Ankle Inversion

Ankle Inversion

Ankle inversion refers to the movement where the sole of the foot turns inward, typically towards the midline of the body. It involves the contraction of muscles like the tibialis posterior and anterior, and is essential for activities like walking, running, and maintaining balance.

Ankle Eversion and Inversion: What Are They?

Movements of the ankle joint are referred to as ankle inversion and ankle eversion. The tibia, fibula, and talus bones make up the ankle joint, which permits both dorsiflexion, lifting the foot upward, and plantarflexion, or turning the foot downward.

Ankle inversion occurs when the foot’s sole moves inside, toward the body’s midline. During this action, the foot’s medial (inner) edge slides downward while its lateral (outer) edge rises. The lateral compartment muscles of the lower leg, such as the tibialis anterior, extensor hallucis longus, and extensor digitorum longus, are the main muscles involved in ankle inversion. Walking, running, and jumping are examples of common activities that include this action.

The movement of the foot sole outward and away from the body’s midline is known as ankle eversion. While the lateral edge of the foot goes downward, the medial edge of the foot is raised during this action. The tibialis posterior and flexor digitorum longus are two muscles in the lower leg’s medial compartment that are mostly involved in ankle eversion. Although more uncommonly, ankle eversion usually happens during specific sports activities or when walking on uneven ground.

Ankle eversion and inversion are both necessary for stability, balance, and healthy foot function. These motions assist in weight distribution during dynamic exercises and allow the foot to adjust to different surfaces. However, if the muscles, ligaments, or tendons around the ankle are weak or unbalanced, excessive or uncontrollable ankle inversion or eversion can result in ankle sprains or other problems.

For athletes, physiotherapists, and anybody else doing activities that put a strain on the ankle joint, it is important to comprehend the biomechanics and appropriate regulation of ankle inversion and eversion. These motions are usually the focus of rehabilitation programs and exercises in order to enhance ankle stability, avoid injuries, and support ideal foot function.

Ankle inversion: What Is It?

One kind of movement or motion that takes place at the ankle joint is called ankle inversion. The ankle joint is produced by the articulation of the foot’s calcaneus and tibia (tibia and fibula). Specifically, ankle inversion refers to a tilting or inward movement of the foot when the sole bends inside toward the body’s midline.

In a neutral standing position, the sole is somewhat outward and the foot is slightly rotated. Rolling the foot inward past the neutral position causes ankle rotation. The foot’s ability to turn and rotate is mostly due to the subtalar joint, which is situated below the ankle joint.

Ankle sprains may occur unintentionally or intentionally. Ankle sprains can occur, for instance, when walking on uneven ground, changing directions quickly, or participating in sports that require quick motion changes. Sprains, strains, and other ankle injuries may result from this, particularly if the foot is forcefully rotated out of its natural range of motion.

Notably, ankle Eversion is the reverse of ankle inversion, which involves moving the foot outward or away from the body’s midline. For the foot and ankle complex to remain balanced, stable, and function properly, both inversion and eversion of the ankle are critical.

Ankle Invertor Muscle

A group of muscles known as the ankle invertors are mainly responsible for controlling ankle inversion. Together, these muscles allow the leg’s internal mobility. These are the ankle joint’s primary invertor muscles:

• Tibialis anterior: This muscle is situated at the front of the lower leg. It is situated on the foot’s medial fibula and first metatarsal and develops from the top two-thirds of the tibia. The primary muscle involved in ankle rotation and dorsiflexion (lifting the leg) is the tibialis anterior.
• Tibialis Posterior: The tibialis posterior muscle, which is situated deep in the back of the lower leg, comes from the back surfaces of the tibia and fibula as well as the interosseous membrane that separates them. The navicular, metatarsals, and other foot bones make up those it extends. The tibialis posterior muscle assists in maintaining the foot’s arch and is a strong ankle joint inverter.
• Flexor Hallucis Longus: This muscle is situated next to the back of the shin, deep within the lower leg. It attaches to the base of the big toe’s distal phalanx after emerging from the backbone. It helps rotate the ankle even though its primary purpose is to flex the big toe.
• Flexor digitorum longus: Located deep in the back of the lower leg, this muscle is comparable to the flexor hallucis longus. The base of the smaller toes’ distal toes (second to fifth) is where it inserts after starting at the back of the tibia. The flexor digitorum longus assists in ankle rotation in addition to flexing the little toes.

During walking, running, and other weight-bearing exercises, these muscles coordinate to create ankle rotation, which is important for preserving balance, stability, and appropriate foot and ankle alignment.

Ankle Inversion Range of Motion

The degree of inward movement or pronation of the foot at the ankle joint is known as the ankle’s reverse range of motion (ROM). Although it varies from person to person, the normal range of motion for an ankle inversion is within a certain range.

The normal range of motion for an ankle inversion in a healthy ankle is between 20 and 30 degrees. This indicates that the leg can rotate or bend inward by around 20 to 30 degrees from its neutral position. Walking, running, and jumping are all of the activities that the right foot and ankle may perform due to this range of motion.

It is important to remember that the range of motion can change depending on a person’s anatomy, flexibility, and any traumas or pre-existing disorders that may influence the ankle. Naturally, different persons may have varying degrees of reverse ROM.

Ankle sprains and other problems can become more likely when ankles are inverted beyond their natural range of motion. To guarantee appropriate function and avoid damage, it is crucial to keep ankle mobility and stability in balance. It is advised that you speak with a physician, such as a physiotherapist or an orthopedist if you have concerns about how your ankle moves. They can evaluate your specific needs and suggest the right advice.

You can use a simple exercise called the goniometric size to examine the ankle inversion’s range of motion (ROM). Here is a step-by-step guide on testing ankle inversion range of motion:

• Comfortably sit or lie down with your leg extended straight in front of you.
• To maintain your mobility, firmly support the leg that has lowered. As long as the ankle joint can move as much as possible, you can keep the leg in place with your palms or a strap.
• Find where the ankle joint’s axis is. The bony protuberances at the inside (medial malleolus) and outside (lateral malleolus) of the ankle are often situated on the midway of the ankle.
• A goniometer should be attached to the ankle joint axis. An instrument that measures angles, the goniometer has a desk-bound arm and a transferring arm.
• Make sure the goniometer’s desk-bound arm is parallel to the long axis of the lower leg and the transferring arm is parallel to the long axis of the foot.
• The person should be asked to aggressively invert their foot by tilting it inward as far as they can. Make sure that they perform the movement without compensating by shifting their leg or other body parts about.
• Observe the position that the goniometer indicates, where the desk-bound and transferring fingers meet, and record it. In this view, the ankle inversion degree is represented.
• In certain cases, repeat the measurement to ensure accuracy and consistency.

It is important to note that goniometric measures are usually performed by qualified medical experts, such as physiotherapists. It is advised that you see a healthcare professional who can properly assess your ankle inversion range of motion and provide appropriate guidance based largely on your unique circumstances if you are unsure or have experienced difficulties performing the measurements on your own.

Ankle Inversion Special Test

Special tests are studies created especially to evaluate the body’s beneficial systems or characteristics. Although there are not any particular “special tests” for ankle inversion, there are a few that are typically done to assess ankle balance and competence since ligamentous accidents can occur during ankle inversion. These examinations help determine the lateral ligaments’ integrity and identify ankle instability. Here are a few commonly used, different tests for ankle instability linked to inversion:

Anterior Drawer Test:

• The person being evaluated should be sitting or in a supine position with their knee flexed to 90 degrees.
• Maintain the foot with the other hand while using the other to stabilize the reduced leg.
• To anteriorly translate the talus bone into the ankle joint, apply direct force at the heel while also supporting the lower leg.
• Examine the joint for any excessive anterior translation or laxity in comparison to the unaffected side.
• The stability of the anterior talofibular ligament (ATFL), which usually gets injured during ankle inversion, is examined and frequently assessed.

Talar Tilt Test:

• With the foot comfortable and the ankle in a neutral position, place the person for examination in a sitting or supine position.
• To maintain your mobility, stabilize the leg that has reduced.
• In an attempt to tilt the foot inward, apply an inversion pressure.
• Compare the affected side to the unaffected side to check for any excessive inversion motion or joint laxity.
• The stability of the ATFL and the calcaneofibular ligament (CFL) is examined and often assessed.

It is important to understand that special tests must be performed by qualified medical experts, such as orthopedic specialists or physical therapists, who possess the critical knowledge to correctly analyze the findings. To end up with an accurate analysis and an appropriate treatment plan, these tests are frequently a component of a comprehensive examination and are combined with other body exam techniques and imaging investigations, if necessary.

Manual Muscle Testing For Ankle Inversion

A physical examination technique called ankle manual muscle testing, or MMT, is used to assess the strength and functionality of the muscles surrounding the ankle joint. Healthcare providers, including doctors and physical therapists, frequently do it to assess muscle weakness, track rehabilitation progress, or identify specific ankle issues.

Muscle testing

Tibialis posterior

The position of the patient

The position of the patient must be side-lying.

Lie on your side, ankle off the bed’s edge, and examine.

To evaluate grades 0–2, the patient should be in a supine or short sitting position.

Position of the Therapist

The therapist needs to be seated in front of the patient on a chair or stool.

Assess the tibialis posterior muscle by palpating it.

For resistance against the dorsum and medial part of the foot, use the other hand.

What is the test procedure?

• Place the patient with their ankle in a neutral posture while they are seated or in a supine position.
• Use one hand to stabilize the lower leg and the other to hold the foot.
• Maintaining a neutral ankle joint position, try inverting the patient’s foot (turning it inside) and instruct them to resist.
• While determining how strong the patient’s resistance is, apply force gradually.
• On a scale of 0 to 5, 0 represents no muscular contraction and 5 represents normal muscle strength with complete range of motion.
• For comparison, repeat the test on the opposite ankle.
• Record your results and include them in the patient’s therapy regimen.

It is important to note that only qualified medical practitioners who have received the appropriate training and methods should do manual muscle testing. Furthermore, it is crucial to take note of any risks or contraindications before doing a patient assessment.

Ankle Inversion Exercise

Strengthening exercises for ankle inversion can help improve the stability and power of the muscles involved in regulating the foot’s inward motion. The following sports may assist with ankle inversion:

Ankle Inversion with Resistance Band:

• With your legs out in front of you, sit together on a chair or the floor.
• Keep your hands and the ends of a resistance band together as you wrap it around the ball of your foot.
• Together, place both of your feet in a neutral position (no longer inverted or everted).
• Pull the band in the direction of your body to progressively invert your foot against its resistance.
• Return to the starting position after holding the position for a few seconds.
• On each foot, complete two to three units of ten to fifteen repetitions.

Towel curls:

• Place both of your toes flat on the floor while seated together on a chair.
• Put something tiny, like a towel, under your foot.
• To increase resistance, bend and compress the towel toward you with your feet.
• Continue curling until the towel is completely pulled toward you.
• On each foot, repeat for two to three sets of ten to fifteen repetitions while relaxing.

Balance on One Leg with Ankle Inversion:

• For stability, place yourself near a wall or other support.
• Raise one foot off the ground while maintaining balance on the other.
• Slowly invert the foot by tilting it inward while maintaining stability on the ground.
• Return to a neutral position after a few seconds of holding the inverted position.
• The aim is to gradually increase the amount of time you can keep the location.
• Do two to three sets of ten to fifteen repetitions for each foot.

Alphabet Writing:

• Place both of your legs out in front of you while sitting on a chair or the floor.
• Elevate one foot off the ground and visualize writing the alphabet with your foot written in the air.
• Pay attention to the use of controlled and concentrated motions, with a focus on the inversion or inward movement.
• Try to complete the entire alphabet by using each foot to complete the exercise.

Keep in mind that sports may be appropriate for your current state of health and can help you progress gradually as you gain stability and strength. Seeing a medical practitioner, such as a physiotherapist, who can provide specific advice and sports based on your requirements, is usually a great idea if you have any recent ankle incidents or concerns.

FAQs

References:

• Patel, D. (2023aa, July 13). Ankle inversion and ankle eversion – movement, ROM, muscles. Samarpan Physiotherapy Clinic. https://samarpanphysioclinic.com/ankle-inversion-and-ankle-eversion/
• Patel, D. (2023j, May 29). Manual Muscle Testing of Ankle(MMT of Ankle Muscle) – Samarpan. Samarpan Physiotherapy Clinic. https://samarpanphysioclinic.com/manual-muscle-testing-of-ankle/#Ankle_Inversion