Foot and Ankle Joint Mobilisation for the Gait Loading Strategy

Original Editor - Ewa Jaraczewska based on the course by Ari Kaplan

Top Contributors - Ewa Jaraczewska  

Introduction

The goal of foot and ankle joint mobilisation is to restore the essential joint mobility required for an efficient, force-absorbing loading strategy during gait. During loading, the foot and ankle absorb impact forces upon initial contact and midstance through coordinated movements, before storing and returning energy during propulsion.

This page discusses how to select appropriate mobilisation or thrust techniques while refining hand placement, vector force, and patient positioning. It helps clinicians understand why a specific technique is indicated for a given patient presentation.

Benefits of Joint Mobilisation to Improve Ankle Dorsiflexion

Joint mobilisation therapy provides several benefits for improving ankle dorsiflexion and overall mobility. Research demonstrates that multiple treatment sessions of manual therapy improve functional ankle performance more effectively than a single application. Joint mobilisation offers short-term benefits for individuals with chronic ankle sprains. Furthermore, manual therapy can produce modest improvements in weight-bearing dorsiflexion immediately after the intervention, with more substantial benefits observed following repeated applications, particularly among older adults and protocols with higher treatment frequencies.

Joint Mobilisation Considerations

Application of joint mobilisation techniques must remain pain-free at all times. While patients may experience pressure, a mild ache, or a subtle stretch during movement, any substantial discomfort indicates they should stop pushing forward. Instead, clinicians should immediately evaluate and adjust their force, direction, and hand positioning.

Do not mobilise or manipulate:

• An unstable ankle (e.g., acute grade III ligament injury)
• A postoperative ankle with movement restrictions
• A patient with osteoporosis (avoid manipulation/thrust techniques specifically)
• An acutely sprained anterior talo-fibular ligament (ATFL) in the direction that would further stretch the injured structure (e.g., avoid anterior talocrural mobilisation in an eversion/inversion sprain with ATFL involvement)

Contraindications always override arthrokinematic logic. If a technique is contraindicated, it is contraindicated regardless of how "correct" it seems biomechanically.

Assessment Before Mobilisation

A structured physiotherapy assessment tells the clinician what to mobilise and how hard to push. Clinicians should work through the staged assessment consisting of functional screen, AROM, PROM, and closed chain. It allows them to identify where the restriction happens before they ever put their hands on a joint to treat it:

Functional screen: Watch the patient walk or squat. This observation helps to generate hypotheses and narrows down what to test next.

Active range of motion: Assess active dorsiflexion and plantar flexion. Observe movement quality: "Does the foot deviate from the sagittal plane, or does it evert/pronate excessively instead of dorsiflexing cleanly"?

Passive range of motion: Compare the quality of passive motion to active motion, and note tissue resistance. Two joints can hit the same end-range number, but one may meet firm resistance early while the other moves freely to end-range. This situation represents very different clinical pictures, even with identical ROM measurements.

Closed-chain dorsiflexion (functional load): To quantify dorsiflexion range of motion in a closed kinetic chain position, the weight-bearing lunge test (WBLT) is recommended. With the patient in a lunge position, bring the knee forward until the heel starts to lift, then back off slightly. Measure tibial angle with an inclinometer. A typical benchmark is 40–45°, though the target should be adjusted to the demands of the patient's goals (walking vs running vs squatting requires progressively more dorsiflexion). Watch for compensation, such as knee drifting medially or excessive rear/midfoot collapse. Cue the patient to keep the "knee over second toe," or block the compensation manually so you can see whether true sagittal-plane dorsiflexion is available.

The Arthrokinematic Model

For clarity, this section discusses mobilisation techniques using classic arthrokinematics, meaning joint mobilisation techniques are chosen based on the shape of the articulating bone surfaces. For example, dorsiflexion requires a posterior glide of the talus within the mortise. This is a useful starting framework, but it is not the whole picture.

Mobilisation is unlikely to be meaningfully stretching connective tissue in most sessions. What is more likely happening is a neurophysiological change, an alteration in tone, protective guarding, and joint-muscle feedback, which is why changes can occur rapidly, within a single session. This situation has a practical implication: if a technique performed in the "correct" arthrokinematic direction is not producing the expected change, the clinician is not locked into that direction. Trying the opposite glide can still produce a positive result, because the input to the nervous system, not the mechanical stretch, is often what matters. The exception, again, is contraindications: the clinician should never trade arthrokinematic logic for a direction that would stress an already-compromised structure.

Clinician's Guide for Foot and Ankle Mobilisation Techniques

Distal Tibiofibular Mortise (Widening for Dorsiflexion)

To accept the talus into dorsiflexion, the mortise itself needs to open. This happens through:

• Internal rotation of the tibia — felt as the medial malleolus gliding posteriorly
• Posterior glide of the fibula — felt at the lateral malleolus

Medial or lateral malleolus posterior glide technique : Stabilise one side of the mortise and mobilise the other. Use your thenar eminence (a broad, gentle contact) directly over the lateral or medial malleolus, lock your elbow, and transmit force through your body weight rather than your hand strength. The medial and lateral malleolus are frequently tender. Check in with your patient, slow down, or pad the contact with a towel if point pressure is poorly tolerated.

Medial malleolus posterior glide

Medial malleolus posterior glide

Tibiofemoral Joint (Rotational)

Often overlooked in foot and ankle complaints, but a stiff tibiofemoral joint (post-surgical stiffness, osteoarthritis) can restrict distal internal rotation at the mortise.

Tibial internal rotation mobilisation technique: Grip the tibia directly (not the gastrocnemius-soleus complex) and rotate. If you feel yourself gripping soft tissue rather than bone, reset your hand position before applying force.

Tibial Internal rotation

Talocrural Joint — Anterior-to-Posterior Glide

Talus posterior glide technique: Stabilise the tibia/fibula, grip the foot just distal to the talus (metatarsals and navicular), and drive posteriorly through your body weight. Stabilising the lower leg matters clinically for two reasons: it protects the patient's leg from table edge discomfort, and it prevents unwanted knee motion from masking how much glide is actually occurring at the talocrural joint itself.

Talus posterior glide

Talus posterior glide

Talocrural Joint — Posterior-to-Anterior Glide

If posterior glide is not producing the expected gain, this is your neurophysiological "other direction" option.

Talus anterior glide technique: In supine, stabilise the tibia/fibula and lift the calcaneus anteriorly. In prone, drive the calcaneus toward the floor through the heel while padding the anterior tibia against the table edge.

Talus anterior glide in supine

Talus anterior glide in supine

Talus anterior glide in prone

Progressing to Manipulation (Talocrural Joint)

Once graded mobilisation has restored enough range, a thrust technique can be considered.

Manipulation is far less effective and can flare a patient up if adequate dorsiflexion range has not already been achieved through mobilisation first. Sequence matters: mobilise to create available range, then manipulate to lock it in.

Thrust manipulation technique: Bring the ankle into dorsiflexion and eversion, take up slack through traction, then apply a small scoop or "J"-shaped thrust rather than a straight pull (a straight pull tends to drift into plantar flexion instead of adding dorsiflexion).

Talocrural joint manipulation-trust techniques

Talocrural joint manipulation- trust technique

Mobilisation with Movement (Functional Loading)

Mobilisation with movement is performed in a weight-bearing position, with the foot on the floor or a step. However, the non-weight-bearing mobilisation is often more effective for larger restrictions because the joint surfaces have more space to move. Functional/weight-bearing techniques are best used as a progression once baseline mobility has improved.

Talocrural joint and medial/lateral malleolus posterior glide with movement technique: Block the talus (or medial/lateral malleolus, depending on where the limitation lies) while the patient actively lunges forward and back, driving the mortise over a stabilised talus. This reintroduces the mobility gained in non-weight-bearing positions into a functional, gait-relevant pattern.

A randomised controlled trial conducted by Georgoulas et al. demonstrates that incorporating posterior talar glide with movement yields significantly greater and more lasting gains in restricted ankle dorsiflexion. These improvements are evident in both open-chain goniometric assessments and functional weight-bearing conditions measured via the Weight-Bearing Lunge Test.

Mobilisation with movement for talocrural joint

Mobilisation with movement for medial/lateral malleolus

Subtalar Joint — Lateral Glide

This is one of the most commonly under-assessed mobilisations because the talus is not adequately stabilised. If you do not firmly fix the talus first, you risk simply tilting the talus rather than gliding through the subtalar joint. What is worse, you may end up stretching an already-mobile structure while missing a true subtalar restriction.

Subtalar joint lateral glide technique: Patient in supine, stabilise the talus firmly, contact the medial calcaneus with your thenar eminence, and glide/tilt laterally. Sidelying positioning lets you use body weight instead of hand strength for a more sustainable, higher-dose treatment.

Subtalar joint lateral glide technique

Subtalar joint lateral glide technique in supine

Subtalar joint lateral glide technique in siedlying

Differentiating Joint vs. Muscle Restriction

A hypertonic muscle can mimic a stiff joint, and a stiff joint can drive muscle guarding. The two are neurophysiologically linked, not separate problems with separate causes.

To help differentiate the primary driver of a dorsiflexion restriction:

• Knee straight vs. knee bent dorsiflexion testing biases gastrocnemius (straight) vs. soleus/joint (bent). If motion improves substantially with the knee bent, suspect gastrocnemius; if it remains limited with the knee bent, suspect soleus or the joint itself. You must check accessory joint motion to differentiate the two.
• Palpation for tautness/tenderness supports a muscular contribution.
• Toe extension testing differentiates between the intrinsic and extrinsic muscle involvement: dorsiflex the ankle first (loading extrinsic toe flexors), then test toe extension. Limitation here suggests an extrinsic muscular cause. If the limitation persists with the foot relaxed, suspect an intrinsic or joint-based cause instead.

Whatever your hypothesis, confirm it clinically: treat for one to three minutes, then retest. If the expected change occurs, your reasoning was likely correct. If it doesn't, recalibrate and consider the alternative structure.

Resources

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