Plantar flexion is one among many movements of the ankle and foot. "Plantar" is a term used to describe the sole of feet, hence the name. Plantar flexion (Plantar + flex) is simply a flexion of the foot in which the sole goes downwards facing the floor, and the heel is at the top facing the ceiling. We can observe it while trying to accelerate the pedal or while reaching for a high shelf.
What to Know?
The “pointe” technique is used in ballet dance in which a dancer stands on the tip of the toe and balances the whole body, an extended plantar flexion. Ballet dancers call it ‘en pointe,’ which means their pointe is perfect. Ballet dancers have the highest ROM (range of motion).
Why Is It Necessary to Know About Ballet and Plantar flexion?
Not only is it essential for ballet dancers, but also for us to walk, drive a car, ride a bicycle, reach for a shelf, thrust to swim, and exercise. Even for football players and athletes, these movements are fundamental.
What Is the Normal Range?
Plantar flexion is the extension of the ankle, while dorsiflexion is the contraction of the ankle. In plantar flexion, the toe goes downwards, while in dorsiflexion, vice-versa. In normal adults, the plantar flexion ROM (normal range of motion) would be 54 degrees to 63 degrees. In children and the old aged, the range is slightly less.
Table depicting a normal range of motion in different age groups:
How Do We Plantarflex?
Whenever we try to walk on the heel or try to accelerate in a car, the action done is plantar flexion. For this to be done, some muscles coordinate, namely, gastrocnemius, soleus and plantaris, flexor digitorum longus, peroneus longus, peroneus brevis, flexor hallucis longus, and tibialis posterior. The plantar flexion movement is propulsive and helps push or thrust above the ground.
What Does Reduced Plantar Flexion Indicate?
1) Trauma:
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Any abnormality in doing the plantar flexion can be a sign of injury or some other underlying disease. Some among them are accidents, sprain, fractures, and gait abnormalities.
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Accidents can cause damage to the muscles and tendons of the foot leading to poor leg movements like dorsiflexion, plantar flexion, inversion, eversion, and medial and lateral rotation.
2) Medical Conditions:
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In medical conditions like stroke, the lower extremity is affected in some cases, and there will be a scissoring walking pattern and an inability to perform plantar flexion.
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Gait (walking stance) abnormalities like atherogenic gait where there is a stiff hip or knee. If the knee or hip is fused and any knee surgery can result in exaggerated plantar flexion.
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Equinus gait, also known as toe walking, can be seen in childhood when the knee is fully extended and the ankle is neutral.
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Posterior ankle impingement syndrome (PAIS) is a disease that causes ankle pain that commonly occurs in people who do too much plantar flexion, namely ballet dancers, athletes, and other sports players. Non-surgical treatment includes rest, physiotherapy, anti-inflammatories, and ultrasound-guided injections. Surgical treatments are also available to treat them.
What Is an Abnormal Plantar Reflex?
Plantar reflex is done to assess the proper functioning of the corticospinal tract. It is done by running over a not-so-sharp object cautiously along the lateral surface of the sole and moving upwards near the big toe. Immediate plantar flexion is a normal response and is termed a flexor plantar reflex. Fanning of the toes in the opposite direction to the same is called extensor plantar reflex (Babinski reflex) and is abnormal. Babinski reflex is a sign that can be due to neurodegenerative disorders, stroke, amyotrophic lateral sclerosis, spinal cord injury, multiple sclerosis, and meningitis. This can also occur in children and infants up to one year of age during deep sleep due to immature corticospinal tracts.
How Can Plantar Reflexes Be Pathologic?
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Rossolimo’s reflex is done to assess pyramidal tract lesions, and it is considered positive when there is plantar flexion of the toes.
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Plantar flexor weakness can cause stiff knee gait (stance) in which the knee flexion is less.
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Five reflex twitches of the plantar flexors indicate signs of an upper motor neuron lesion.
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Modified trendelenburg test is done to assess abnormalities in the gluteus medius and gluteus minimus. In this test, the patient slowly moves the toes up and down for five seconds. Assessment is done.
What Exercise to Do for Improving Plantar Flexion?
Any injury or weakness to the ankle and feet can cause restricted motion, and there will be a loss of plantar flexion too. Especially for athletes, football players, and ballet dancers who strain ankles and feet, there are chances of injury and muscle tear, which can lead to a restricted range of motion. Strengthening and stretching the muscles that support the lower leg can keep the muscles flexible and pain-free. Wearing ankle braces can prevent such incidents.
The following exercises can help improve plantar flexion:
RICE Protocol:
In case of an injury, follow the RICE protocol (rest, ice, compression, and elevation). Following an injury, give some rest by restraining movements, place an ice pack over the affected area, compress the area to reduce swelling, and keep the foot in an elevated area using a pillow.
1) Heel Cord Stretch:
It is done by facing against a wall with the unaffected leg bent forward slightly and the affected leg behind and trying to push the hip toward the wall. Hold this position for 30 seconds and relax for 30 seconds and repeat the same for two sets of ten.
2) Heel Cord Stretch With the Bent Knee:
It is done just like a normal heel cord stretch (exercise two) with the affected leg bent forward and unaffected behind. Hold this position for 30 seconds and relax for 30 seconds and repeat the same for two sets of ten.
3) Ankle Range of Motion:
It is done by sitting on a chair in such a way that the feet do not touch the floor and trying to draw all the alphabet using the big toe.
4) Towel Curls:
This needs to be done using a towel. It is done by sitting in a chair, placing a towel under the feet, and trying to grab the towel using toes; repeat this five times.
5) Dorsiflexion:
Moving toe towards ankle creates a convex angle and plantar flexion alternatively for five seconds each by sitting in a chair.
6) Golf Ball Roll:
It is done by sitting on a chair with both feet planted on the floor and trying to roll a golf ball using the affected leg for two minutes. Repeat it once a day daily.
7) Towel Stretch:
It is done by sitting on the floor with the legs stretched out in front and then wrapping a towel around the affected foot and trying to pull the towel by holding its ends. Hold for 30 seconds and relax for 30 seconds. Repeat thrice.
8) Calf Raises:
It is done by standing behind a chair and lifting the unaffected leg while trying to balance the full weight on the affected leg and lifting it slowly. Repeat this ten times.
9) Marble Pickup:
It is done by placing 20 marbles in front and picking each one of them with the toes, and placing it in a bowl. Do not keep the marble too far or away.
Conclusion:
Plantar flexion can be useful in day-to-day activities, and it is important not to overdo or underdo it. Always be vigilant of symptoms or anything the body is trying to tell. If pain or any kind of discomfort occurs, the first thing to be done is to give it some rest. Long-term prevention of any injuries can be done by strengthening and increasing the flexibility of the ankle joints. Any abnormality in plantar flexion can lead to improper movements and difficulty in performing basic movements. Every joint has its function, and it is important to preserve the function of each one of them.
