Key Point

• Ankles often get overlooked during a bodywork session in favor of the feet or calves, but giving attention to this complex area can provide more balance to the greater whole. 

The most common concerns clients bring to the table are aches and pains in the neck, shoulders, and low back. Certainly, there are other areas, but these are, without a doubt, in the spotlight. Naturally, many practitioners focus solely on the spine and pelvis to treat these concerns without thinking more expansively—most notably, how the ankles and feet might be (and likely are) part of the bigger picture. 

There are many reasons to pay attention to this complex of articulations as an integral part of a greater whole, especially when evaluating tension patterns in the body. Let’s review this region’s structure, function, and significance, then consider simple methods to incorporate some ankle TLC into a session.

Ankle Anatomy and Kinesiology

While many hours could be dedicated to the ankle
region, we’ll keep our review concise and homed in on
the key message. 

The talocrural (ankle) joint comprises the distal ends of the tibia and fibula and the talus. Thanks to the unique shape of the talus, movements at this joint include plantar flexion, dorsiflexion, inversion, and eversion.

The inferior surface of the talus further articulates with the calcaneus, creating the subtalar joint where rotation occurs (which includes inversion and eversion). Even though the subtalar joint is technically the hindfoot and not part of the ankle, it is a significant articulation in this region for its role as the bridge between the ankle and foot. Because of this joint, the complex movements of supination and pronation occur. Without supination (a combination of plantar flexion, inversion, and adduction) and pronation (a combination of dorsiflexion, eversion, and abduction), walking would be a lot more difficult, and it certainly wouldn’t occur with fluidity.

Why Ankles Matter 

Studying the ankle in isolation from the foot leaves an incomplete picture. The ankle and foot work cooperatively to perform functions such as supporting and balancing the weight of the entire body, absorbing shock during ambulation (walking and running), adapting to changes in terrain, and compensating for misalignment in the hips and pelvis. However, I highlight the ankle region here because it often gets skimmed over in a session unless a client specifically says there’s an issue with one or both. Case in point, think of the last time a practitioner spent even one minute focused solely on your ankle? I believe it is more common that, after giving specific attention to the leg, the ankle and hindfoot become a transition to the midfoot and forefoot, where, again, more specific work is performed. But this transitional place is very important! 

Walking, which requires supination and pronation, is one of the primary actions we do every day. So, if there is restriction in these joints, everything above the ankles has to adjust accordingly. The muscles and surrounding fascia along lines that run from head to toe will change to accommodate the need for balance and stability. For this reason, it’s important to consider them when working with clients who experience back and neck pain. What is below affects what is above just as much as what is above affects what is below. Therefore, it’s very important to include these key joints in our assessments and in our session protocols, even if only for a few minutes.

Simple Approaches

Given how many tendons of the leg cross this joint region, you can work on many muscles at once. The flexor group runs posterior to the medial malleolus, the fibularis longus and brevis run posterior to the lateral malleolus, the extensors run across the anterior ankle, and the calcaneal or Achilles tendon runs across the posterior ankle. 

The following approaches are easy to incorporate into a session without taking up much time. (Trust me, I know how hard it is to include everything in an hour.) But it is worth it for the body’s overall stability and balance. Plus, I guarantee your clients will comment on how good it feels.

Heat ’Em Up

• In supine position, apply small circles using your
thumbs simultaneously in opposing directions on the anterior ankle.

• In supine, apply friction posterior to the malleoli bilaterally using the medial side of your hand in swift, opposing, back-and-forth motions (Image 1). This will cause the foot to naturally move with your strokes, so be sure to keep pressure in toward the joints to provide stability while creating a freeing movement. 

• Supine or prone, apply small circles using your
fingertips bilaterally around the entirety of the medial
and lateral malleoli (Image 2).

• Supine or prone, apply crisscross strokes to the calcaneal tendon using the lateral side of your index fingers as
they wrap around the posterior ankle (supine) or the thumbs (prone).

Follow the Lines

First, educate yourself on the tendons that run all around the ankle region. Visualize them in your mind. Then, muscle by muscle (or stay broad going group by group), follow the tendons proximally and distally. This can extend as far as you like proximally, considering the fascial lines that connect from foot to ankle to knee to hip to pelvis and beyond.

Passive Range of Motion

Using one hand to stabilize the leg just proximal to the ankle joint: 

• Apply rotation by using the other hand to grasp the foot and rotate it in both directions. (I usually rotate 3–5 times each way.) 

• Apply dorsiflexion by pressing your hand against the ball of the foot. Pump the foot by pressing for three seconds, then releasing. Press again for three seconds, then release. Repeat 3–5 times.

• Apply plantar flexion by pressing your hand against the top or dorsal surface of the foot. Pump the foot just as you did with dorsiflexion (Image 3).

• Apply inversion and eversion by cupping the calcaneus with your hand and alternating the motion medially and laterally (Image 4).

Thank the Ankles!

Even in a wellness session with no goal in mind, including the ankles creates a well-rounded approach that acknowledges this vital joint’s role in keeping the body balanced from the ground up. A client doesn’t need to experience an ankle or foot injury to experience restriction in these joints. Simply wearing shoes is enough. And a little bit of attention can go a long way to support the daily demands that are placed on our ankles and feet.