Ankle Rehabilitation Using An Unstable Surface (Follow-up to Medial Tibial Stress Syndrome)

In this video, I will discuss ankle rehabilitation using an unstable surface, in combination with the short foot exercise. This is a follow-up companion piece to medial tibial stress syndrome.

The condition is called medial tibial stress syndrome, because there is stress on the periosteum of the medial tibial bone, leading to periostalgia of the shin.

Where there is the pain, there is a point of weakness on the kinetic chain. Ankle rehabilitation using an unstable surface is based on the concept that myofascial chains connect and work synergistically. For more information: Fascia & Tensegrity

The intrinsic muscles on the plantar aspect of the foot act collectively to stabilize the arches of the foot, and individually to control movement of the digits. Balancing on an unstable surface is a good strengthening exercise for the intrinsic muscles of the leg and foot.

Muscle Origin Insertion Action Innervation
Abductor Hallucis Medial Tubercle of the Calcaneus, Flexor Retinaculum & the Plantar Aponeurosis Medial Base of the Proximal Phalanx of the Great Toe Abduct & Flex the Great Toe Medial Plantar Nerve
Flexor Digitorum Brevis Medial Tubercle of the Calcaneus & the Plantar Aponeurosis Middle Phalanges of the Lateral Four Digits Flex the Lateral Four Digits at the Proximal Interphalangeal Joints Medial Plantar Nerve
Abductor Digiti Minimi Medial & Lateral Tubercles of the Calcaneus & the Plantar Aponeurosis Lateral Base of the Proximal Phalanx of the Fifth Digit Abduct & Flex the Fifth Digit Lateral Plantar Nerve
Quadratus Plantae Medial & Lateral Plantar Surface of the Calcaneus Tendons of Flexor Digitorum Longus Assist Flexor Digitorum Longus in Flexing the Lateral Four Digits Lateral Plantar Nerve
Lumbricals Tendons of Flexor Digitorum Longus Extensor Hoods of the Lateral Four Digits Flex at the Metatarsophalangeal Joints, while extending the Interphalangeal Joints Medial & Lateral Plantar Nerves
Flexor Hallucis Brevis Plantar Surfaces of the Cuboid & Lateral Cuneiforms; Tendon of the Posterior Tibialis Tendon Base of the Proximal Phalanx of the Great Toe Flex the Proximal Phalanx of the Great Toe at the Metatarsophalangeal Joint Medial Plantar Nerve
Adductor Hallucis Bases of the Second, Third & Fourth Metatarsals (Oblique head); Plantar Ligaments of the Metatarsophalangeal Joints (Transverse Head) Lateral Base of the Proximal Phalanx of the Great Toe Adduct the Great Toe; Assist in forming the Transverse Arch of the foot Deep Branch of Lateral Plantar Nerve
Flexor Digiti Minimi Brevis Base of the Fifth Metatarsal Base of the Proximal Phalanx of the Fifth Digit Flex the Proximal Phalanx of the Fifth Digit Superficial Branch of Lateral Plantar Nerve
Plantar Interossei Medial Side of Metatarsals 3-5 Medial Sides of the Phalanges of Digits 3-5 Adduct Digits 3-5 & Flex the Metatarsophalangeal Joints Lateral Plantar Nerve
Dorsal Interossei Sides of Metatarsals 1-5 Medial Side of the Proximal Phalanx of the Second Digit; Lateral Sides of the Proximal Phalanxes of Digits 2-4 Abduct Digits 2-4 & Flex Metatarsophalangeal Joints Lateral Plantar Nerve

Decrease in proprioception associated with weakness in the plantar intrinsic foot muscles accompany plantar fasciopathy, iliotibial band syndrome, patellofemoral pain syndrome, medial tibial stress syndrome, medial knee pain, et al.

Plantar intrinsic foot muscle strength is correlated with gait function and postural control. Conditioning exercise, such as ankle rehabilitation using an unstable surface, involves the anatomy trains, defined as direct fascial connections between adjacent muscular structures within the fascial system.

The foot is a significant element of the four main anatomy trains: the superficial back line, the superficial front line, the lateral line, and the spiral line. The plantar intrinsic foot muscles are a part of the superficial back line, and, together with plantar fascia, they control the maintenance of the longitudinal foot arch. They allow bringing both ends of the foot closer to each other, maintaining proper relations between the heads of the first and the fifth metatarsals and the heel bone. In addition, the longitudinal arch of the foot is enhanced by the plantar ligament and the plantar calcaneonavicular ligament, which are located in deeper layers. The dysfunctions within the plantar surface of foot may cause problems, which are transmitted to the upper parts of the anatomy trains. A dysfunction of this part is often associated with hyperextension of the knee, shortening and reduction of flexibility of the hamstring muscles, increased cervical lordosis, and decreased lumbar lordosis.

The strength of short flexors of toes has an impact on postural control. When the postural demand is increased, for example, during single leg stance, the plantar short foot muscles are significantly more activated than in double leg stance.

Short Foot Exercise

Engage the intrinsic foot muscles by pulling the metatarsal heads (balls of the toes) toward the heel, which shortens the length of the foot.