movements. If they’re not moving, these don’t get to work. Remember Wolff’s law says what?
21:25
Mike Julian LMT, CAMTC
The body is going to change depending on the demand placed on it.
21:29
Julie Pitois LMT, CAMTC
Yeah. If you don’t use it, you lose it.
Now all of a sudden the muscles aren’t working as hard as they have to, because they’re not getting the attention because the joint doesn’t move.
Remember muscles, pull bones. If the muscles are contracting, but the bones aren’t moving, these guys, aren’t going to get to where they need to be either. It messes everything up in your kinetic chain, the nerves get overridden.
They don’t know what to do. They’re like, I just, I dunno, I keep calling out sick suggestions and nobody’s following suit. The muscles are like, dude, I can’t, I can only do so much in the joints.
Like, dude, I’m stuck. So we need to help everything out. Right. Everybody’s I mean, the body’s a very needy body, especially ankles who are very needy.
Yes, you’ve sprained or strained your ankle. You’ve injured your ankle, but is it just your ankle that you’ve injured?
22:21
Julie Pitois LMT, CAMTC
No. You can’t just wait for your ankle injury to get better. I know you, and I’m talking to all of you guys that roll your ankles and then you’re like, man, I’m going to be fine.
I’ll just tape it, put a brace on it. We’ll be fine because you have no patients to actually go through all of the stuff that you need to do in order to get that guy back.
22:40
Mike Julian LMT, CAMTC
I find by next week, and then I’ll go, do jujitsu, have somebody crank on my ankle. Yeah.
22:45
Julie Pitois LMT, CAMTC
They go to see somebody and, or they can’t do it. Somebody just cranks on their ankle and pulls it. Boom starts a process all over again.
We do see that quite a bit. The reason why I’m telling you this is there’s more to it than just an ankle sprain. You have to determine whether it is from the tendon or the ligament as to how you’re going to treat it.
Is there bruising? Is there not bruising? Is there heat? Is there not heat? Was this time for you to see the doctor or not see the doctor and how are you going to treat it after the soft tissue heals?
Because when the soft tissue heals, it still leaves behind the bones. If these bones aren’t moving, the soft tissue is going to get injured again and, or is the ligament too lax and you got too much movement in there and then you gotta strengthen it.
Lengthening & Strengthening The Foot And Ankle Ligaments and Muscles
23:37
Julie Pitois LMT, CAMTC
So do you lengthen, do you strengthen? Do you move it? Do you not move it?
23:41
Mike Julian LMT, CAMTC
How to strengthen a ligament or put that intention back into ligament? That’s another.
23:44
Julie Pitois LMT, CAMTC
Show. Yeah, for sure. For sure. The thing is that we need to understand is when you’re talking ankles, there’s way more to it than meets the eye.
It doesn’t mean that just because you sprained ankle, your daunted sprained ankle for the rest of your life. Because once you do it, you can get it back. You get to go to the right people and have them work with you as far as how to move it.
Because this ankle does like to move the heel, likes to move. The fibula likes to move the tibia. Doesn’t like to move so much in this aspect, but it does love here. Without this, then we’re working into the foot.
Remember if this is a moving, these have to move way more. We’re about to get into the foot next week. If you have ankle sprain, you probably have a foot issue.
24:35
Julie Pitois LMT, CAMTC
If you have ankle sprain or a strain, you may have a knee issue. If you have ankle sprain, you might have a hip issue.
Remember it goes up and down the chain, because if you can’t walk properly and you can’t do this, your body’s going to figure out how to get it done and adjust it. It may not be right, because remember that gall goes back to compensation and compensatory patterns.
The thing to find out with the ankle is a, is it a sprain or a strain? It attendant or is it a ligament? Is there bruising his or not? Did I hear a pop? Did I hear or not? Can I move the ankle? Can I not?
From there, move into how to get it feeling better, get a stable again, but make sure that no matter what you’re doing, you know that your hip, your knee, your ankle, your pelvis, your back, your upper back, your shoulder, your head, your neck, all of these kids would be affected because we move all the way up and down the body.
The Ankle Joint Is A Key Player In Proper Form And Movement
25:37
Julie Pitois LMT, CAMTC
All of our joints look at Scully. Scully’s a mess back here.
Where it started from ankle sprain, swear to God. He was just walking along and then this ankle doesn’t move. Bam, next, his leg fell off and now he has scoliosis. That’s exactly how it has exactly how it happened.
Don’t be a Scully, check your ankles. Listen, if you have anybody that’s ever rolled their ankle, that’s ever torn their ankle. That has a high ankle sprain versus a low ankle sprain that has ankle sprain versus a strain.
Pass this along to them. Hopefully it will help if your yes, if your ankle sprain is not going away and you keep doing it over and over again, check your ligaments, but also check the ankle joints.
The ankle joint is a big player in the game to.
26:25
Speaker 3
Check yourself before you wreck yourself,
26:27
Julie Pitois LMT, CAMTC
Literally little rolly.
Let next week we’re going to get into all the bones of the foot and why the foot is so important and that little like plantar fasciitis that all of us get and where it might actually be coming from.
All right. I hope you guys enjoyed this week. If anybody that needs a, of help with their ankles or any other body parts, please pass this video along to them.
If you have anything that you would like to hear from us, please connect with us. We would love to hear from you. If you’re having a great one, we’ll see you next week.