Know Your Numbers: Ankle Pain, Foot Pain, and Ankle Dorsiflexion

Know Your Numbers: Ankle Pain, Foot Pain, and Ankle Dorsiflexion Barefoot Rehabilitation Clinic

15 Jan Know Your Numbers: Ankle Pain, Foot Pain, and Ankle Dorsiflexion

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Without an ankle dorsiflexion (knee to wall test) measurement, don’t bother trying to get your ankle pain or foot pain fixed. ~Barefoot Rehab

So … you have a calf, ankle, or foot problem.

Hopefully, it hasn’t gotten so bad that you have plantar fasciosis or achilles tendinosis.

Do you know how many inches of ankle dorsiflexion you have?

If you don’t, you need to.

The most important test when it comes to measuring the integrity of the leg and foot is ankle dorsiflexion or the Knee to Wall Test.

It is the most functional range of motion for the ankle because as human beings, we walk arguably more than any other activity we do (excluding sitting and sleeping).

Before you push off to swing your foot through when you walk, your ankle approaches your end range of dorsiflexion.  Without sufficient range of motion, your body compensates.  One compensation is when your hip flexes early to avoid touching the end range of dorsiflexion (contributing towards hip flexor overuse and adhesion).  Another compensation occurs when your foot externally rotates (contributing to first metatarsal overuse, adhesion, and risk of bunion) and you walk like a duck.

Quack, quack.

We also need access to ankle dorsiflexion range of motion to squat to maximum depth with an upright chest.  Restricted dorsiflexion results in an immature squat (with your chest way over your knees to counterbalance your butt, which is too far back) or the feeling that you are falling backwards.ankle-dorsiflexion-during-squat

Three Key Tips to Tip The Scales of Success

Your ankles are on your feet and carry your body around for most of the day when you walk and stand (obviously, not when you sit).  Your ankles are load-bearing and work the majority of the day, even when you’re not exercising, running, jumping, or lifting.  The load faucet, due to the nature of ankles, drips into your capacity bucket all day long when you’re on your feet.

By comparison, your shoulders, which are hanging freely from your clavicles, are not load-bearing and therefore, recover more quickly than ankles.  With shoulder injuries, you can turn the metaphorical faucet off by not using shoulders.  You don’t use (load) your shoulders when you sit, walk, or stand.

  • Ankles = Load – bearing = work harder throughout the day = difficult to give time to repair.
  • Shoulders = Not Load – bearing = work less throughout the day = easier to give time to repair.

As we discussed in Why You’re In Pain, when Load exceeds Capacity, you get pain.  When you’re in pain and Load continues to exceed Capacity, you don’t heal.

Key Tip #1: If you’re serious about restoring ankle dorsflexion range of motion or recovering from your calf, ankle, or foot injury, then you need to deload.  In this case, that means minimizing walking and especially, prolonged standing.

Key Tip #2: Orthotics are a must when it come to load management.  In some cases, an over-the-counter insert can decrease load and reduce symptoms.  In our office, we use the best orthotics out thereSole Supports (FYI – We get nothing for telling you how amazing these supports are).  They’re wonderful orthotics casted seated in a maximally supinated position, thus cushioning the arch with each step you take. A non-maximally supinated orthotic does not cushion the arch like this.  The orthotics take into account your body weight and foot flexibility as well, which makes them quite individualized.

Key Tip #3: Stretch the right tissue.  Too many people waste their time stretching the calf with their knees straight.  The gastrocnemius rarely ever has adhesion and does NOT stop the knee to wall test.  It’s best to stretch the ankle with the bent. See the “Specific Dysfunction” part below about which tissues are relevant.

Ignoring these key tips could mean that you’re doing all of the right stretches and getting all of the right treatment and if your range of motion isn’t increasing, you are simply not giving your tissue a chance to recover and loosen up.

Mobility: Knee to Wall Test | Ankle Dorsiflexion (AD)

Don’t judge my orange SkyZone socks.  First, that place is like heaven for adults who want to peg kids in the head with dodgeballs, as I did and wrote about in The Good Body Project.  Second, the socks come with grips on the soles of the feet that give you extra traction when you’re trying not to slide across wooden floors.  Super comfy!


The ability to touch a wall with your toes 5″ away from a wall and your heel down is something that anyone should be able to do, when healthy.  The “Knee to Wall Test”, or in mechanical terms, ankle dorsiflexion, will let us know if you have that ability.

What do I need to Measure this Test? In our office we use white blocks in 3″, 2″, 1″, and 1/2″ increments.  It’s easier for patients to visualize their range of motion with a 3-D block.  You can just as easily use a ruler on the ground.


What is the Knee to Wall Test assessing? The mobility of your calf, ankle, and foot integrity. These structures include bone, ligaments, tendons, cartilage, and muscles.

What Specific Dysfunctions are relevant here? Unlike the lumbar spine that tends to accumulate many structural dysfunctions, the ankle tends to be structurally healthy.  That’s good news for us!  This means that the majority of individuals with restricted ankles should be able to increase range of motion except when trauma has caused permanent damage.  When dysfunctions are present, pathologies around the mortise joint are the most common and what would limit this range.

Relevant muscles include:

  • tibialis posterior – the stretch is in the middle of the calf, deep.
  • flexor digitorum longus – the stretch is in the medial portion of the calf, deep.
  • flexor hallucis longus – the stretch is in the lateral calf, deep.
  • posterior tibiotalar ligament – If this is problematic, you’ll feel a pinch on the front of the ankle. This ligament cannot be stretched or mobilized. The only way to affect this tissue is with a manual therapist who would take the small edge of a finger and put it under the malleolus to treat it.
  • posterior talofibular ligament – see “posterior tibiotalar ligament” above.
  • soleus – This muscle, while relevant on occasion, is not as significant as the 1st 5 structures above.  What this means for you if you’re mobilizing, go as deep as possible.  The structures above are deep to the soleus. Use an object with a smaller surface area – lax ball, or even a golf ball – than an object with a larger surface area – foam roller.

Completely irrelevant muscles include:

  • gastrocnemius (This muscle is stretched with the knee straight. Don’t bother stretching this muscle as it almost never has adhesion.)

What You Need to Know: A calf stretch during the SLPF Test has a completely different physiologic cause than this test.  It’s nerve in the former, muscle in the latter.

How to Test: Take your shoes off.  Put a ruler against the wall.  Start with your toes against the wall, standing on top of the ruler.  Heel down.  Keeping your heel down, move your knee straight forward toward the wall without letting your knee cave in towards your first toe.  If you knee touches the wall with your heel down, you have that range of motion.  Move your toes 1″ away from the wall at a time, continuing to be sure that your heel is down and your knee doesn’t cave in.  The last range of motion before your heel is about to lift or when your knee just barely touches the wall is your Ankle Dorsiflexion Range of Motion.

Watch the three minute video below if you’re of a visual person.


Write this number down.  Any mobilization, stretching, or treatment interventions are attempts to increase this number.  If the number isn’t increased after a month, you’re wasting your time.


A pass for this test is the ability to touch a wall with your toes 5″ away from a wall and your heel down (best visualized from the side).  When observed from the back, the knee should be over the 2nd toe.  Notice, for integrity’s sake, I only have 4.5″ of range of motion in the picture below titled “Passing End Range of Motion”.  I want to show you what a full range of motion looks like.  For the passing test’s sake, imagine another 1/2″ block thrown in there.

ankle-dorsiflexion-passing-end-range-of-motion ankle-dorsiflexion-blocks

  • Range: 5 inches (don’t be confused by my 4.5 inches of maximum range – I fail this test).
  • Effort: Fast and easy.
  • Symptoms: No symptoms, including stretching.


A fail is any range of motion between 3″ – 5″ with the heel down, the knee touching the wall and the knee over the 2nd toe.  For the athletes out there, the lower end of the spectrum here is the minimum amount of dorsiflexion needed to perform a hip width, toes slightly out, Olympic-style squat.  In this case, 3″ was my personal measurement, given the length of my femur (thigh bone), tibia (weight-bearing leg bone), and foot.  Your body is different than mine, so your number will likely be different as well.

  • Range: 3 inches – 5 inches.
  • Effort: Fast and easy.
  • Symptoms: Because your range of motion is limited, some tissue will be stopping your range of motion, which means that you will likely feel a “stretch” sensation somewhere in the calf, posterior ankle, or foot.  You could also have an impingement (“pinching sensation”) in the front the ankle, which would indicate that the posterior tibiotalar ligament or posterior talofibular ligaments are adhesed.  Don’t even bother rolling out if this is the case.  See a manual therapist to remove the adhesion in those ligaments.  If you have pain, you have a problem and you should either rest before you test again or see a qualified therapist.


A fail, with an individual having no business doing any non-essential walking or exercise, is anything less than 3″ with the heel down, the knee touching the wall and the knee over the 2nd toe.

  • Range: Less than 3 inches.
  • Effort: Slow and cautious, indicative of “protective tension” and “red-lighting” from the central nervous system.  This protective mechanism occurs when tissue is damaged and the body is subconsciously protecting further load from occurring to the damaged tissue.  If you feel a “stretch” when combined with this slowness, the cause of the “stretch” is actual muscle contraction or “protective tension”, not the lengthening normally thought of as a “stretch”.  This means that if we cut look at the tissue on a microscope, we would see the muscle’s active units, the sarcomere, sliding past each other (indicating contraction), not moving further away from each other (as seen in a stretch).
  • Symptoms: See above in the “Low Risk” section.  If the range is this bad, it’s possible that this range of motion has been restricted for a long duration of time, which means that you’ve been compensation for a long time as well.  Knee and hip symptoms during this test indicate that you should really consider getting help.

Movement Faults:

If your heel lifts (see A), if your knee can’t touch the wall (B), or if your knee caves in (out of alignment with the 2nd toe), you’re toes are too far from the wall and you need to move closer.





I Know My Numbers – What do I do now?

Insanity: doing the same thing over and over again and expecting different results. ~Albert Einstein

There are a plethora of mobility and stretching resources out in the interweb for you to experiment with to improve your ankle dorsiflexion.  I like this post with 7 advanced mobility exercises.  It is not our intention to give prescriptive answers, simply to bring awareness to where your body currently is in time.  One meta-analysis done in 2006 supports the notion that static stretching from 5-30 minutes can create small improvements in ankle dorsiflexion.

Use whatever tools you’d like to use for a month, stretching about from 5-30 minutes a day, for 3 days a week, for a month.

After a month, re-test.

If you’ve gained range of motion, wonderful!  Wash, rinse, repeat, and continue stretching.

If you’re no more flexible or mobile than you were before, STOP THE INSANITY AND THE STRETCHING!  barefoot_stopstretching

It’s now time to see a Manual Adhesion Provider or Active Release Technique Provider to diagnose your condition and potentially remove the adhesion in relevant tissue to restore your mobility before you go on layering strength on top of unhealthy tissue.

Below, our clinical assistant Sharon and I treat a patient with chronic ankle pain’s flexor hallucis longus.  This muscle is one of the primary tissues responsible for restricting ankle dorsiflexion.

Once you’ve gotten your Ankle Dorsiflexion range of motion to as close to 6″ as possible it’s time to strengthen. I really like this comprehensive guide for strengthening the calves and shins to increase your capacity so this restriction in joint range doesn’t happen again.

Want to test the rest of your muscles and joints? It’ll only take 2 minutes per test, but you need a friend to help.

speechbubblesWhat are you ankle dorsiflexion numbers? Please share range, effort, and symptoms below and we can discuss what you should be doing to restore musculoskeletal integrity.

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Dr. Chris Stepien, DC, Full-Body ID Certified, ART Certified, CSCS, and CrossFit Level 1 Certified, fixes your annoying and frustrating pains, even when it's been over 6 months and you've seen 3-5 other doctors or therapists without lasting relief Barefoot Rehab in Denville, NJ. And when you're sad, depressed, or not enjoying life, Dr. Chris wants to hug you. He invites you to reach out, no matter what your concern is. Barefoot Rehab is here to serve you.
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  • Know Your Numbers: Ankle Pain, Foot Pain, and Ankle Dorsiflexion Test | Primal Docs
    Posted at 20:51h, 15 January Reply

    […] Know Your Numbers: Ankle Pain, Foot Pain, and Ankle Dorsiflexion Test […]

    • Maria Sexton
      Posted at 18:17h, 19 November Reply

      I was told I suffered a grade 3 ankle sprain almost 6 weeks ago. I stumbled across this site and out of curiosity tried the knee to wall test. My range was less than an inch and at 1 inch there was pain. My orthopedic doctor has yet to even lay hands on my ankle. I am to begin physical therapy in 2 days and I am afraid of pain or accidental injury from improper diagnosis. My ankle, when I stand and put weight on it slides in and down making my foot look like it is flattening out. This is also very painful. The pain is on the outside, Inside and in front but above my ankle as well as below my knee on the outside of my calf.

      • Dr. Chris
        Posted at 11:12h, 20 November Reply

        Hi Maria, the good thing about injuries like yours is that the diagnosis is usually correct. Based on what you mention about your symptoms and how the ankle moves, it sounds correct. You should keep doing this test to assess how you are progressing. The goal is 6″ of range of motion. If PT doesn’t help you get there, you may need a manual therapy specialist. Let me know how I can support you.

        • Maria H Sexton
          Posted at 21:00h, 10 February Reply

          Hi Dr. Chris. I wanted to update you since my last post. After 9 weeks of no pain/stability improvement I had an MRI of my right ankle done. Turns out I sustained grade 2 sprains of atfl, anterior and posterior tibiotalar components of the deep deltoid ligament. Grade 2 sprain of the syndesmotic ligaments as well, but here is the kicker: mildly displaced vertical fracture of posterior malleolous w/ persistent (don’t know what this means) hypointense fracture line extending to articular surface and significant associated marrow edema. Marrow edema extends to the syndesmosis. Again, this is 9 weeks AFTER the initial injury and the MRI report stated the fracture was in the earliest stage of healing. I’m assuming this is because of walking on it , well limping on it. As of yesterday I was allowed to put away my crutches and focus on proprio-something, learning to keep the ankle stable right? The pain has decreased significantly but my tibia still hurts/ aches and the ligaments still sting a bit.

          • Dr. Chris
            Posted at 13:55h, 12 February

            This is awesome Maria. We have more data that now makes your pain, stability, and functional ROMs make sense. Yes, the walking is likely the reason why you weren’t healing (your body can’t heal and take more stress at the same time). Now, the plan is to use your crutches and let it heal as much as possible. I would do some really gentle “loading” (or putting stress on it) by putting your foot on the ground and gentle re-creating the knee-to-wall test to encourage blood flow into all of the ligaments. Less is more here. It’s not a workout. I’d literally start doing this maybe twice a day for 20 seconds, performing 2 or 3 reps. Let ease be your guide. If it’s painful or feels off, stop. If it starts feeling better after a week, do more. If you’re overweight or have any metabolic conditions, know that those factors are also inhibiting your progress. You should make sure you’re getting as much nutrition in your body as possible (grass-fed meats, wild-caught fish, colorful vegetables, bone broth, etc). Hope this is helpful?

      • Katie
        Posted at 20:59h, 14 September Reply

        What should I do? On my left leg I just got 1cm (never broken before) on the right with several metal implantats I am not able to touch the wall with my knee even if touch the wall with my toes without Lifting heels. Is this even managable?

        • Dr. Chris
          Posted at 18:03h, 15 September Reply

          Hi Katie, yeah, that’s very bad. It’s hard to say what’s restricting you. You’d need to have an in person exam with an adhesion specialist to figure it out to set your ankle up for long term health.. You can find one at

    • Kim Ray
      Posted at 20:15h, 17 March Reply

      I had Lapiplasty Bunionectomy on my right foot Dec 17, 2019. Recovery progress seemed good until I realized I couldn’t dorsiflex my foot while my leg was straight, weight bearing or not. I’ve been trying to mobilize the ankle and stretch the calf and have gained a little bit of dorsiflexion but now the front of my ankle has pain almost all the time. I did the test and got exactly 3” slow and cautious. Any suggestions would be appreciated.

      • Dr. Chris
        Posted at 23:14h, 17 March Reply

        Hi Kim, it’s hard to say. But you can dorsiflex your foot when your knee is bent? If yes, would likely be a gastroc issue, potentially adhesion. If no, then it sounds like there’s an impingement in the mortise joint. Could be a bony joint issue, or more likely, there’s adhesion in flexor hallucis longus, followed by tibialis posterior, flexor digitorum longus, and posterior tibiotalar ligament. You can try sitting with your calf on a golf ball or lax ball and finding sore spots. I wouldn’t stretch it as you could make it worse. Best option is to find an Integrative Diagnosis doctor to remove adhesion. Hope that helps.

        • Kim Ray
          Posted at 20:19h, 18 March Reply

          Dr Chris,
          Thank you for answering my question, however I need to know what I can do for myself at home right now as I won’t go to a Drs office right now during the Pandemic unless it’s critical. I believe I am able to dorsiflex with my knee bent but I don’t know how to measure it to be sure.

          • Dr. Chris
            Posted at 21:16h, 18 March

            If you did this test the way we describe it, then the knee would have to be bent. Try the lax ball trick. Let me see if I can film a video and I’ll upload it.

        • Kim Ray
          Posted at 15:00h, 19 March Reply

          Dr Chris,
          Thanks, I will try that.
          Is there a functional difference between being able to dorsiflex against the floor like while doing the test and dorsiflexing under my own power without assistance? I can force my foot into more dorsiflexion both straight legged and knee bent than I can achieve in the air without assistance.

          • Dr. Chris
            Posted at 01:56h, 20 March

            It’s better (healthier) that you can do it with foot on floor. It’s more practical. Ideally, you’d be able to do it in air without assistance. Obviously, suggests something isn’t right.

          • Richard
            Posted at 22:43h, 13 April

            Hi Dr Chris. Thanks for the dorsi flexion guide.
            It’s 8 weeks since I sustained a suspected grade 2-3 ankle sprain with an avulsion.
            I can walk fine without a limp.
            My measurement doing this exercise is 2 inches. I only measured it today but I’ve been doing this exercise for about 4 weeks. I think I have probably progressed about an inch and a half since then.
            Any advice on how I could progress with this would be appreciated.

    • Kim Lewis
      Posted at 01:55h, 06 August Reply

      Hi ! I broke my tibia in several places as well as my fibula skiing almost 8 months ago abroad. The tibia was repaired with a nail. The fibula was not touched. I have partial union of the breaks in the tibia and non-union in the fibula (which is hugely painful). My local ortho said repairing the fibula isn’t worth it (?) and I’m now doing my best to get back to my normal (very active) life while trying to manage the pain. I can somewhat successfully work out (all low impact – I cycle on my peloton!) – no jumping, running, skipping, lateral movement – which is torture for me as a basketball player!!! Who knows if skiing is in my future! just came across your material – very helpful! My dorsiflexion has been terrible – less than 2” for a long time – no improvement in well over 4 months. Pain deep in my ankle, front of ankle and all up the outside of my leg. I know part of this is where the unhealed break is… I also notice that my calf doesn’t seem to engage at all (maybe minimally). You’ve probably seen this before…and was hoping for some advice. I do think that unlocking my ankle will help (at least mentally!). Thanks!

      • Kim Lewis
        Posted at 02:08h, 06 August Reply

        Hi ! I broke my tibia in several places as well as my fibula skiing almost 8 months ago abroad. The tibia was repaired with a nail. The fibula was not touched. I have partial union of the breaks in the tibia and non-union in the fibula (which is hugely painful). My local ortho surgeon said repairing the fibula isn’t worth it (?) and I’m now doing my best to get back to my normal (very active) life while trying to manage the pain. I can somewhat successfully work out (all low impact – I cycle on my peloton!) – no jumping, running, skipping, lateral movement – which is torture for me as a basketball player!!! Who knows if skiing is in my future! just came across your material – very helpful! My dorsiflexion has been terrible – less than 2” for a long time – no improvement in well over 4 months. Pain deep in my ankle, front of ankle and all up the outside of my leg. I know part of this is where the unhealed break is… I also notice that my calf doesn’t seem to engage at all (maybe minimally). You’ve probably seen this before…and was hoping for some advice. I do think that unlocking my ankle will help (at least mentally!). Thanks!

      • Dr. Chris
        Posted at 12:00h, 06 August Reply

        Tough Kim. You may have adhesion which would help getting it removed. But it’s likely the break may prevent the range from ever coming back. It’s difficult to say more without seeing you in the office. You’ll have to use your discretion with what surgeon and manual therapists tell you.

  • The Truth About Plantar Fasciitis (and Arch Pain)
    Posted at 12:56h, 19 January Reply

    […] which is often very true with restricted ankle dorsiflexion and plantar flexion (see below – Measure your ankle dorsiflexion through the directions here).  Tissues can be tight for various reasons that warrant further detail to resolve (ie. muscle […]

  • Do You Trust Your Doctor & Advanced Pain Management: The Research on Expert Intuition
    Posted at 15:39h, 08 February Reply

    […] sustainable improvement in her functional range of motion (her restricted and relevant test is ankle dorsiflexion, showing 2.5″ on both sides) and no improvement in her capacity upon walking barefoot. […]

  • Foot Positioning in the Squat and Ankle Dorsiflexion Range of Motion
    Posted at 23:38h, 20 April Reply

    […] I already showed you how to measure your ankle dorsiflexion here. […]

  • Know Your Numbers: The Thigh to Chest Test
    Posted at 20:58h, 01 June Reply

    […] awaiting 30 days from now to reassess, you might as well get baseline measurements for your ankles and your low […]

  • Know Your Numbers: The Lunge Stretch Test
    Posted at 14:28h, 15 June Reply

    […] 30 days from now to reassess, you might as well get baseline measurements for your hip flexion, ankles and your low […]

  • Sally M
    Posted at 21:34h, 12 July Reply

    I have roughly minus one inch of dorsiflexion on my right foot (knee roughly one inch from wall when toes touch wall). I run about 30 miles a week and feel fine except when running uphill, in which case the arch of the right foot feels strongly overstretched to the point of pain. The left foot has positive dorsiflexion of about one inch and feels fine when running. I tried daily calf stretching (both with straight knee and bent) for a few months but dorsiflexion didn’t improve. I felt no stretch in my ankle, just compression at the front of the foot. Is there any way to compensate for lack of dorsiflexion when running, since it doesn’t seem to be improving.

    • Dr. Chris
      Posted at 21:57h, 12 July Reply

      Hi Sally, Unfortunately, there is not a way to compensation for a lack of dorsiflexion. When you run, you need more dorsiflexion than 1″. My recommendation is that you stop running, or at least, stop running so much. Because you don’t have 100% capacity in your ankles, your mileage combined with your greatly diminished capacity will only worsen the ankles quickly and surely, other joints upstream (knees, hips, low back). Only time will tell. Riding a bike would take the ankles out of the equation. Is this something you would consider?

      Of course, the other option is to find a myofascial worker who can help you regain that range of motion. If you feel compression in the front of the joint, the posterior ankle ligaments are likely involved. There is NO way for anyone to stretch or mobilize these tissues without a skilled provider.

      I hate to be the one to give this recommendation. Know that my perspective comes from wanting to see you able to walk ( and run if you have to) decades down the road. That’s why I make this recommendation. Let me know your thoughts.

      • Sally
        Posted at 06:48h, 02 June Reply

        I’ve switched to barefoot running (in fact I’m barefoot or in Xero sandals 100% of the time) and feel great! Still get a negative result on the wall dorsiflexion test on my right foot, but not having foot pain any more.

        • Dr. Chris
          Posted at 11:33h, 02 June Reply

          Wonderful Sally.

          With 1″ of dorsiflexion, you should continue to be mindful over the months to years how your feet and calves feel. Barefoot running puts MORE load on these structures (generally), not less. But if you’re having more relief, whatever tissue was causing your pain is being loaded less, at least in the short term.

          If you’re really mindful and you do get a little symptom here or there, respecting those symptoms will help you to do the right thing by whatever is damaged.

          • Sally
            Posted at 12:55h, 02 June

            I have MINUS one inch actually on my less flexible side…

        • Dr. Chris
          Posted at 15:59h, 02 June Reply

          Yeah. You have a giant mass of an iceberg brewing underneath the surface, you just can’t see it yet. Please keep your running down to low volume and introduce intervals if you’re going to run at all. I’d be really surprised if 6 months from now, you’re still running barefoot like this.

          Forgive me for being the bearer of bad news, but I’d rather you get reality than false statements.

          • Sally
            Posted at 08:41h, 16 June

            That’s exactly what you said last year. I’ve increased mileage with no pain. I get that you’re trying to make money here, but why lie?

          • Dr. Chris
            Posted at 11:28h, 19 June

            Hi Sally, I’m glad you’ve been able to increase your mileage with no pain. It’s very common that over months to a few years, people can increase the amount of activity they have, even with severely restricted joints. So I’m not surprised you have no pain. My previous messages are warning signs that you will have growing pains over the next few years due to the 1″ of ROM. The more you monitor your activity, take care of your soft tissue, and understand “what’s going on underneath the car’s hood,” the more you’ll be able to prevent this. My intention in replying again is bringing this mindfulness to your running, not to upset you in any way. I apologize if I’ve done so.

            As far as trying to make money, I’m not quite sure what you’re talking about. Do you think I”m trying to get you to NJ as a patient? I don’t know where you live in the world but that’s usually not possible for people.

  • Know Your Numbers: The Face-Up Heel to Butt Test
    Posted at 17:49h, 16 July Reply

    […] now to reassess, you might as well get baseline measurements for your hip flexion, hip extension, ankles and your low […]

  • Seth Hamilton
    Posted at 19:01h, 22 December Reply

    I have a dorsiflexion of 1 1/8th inch. I “fractured” my talus in Feb 2015, and it doesn’t seem to be getting any better. Any suggestions to restore my range of motion if the exercising doesn’t work?

    • Dr. Chris
      Posted at 14:34h, 27 December Reply

      Hi Seth, I’m sorry about the fracture. Before asking your question, the real question is, “What is stopping your dorsiflexion at 1 1/8th inch?” If it’s soft tissue, you can gain that ROM back. If it’s due to the fracture, the talus, and a bony stop (imagine a wallet in a door hinge), then you cannot get it back.

      Let me ask you a few questions.

      – Did you need surgery?
      – Do you have the images of the fracture?
      – Did your doctors tell you if they thought you would get that ROM back?
      – Have you had a skilled manual therapist feel your deep calf tissue (or posterior ankle ligaments) to determine if they’re pulling tight and stopping that ROM?

      Answer those questions, feel free to send me any imaging or reports you have (delight [at] barefootrehab [dot] com), and I’ll take a look for you.

  • Dean Webber
    Posted at 14:20h, 30 April Reply

    Really glad I found this site! I have roughly 2″ dorsiflexion on both ankles, and have tried visiting numerous chiropractors and physios with no improvements (over a year!). It’s really hard trying to find a decent practitioner! Besides coming to your clinic (wish I could but I live in Japan!) could you give me some tips on how to tell a good practitioner from a lazy one. Thanks

    • Dr. Chris
      Posted at 22:17h, 30 April Reply

      Hi Dean! Glad you enjoyed the post. Sure, here are a few tips:

      1. Does the doctor have testimonials and case study proof of range of motion gains?
      2. Does the doctor claim to fix everyone (100% of the time) or are they realistic about the gains that can be made (expressing humility and realism – some people won’t have increases in ROM based on structural damage or overuse).
      3. If you do see a doctor and you don’t notice any range of motion changes in 5 visits, find another doctor.

      Hope this is helpful.

  • Mary Ann Johnson
    Posted at 16:49h, 03 May Reply

    I have bilateal foot drop. I had back surgery of decommpression and fushion of L4 L5 and,S1 with hopes of it helping but no improvement. My legs, hips and everythung below waist are weak. I’m doing physical theraphy with no improvement. I had an emg and dr said findings could be consistent with cidp. What kind of dr do I need to go to. I have been in wheelchair since Christmas of 2016.

    • Dr. Chris
      Posted at 17:09h, 03 May Reply

      Hi Mary Ann, I’m so sorry for your struggles. What happened around Christmas 2016? Was there any trauma? Were you really stressed out? Were you doing anything with your body prior to that time? Maybe a new workout or work activity?

      If your doctor is right, CIDP is a neurological condition. You should see a neurological specialist.

      Physical therapy wouldn’t work because while you’re “weak”, it’s not a “muscle weakness” issue but a “nerve isn’t activating muscle” issue. So that makes complete sense.

      Someone like me wouldn’t be able to help you UNLESS the nerve part was managed.

      Hope this is helpful. If I can do anything else, please let me know.

  • BarefootRunner
    Posted at 17:27h, 29 November Reply

    “The ability to touch a wall with your toes 5″ away from a wall and your heel down is something that anyone should be able to do, when healthy.”

    These numbers simply don’t work for shorter people. My foot length is 24cm. Heel-to-knee length is 44cm. To get my knee to touch a wall with my toes 5″ (13cm) away would require an angle of arccos((24+13)/44) = 33 degrees between foot and shin, or the ability to flex the foot 57 degrees upward from perpendicular to the shin. That seems like a rather extreme amount of flexion.

    “A fail, with an individual having no business doing any non-essential walking or exercise, is anything less than 3″ with the heel down, the knee touching the wall and the knee over the 2nd toe.”

    I measure zero on the wall test when fully warmed up. I’ve spent my life walking, hiking, and dancing and I’ve been running for several years. During 2017 I transitioned to barefoot running and am currently at 40km a week with no issues.

    • Dr. Chris
      Posted at 17:57h, 29 November Reply

      Hey there,

      I agree that the numbers don’t work for much shorter or taller people. But it works for most people.

      I don’t know how old you are. But with 0″ of dorsiflexion in this test, I will make 3 assumptions that may not be true:

      1. You’re genetically gifted when it comes to having strong connective tissue.
      2. You’re probably healthy in your other joints.
      3. It’s likely only a matter of time before something breaks down in your ankle or foot.

      But yes, I agree that 5″ isn’t passing for every individual.

  • John K
    Posted at 19:46h, 30 January Reply


    I have rupture my Achilles tendon in Mar 2017 and had surgery in Apr 2017. My surgery was the PARS with the Speedbridge Midsubstance anchors to the heel. My doctor said that this surgery involves fiber wires anchored to the heel therefore my dorsiflexion is harder to regain. I’m 10 months post surgery and my dorsiflexion is only 2″ from the wall. Can you recommend exercises that can help stretch my achilles to regain my dorsiflexion ?

    Thank you so much.

    • Dr. Chris
      Posted at 22:13h, 01 February Reply

      Hi John, I’m sorry about the injury. I don’t know if “fiber wires” are elastic or not. When the surgeon said dorsiflexion would be “hard to regain”, is it even possible to regain? Before you do anything, I would ask him if this is possible and potentially ask if he has any patients who have had the same surgery who did regain this range. Ask if you can speak to him/her. My humble opinion, now, is that it is not regainable. Let me know what he says?

  • John K
    Posted at 19:09h, 06 February Reply

    Hi Dr Chris, Thank you for your reply. These fiber wires are not elastic, here’s a link to the exact surgery that I had Yes, my surgeon said it was possible with stretching and exercises. I’m now 10 post surgery and I need some more ideas of exercises at home or local gym. My PT session have ran out therefore I’ll have to do these on my own. Thank you.

  • Sophie Cowper
    Posted at 09:57h, 12 April Reply

    Hi, I have a negative figure on left foot which has a bone spur on the heel which I feel is restricting me. Is there any way I can increase dorsiflexion, as surgery is a last resort. Thanks.

    • Dr. Chris
      Posted at 13:36h, 12 April Reply

      Hi Sophie, what do you mean by a “negative figure”? Where is the bone spur? read exactly what the x-ray or MRI report says. Typically, bone spurs happening at the heel (where plantar fascia inserts) wouldn’t restrict this range of motion. It’s not involved with any of the muscles that could be limiting the range of motion.

      So the suspect that is limiting your range is still unknown.

      What is your range?

  • Tammy Romer
    Posted at 22:24h, 19 June Reply

    Dr. Chris,

    Hi! I am 14 weeks post-op plantar fascia release, bone spur removal, and tarsal tunnel release surgery. Since surgery, I have lost dorsiflexion. I do not know what my numbers were before surgery but I know that I did not recognize it as an issue. Since surgery my measurement in PT is 10 degrees. I have been going to PT three days a week for 10 weeks with zero improvement. I attempted your easy measurement trick and with my toes up against the wall I could not get my knee closer than 4 inches to the wall. Since surgery, I developed a DVT and was diagnosed with complex regional pain syndrome. I am told that this CRPS is the cause of my lack of dorsiflexion but not given any other information. Any thought or suggestions you may have would be greatly appreciated. I want to get back to work but between the nerve pain and mobility issues I’m just not sure how that will happen. Thanks in advance!

    • Dr. Chris
      Posted at 10:57h, 20 June Reply

      Hi Tammy, I’m sorry for your struggles. 4″ is 64% function. Not horrible, but could be a lot better. 30 Treatments is WAY to many to not have improvement. CRPS is 100% not the cause of your lack of dorsiflexion. It tells us nothing about what tissue is stopping your range of motion. Now, with the surgeries you had, it’s very possible that you won’t be able to recover that range due to structural (joint, cartilage) damage of the joint, kind of like gears in a machine that are tinkered with and can’t be repaired. I’d try to find the most precise myofascial therapist you can find near you. Ideally, they’re an Integrative Diagnosis provider. They’re taught to get range changes in 3 treatments or less and can often diagnose what the cause of your restricted range is. Let me know your thoughts.

  • kartik wadhawan
    Posted at 15:12h, 07 October Reply

    i am having ankle dorsiflexion problem i am a gymnast from india i am having 4″ movement in my right ankle with little effort and 5.5″ in left easily wall test i cannot take deep landing if feel like sumthing is torn from inside i have pain in front little to right side near the bone and the pain is painfull i have been doing some balancing and streching exercise and move i am doing so strengthening but i cannot see any improvement i can feel the stiffness with i sit in squat position with both legs join please can you help me with somthing

    • Dr. Chris
      Posted at 19:56h, 07 October Reply

      You need to find someone to treat you Kartik. You have a problem. Hopefully, it’s adhesion. You could have cartilage damage in the location you describe. There’s nothing you can do besides treatment. I’m sure you’ve tried a lot already!

  • Mike
    Posted at 20:39h, 15 October Reply

    Hello Dr. Chris,

    Glad I found this website. 16 months ago I fractured my calcaneous and had 17 screws and a plate put in the heel. A year after the injury I rushed back, and wound up getting posterior tibial tendinitis. After a few weeks of rest, I started to see a PT. We have been doing joint mobilizations to restore my joint mobility/dorsiflexion. There has been a massive improvement and I’m around 4-4.5” once I’m warmed up, but still feel some pinching at times in the Posterior tibial tendon (although no inflammation). It’s been 12 weeks. I also get a pinch in the front of my ankle at times too. I saw you don’t recommend Graston for the post tib tendon…what would you recommend? I feel like I need something other than just joint mobilizations.

    Thank you for your time.

    • Dr. Chris
      Posted at 11:13h, 16 October Reply

      Hi Mike,

      An instrument can’t reach the tibialis posterior muscle. Although it can reach the tendon on the bottom of the foot by a skilled practitioner. i recommend you get someone who can use an instrument on the bottom of your foot and his/her hands in your calf.

      I don’t ever care what someone’s range is after warming up. What matters is what your range is when cold.

      Where exactly is the pinching?

      Sole supports orthotics will be helpful too. Tibialis posterior is responsible for holding arch up and it’s essentially overloaded if you have a true tendonitis. If your symptoms get BETTER with warming up, you also have tendinosis there.

  • Bailey Harvey
    Posted at 23:14h, 26 October Reply

    I injured my ankle playing basketball 3 months ago. I landed on someone’s foot after grabbing a rebound and my ankle inversed and dorsiflexed to the extreme. Soon after this incident (a week) I hiked about 30 miles on my bum ankle and I tried to return to sports after a month of my injury. My ankle is no longer swollen, and I am waking normally. I iced and did ankle exercises till now but I am still having problems putting my knee over my toes. I can get my knee to my toes but never further, and I feel pain along the posterior medial portion of my ankle when I try to push my ankle to my toes and past that point. I am a 20 year old who leads a very active lifestyle. What is my injury specifically? And what is your advice for combatting this injury?

    • Dr. Chris
      Posted at 02:10h, 27 October Reply

      It’s hard to say Bailey. The posterior medial ankle houses the deep ankle stabilizing muscles (tibialis posterior, flexor digitorum longus, and flexor hallucis longus) as well as the posterior tibio talar ligaments. You also could have damaged the cartilage or mortise joint thehre. Have you seen anyone to check this out? The best way to combat this is to find a specialist who knows what they’re doing. An MRI would provide information. Someone who can feel tissues can tell you how bad they’re adhesed or damaged. I hope this helps.

      • Bailey
        Posted at 14:00h, 27 October Reply

        I will see a specialist as soon as I can, thank you for your help!

        • Dr. Chris
          Posted at 20:02h, 27 October Reply

          : ) Let me know how it goes brother.

  • morteza
    Posted at 18:59h, 19 November Reply

    Hello and thanks for your advice
    I am a soccer player who suffered ankle sprain and ankle sprain 9 months ago, and I already have ankle limitation after surgery.
    I can run but the starter is not like before ……. after running … at home, I get cramps in the ankle area
    My ankle bends to the front most likely
    Evaluating Ankle Dorsiflexion
    To assess if you may have poor ankle dorsiflexion

    • Dr. Chris
      Posted at 11:57h, 20 November Reply

      Hi Morteza, what are you asking exactly? Can you be more clear?

  • Rae
    Posted at 06:08h, 25 November Reply

    I am at less than 2” in ankle knee to wall test on right side and 3 on my left. Shock therapy, gestard tools, fascia massage, chiro and physio. Need diy stretches seeing as I’m not able to stretch per say

  • Emma
    Posted at 12:52h, 13 June Reply

    I only could do 2inches!
    I felt pain in the front of my foot when I did the test.
    I am 25yrs old and have sprained both ankles multiple times over the years. It has been 4years since my last sprain.
    I don’t do any regular exercise. I am unable to complete a full squat as I can’t bend my foot, i have attempted multiple times and it won’t allow me to drop down.
    On plantar flexion, it almost feels like it hyperextends. My physio has previously said I hyperextend all of my limbs..
    Would appreciate some recommendations that I can do while I wait to locate a manual adhesion provider.

    • Dr. Chris
      Posted at 21:19h, 13 June Reply

      Hi Emma, if you have 2″ of dorsiflexion, but full plantarflexion, you’re likely experiencing an impingement. The adhesion provider will likely need to treat the posterior tibiotalar ligament and posterior talofibular ligaments primarily, and tibialis posterior, flexor digitorum longus, and flexor hallucis longus secondarily. In the meantime, avoid movements that put you into dorsiflexion as you don’t have access to it. You can try some lax balliing of the calf to see if that improves the range and symptom.

      • Emma
        Posted at 23:34h, 13 June Reply

        Hi Dr Chris, thank you for the quick response! I will find an adhesion provider.

        • Dr. Chris
          Posted at 19:58h, 02 July Reply

          : )

  • Mike M
    Posted at 07:00h, 07 November Reply

    My wife runs marathons and suggested I need to start an exercise routine. I tried to work out with her, but she told me to stop because my posture and form were “terrible.” I tried the wall test and cannot touch my knee to the wall without my heel coming up even with my toes against the wall. If I bend my knees at all while standing up, my heels start to rise. I assume this means I have almost no ankle dorsiflexion. My wife and I were hoping I’d be able to start running with her, however, when I run I am basically running on my tippy toes. There are some times I cannot even bring my heel all the way down to the ground.

    My wife suggested I find some exercises to improve ankle range of movement. In addition, I am duck footed so it takes effort to get my feet pointed straight. When I point my feet straight (say when I’m in a picture), you can feel a major tightness in the sides of my legs just to hold the feet straight. I cannot turn my feet inwards at all. I am not sure if that affects anything or not.

    • Dr. Chris
      Posted at 00:46h, 28 January Reply

      Hi Mike, with 0% function in the ankles, if you chose to ran, you’d DEMOLISH your ankles. Please don’t. Try Active Life Rx’s Ankle Mobility program. If that doesn’t work, you’ll have to see an adhesion specialist.

  • Kylee Underwood
    Posted at 21:12h, 12 December Reply

    I’ve been trying to improve my squats for a long time. I’ve got some lovely hip and SI joint issues…and I think it may have stemmed from having ankle mobility issues. I sprained my ankles multiple times years ago in my rock-climbing years….and now at 32, I’m only getting a score of about 1″ on my left ankle and 3″ in my right ankle! I feel dang defeated (de-feeted perhaps BAHA!) Anywhooooooo…there are no providers near me, so I’m wondering what you’d suggest. I work out 4-6 days a week from yoga, running, and weight-lifting. How can I get over this barrier?!

    • Dr. Chris
      Posted at 00:47h, 28 January Reply

      Hmmm, I’d avoid end range dorsiflexion. Of course, you can try stretching for a month. But most often, that doesn’t get mobility back if you have aa lot of adhesion. I’d plan on seeing an adhesion specialist at some point to fix this if you want to ever do this movements safely again. Not worth the risk otherwise.

  • Hunter Hayden
    Posted at 03:59h, 04 February Reply

    Dr. Chris,
    First off THANK YOU for all this content on dorsiflexion. I’ve got an interesting dorsiflexion issue and I’d be very appreciative to get your thoughts on it. I’m 29 years old and have been playing competitive basketball my entire life. I was recently playing in a pro-amateur game and did a spin move that caused a sharp pain in the left side of my lower back which my doctor has identified as sciatic nerve pain. But in the same moment I hurt my back, I lost about 80% of the strength when I dorsiflex my left foot and when I point my toe straight down I get a cramp below my calf muscle. This happened without feeling any pain in my left calf or achilles. It felt more like something when numb in there. I remember limping off the basketball court and it was like my leg was giving out. My left dorsiflex is about 1.75 inches and my right is about 2.25 inches. Based on your scale it seems my right leg is in big trouble too but so far I haven’t had any issues arise. My left side has had a few major and minor injuries.
    Around age 15 I started having back spasms due to my right leg being longer than my left leg by about 5/8ths of an inch so I was recommended by a chiropractor to wear an orthotic with a lift in my left shoe. i sprained my left ankle a few times so I decided to have a cobbler put the lift on the outside of the shoe so my foot would go deeper into the shoe and that seemed to prevent ankle sprains. Then in 2016 I was playing basketball and made an awkward turn and fractured my left foot’s 5th metatarsal. After that healed I was back to playing basketball but I now had numbness in my left big toe that would get worse while playing basketball but would go away when I took my shoe off and rested.
    So here I am now with 1.75 inch dorsiflex on my left and 2.25 inch on my right with numbness in my left big toe. I got a massage recently and the guy said that it felt like I have a layer of leather down my lower calf/achilles area and it’s a lot softer and normal on my right calf. I’ve been going to the gym to lift weights and do cardio on the machines. Should I stop doing things that work my calf muscle? Should I work with an ”adhesion specialist”? I haven’t heard of any of this until visiting your site today. My physical therapist through my insurance said I just need to massage it and do dorsiflex stretches and wiggle my big toe a lot but after about 4 months I’ve seen hardly any improvement.
    I just want to be able to play basketball again. I hope that’s still possible. Where do you suggest I go from here?
    Thank you,

    • Dr. Chris
      Posted at 16:46h, 04 February Reply

      Hello my friend – sorry for your struggles. It sounds like a lumbar disc issue with L4 nerve root involvement (big toe dermatomes) AND adhesion in the calf (flexor hallucis longus and likely the other deep tissues). I wouldn’t waste my time with anyone who isn’t an adhesion specialist. You’re throwing money away. Massage won’t improve that range. Yes, I’d stop strengthening becauses it’s not a muscular strength issue. It’s a neurological/adhesion weakness issue. Different problems require different solutions. Hope this is helpful.

  • Matt
    Posted at 03:48h, 24 June Reply

    The evaluation of the “wall test” results must take into consideration height of the patient and proportions of their body in general. Obviously the taller the patient, the easier it is for him/her to reach the 5” of toe-to-wall distance. It’s just trigonometry. Your article does not address it in any way. I

    • Dr. Chris
      Posted at 22:56h, 24 June Reply

      You’re 100% right. Practically speaking, we don’t find those types of details too be significant enough to address in the article – but they do need to be taken into account. Shorter people have max ranges of 4.5-5″ and taller people 7″ or so.

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