I thought this would be a wonderfully appropriate topic to bring up since I am currently wearing a lovely CAM boot – having broken my mid-foot and ankle a month ago.
One of the most common misnomers in the general population is that people have “weak ankles.”
You may frequently sprain your ankles, or have balance difficulties, or trip and fall a lot, or need “arch support,” or even wear prescribed orthotics. But the fact is, while most of our ankles certainly can use some strengthening, the problem is not at all that they are weak. The problem is that you don’t know where you are putting your foot when you step on it.
We have a 6th sense that is very important to us called proprioception – our body’s ability to know where it is in space without looking at it. Close your eyes, stick one arm out and do something with your hand – now mimic it on the other side without looking. Easy, right? Exactly. Your proprioceptive sense knew what the arm looked like, where it was in space, and could easily match it without using your eyes.
When you have an injury of some sort – remember all those “twisted ankles” as a kid? or perhaps you really did sprain it badly at some point – you interrupt that proprioceptive input to your brain. And that means every single time you put your foot on the ground – level or uneven, sloped or flat – it’s a crapshoot as to whether or not it lands in the right place to take your weight. Sometimes there is quite a bit of last-minute correction that happens (there is a ton of great research about what our foot does right before it hits the ground in people with chronic ankle sprains) but maybe your foot is ready to accept weight…maybe it’s not. If it is turned a bit, or sideways…there you go…you just “tweaked” your ankle again.
So in order to change this, it isn’t so much making your muscles any stronger. It’s more of a question of getting the muscles to fire in the correct order and improving the sense of what your foot is doing when it’s swinging in the air during gait and when your heel strikes the ground.
The most basic exercise to improve all of these things is as simple as it gets: stand on one leg barefoot. Try to do it for 30 seconds without falling. If you can do that, then do it with your eyes closed – 30 seconds without putting the other foot down. This exercise is brilliant for balance and strengthening the teeny muscles of the foot and lower leg that help hold you up when you step.
Another set of exercises involves drawing the alphabet with your toe in the air. Take off your shoes and socks and every day write the alphabet at least once – if not 3-4 times. Try to go through the entire range of motion of your ankle.
To help with proprioception, one of the best ways to do that, interestingly enough, is to walk on uneven ground CAREFULLY, watching your feet. We can do all kinds of things in the clinic, but in my opinion the best way for a hiker to work this sense independently is to practice what you really need to practice – stepping on rocks and roots and uneven things. Wear the most minimalist shoes you have and go for a LEISURELY walk for about 15-20 minutes (think about how fast you’d go if your osteoporotic grandma were hiking with you with her cane). Watch your feet, step carefully, and PAY ATTENTION to what you are doing. No mind wandering here. This is not an aerobic exercise, it is what we call a “motor control” exercise – meaning you are working on the connection between the brain and the muscles, not just the strength in the muscles (which, of course, needs to happen a bit as well). Once this gets a bit easier, try to speed it up JUST A BIT, not a lot. This means your grandma doesn’t need her cane anymore, but still walks carefully and slowly next to you. As you become more comfortable then try increasing either speed, OR time on the walk, OR the difficulty of the terrain. Do not try to make all of them harder at once – you only get to do one at a time.
Now for the hard ones. These you would do barefoot, in your home, no distractions; they take a LOT of thought. These are to recruit and then strengthen your tibialis posterior, the muscle that dynamically supports your arch.
This first one will engage this muscle by actively raising your arch:
This second one targets tibialis posterior by trying to rotate your tibia:
Now, there are people out there who have incredibly floppy feet. These folks cannot control their arches, the mid portion of their feet have no support, and they have simply just blown out a few too many ligaments that no matter how much they strengthen they are going to have an uncontrollable foot. In these cases, orthotics or even a lace-up brace may actually be the way to go. But otherwise, try working on balance and proprioception first before resorting to “arch supports” or very expensive orthotics.
One more quick point about your feet: your arch is NOT a weight bearing surface. Think of your foot as a tripod: the ball of your big toe, the ball of your pinky toe, and your heel. The rest of the foot is SUPPOSED to move all around to adapt to surfaces you step on. Some people are more used to this than others, but the fact is that the normal function of a foot is a mobile one. I’m not at all recommending you go backpacking in minimalist barefoot running shoes. But just be careful about trying to fix your “weak ankles” by wearing high topped heavy leather boots with steel shanks in them and massive prescription orthotics. There is a middle ground, and for most of us that’s where we should be walking.