Ankle mobility, particularly the range of dorsiflexion, is one of the key determinants of lower extremity biomechanics. Limited ankle mobility can cause compensatory movements at the knee and hip, which may contribute to various musculoskeletal issues. During functional activities such as squatting, lunging, and stair climbing, restricted ankle flexibility alters how mechanical loads are distributed. This paper examines how limited ankle dorsiflexion affects knee and hip function, drawing on evidence from the literature, clinical observations, and targeted exercise strategies.
Literature Review
Decreased ankle dorsiflexion can increase valgus moments at the knee and raise the risk of anterior cruciate ligament (ACL) injury.
(Bell et al., 2019)
If the ankle’s ability to bend upward is limited, the knee may collapse inward, which increases the risk of ACL injury (a major knee ligament that helps keep the knee stable.)
Reduced mobility may lead to hip compenstion, disrupting gluteal muscle activation.
(Macrum et al., 2012)
When movement is restricted, the body tries to compensate through the hips, which can result in poor gluteal muscle function.
Healthy dorsiflexion is a critical parameter for dynamic stability and proprioception.
(Dill et al., 2014)
The ability to comfortably bend the ankle upward is essential for maintaining balance and sensing body position during movement.
Clinical Findings and Observations
As frequently observed in clinical practice:
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Many patients with anterior knee pain show limited ankle mobility during the “heel lift” test.
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Common compensations seen during squats include heel lift-off and excessive forward knee translation.
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Knee valgus during lunges is often associated with inadequate dorsiflexion.
Practical Exercise Approaches
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Mobility Exercise: Ankle anterior glide + dorsiflexion stretching
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Dynamic Mobilization: Resistance band-assisted dorsiflexion exercises
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Functional Transfer: Squat training with heel support progressing to unsupported squats
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Proprioceptive Rehabilitation: Single-leg hip control exercises
Discussion
Although often overlooked, ankle mobility is a fundamental component of the kinetic chain. Instead of focusing solely on pain in physiotherapy, evaluating movement restrictions and biomechanical imbalances can lead to longer-term relief and improved performance.
Conclusion and Recommendations
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Ankle mobility assessment should become routine in individuals with knee and hip complaints.
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Exercise programs must be individually tailored, with priority given to mobility and strengthening protocols that address dorsiflexion limitations.
References
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Bell, D. R., Padua, D., & Clark, M. A. (2019). The influence of ankle dorsiflexion range of motion on landing mechanics. Journal of Athletic Training, 44(4), 356–362.
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Macrum, E., Bell, D. R., Boling, M., Lewek, M., & Padua (2012). Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. Journal of Sport Rehabilitation, 21(2), 144–150.
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Dill, E., Begalle, R. L., Frank, B. S., Zinder, S. M., & Padua, D. A. (2014). Altered knee and ankle kinematics during squatting in those with limited weight-bearing–lunge dorsiflexion range of motion. Journal of Athletic Training, 49(6), 723–732.
