For decades physical therapists and physicians have been instructing their patients to stretch their calves for ALL manner of foot pain, heel pain, Achilles tendonitis, ankle pain and calf pain.
What if I told you that the underlying etiology of just about all musculoskeletal foot, ankle and leg pain is hypermobility (over flexible)?
You might reply, “But when I stretch I can feel how tight it is.”
I would counter with, “It’s tight because of an instability elsewhere in the foot-ankle-leg complex…which you are arguably making worse by stretching it.” EVEN THOUGH IT CAN FEEL BETTER SHORT-TERM following stretching. The most common place for hypermobility in the foot-ankle-leg structure is the oblique axis of the midtarsal joint. Every time you walk it
is common to bend your foot at this joint instead of at your ankle joint…so the ankle joint/calf is stiff because your body does not make it move in normal gait.
When you stretch your calf, you are actually stretching everything on the bottom of your foot to the back of your knee. Those structures already hypermobile stretch first and most easily, then the structures that have normal flexibility and if you continue to stretch you will gradually make gains in the most “stiff” structures in the chain….but not until you’ve already stretched PLENTY of stuff that did not need it.
Yes, I’ll admit you will gain motion temporarily in the most “stiff” structures, but you won’t retain it, because your body will just continue to bend through the hypermobile joint because it’s easier. The underlying issue is INSTABILITY…you should just about NEVER stretch an unstable joint. You heal the stiffness in the calf, by stabilizing the foot.
How to stabilize the midtarsal joint…
TAPING: In my clinical experience, there has NEVER been a foot pain that didn’t feel better with a low-dye tape job. This rigid athletic tape application stabilizes the hypermobile components in the chain and the whole system feels better when stabilized…not when stretched. There are about a dozen elastic tape options as well.
STRENGTHENING: There is really no external lower extremity muscle that stabilizes the oblique axis of the midtarsal joint…so calf exercises and theraband exercises are fairly useless. There is value in strengthening the intrinsics, so proprioceptive exercises are very useful if symptoms allow.
ORTHOTICS: Arch supports custom and otherwise are of very limited value as they push up into the longitudinal axis of the midtarsal joint and if anything push the Center of Pressure laterally to the already unstable oblique axis. However, custom orthotics designed to specifically stabilize the oblique axis of the midtarsal joint will have a dramatic and immediate impact. If you have any questions about how to order this type of orthotic, please email me at Tony@BarePT.com or visit my webpage at BarePhysicalTherapy.com.