Ankle injuries—is there another type of injury that gets any lessrespect? If an athlete goes down grasping their knee in pain, time isstopped as players and fans alike look on in concern while coaches

and trainers rush to lend support. But if an athlete twists an ankle and has tohop off the field or court, there’s a collective sigh of relief that “it’s probablyjust an ankle sprain.” In no time at all the athlete will be back in the gameafter a good taping job, or at worst, the next game after a little rest and ice.But the reality is that ankle injuries need to be taken seriously, not just fortheir effect upon performance but also because they can increase the risk ofother injuries.

Let’s look at some numbers. According to the National Center for HealthStatistics, injuries to the feet, toes and ankles accounted for 11 million visits tophysicians’ offices in 2003. Of those visits 800,000 were for ankle fractures. Infact, because many of these injuries are often treated by coaches and trainers andtherefore not reported, the numbers may be greater than this study suggests.

To make matters worse, a study conducted in Australia reported that anathlete who injures an ankle is five times more likely to injure that ankleagain. On a personal note, a coach of a high school women’s basketball teamin Utah recently told me that she spends 45 minutes before practice tapingankles because approximately half the athletes on the team have had repeatedankle injuries!

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PracticalStepsAnkle Injuries

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Part I

Don’t let ankle injuries sidelineyou from achieving your goals

BY KKIM GOSS

PracticalSteps to Prevent

BEYOND SENSIBLE SHOES

One field of study that addresses issuesof the feet is called posturology, developedby Dr. Bernard Bricot of France. One ofthe practitioners and instructors in thisfield is Paul Gagné, a strength coach whoseclients include two of the best golfers in theworld, Michelle Wie and MichaelCampbell, as well as numerous professionalhockey and football players. Says Gagné,“Posturology is the science of posture.What regulates posture, basically, are theeyes and the feet. They provide informa-tion to the brain about body position, theeyes providing the horizontal reference andthe feet the vertical reference.”

According to Gagné, it’s bad enoughthat ankle injuries stop athletes from par-ticipating in their sports, but often theseinjuries can lead to serious injuries to theknees and spine. “The feet and ankles arethe foundation that the body is builtupon; so if that foundation is weak, theneverything above it is at risk.” One exam-ple is valgus feet.

Valgus feet, which resembles flat feetbecause the arches of the feet collapse,occurs when the ankle bones internallyrotate. As shown in Figure 1, with a val-gus foot the ankle does not rest directlyabove the foot. Gagné says this conditioncreates excessive stress on the ligamentsof the ankles, stress that is magnified inathletics. “Athletes who have valgus feetare especially susceptible to ankle strains,sprains and fractures because the musclesare not as effective at absorbing force,especially in sports such as basketballwhere so much jumping occurs.” Butthat’s not all.

VALGUS FEET

With valgus feet, Gagné says theupper and lower leg bones internallyrotate, placing excessive stress on the kneesand thereby significantly increasing therisk of injury to this area. “Women havean intrinsically higher risk than men for

such injuries, as they have wider hips andthus their leg bones come inward, makingthem less structurally stable compared tomen.” Further, as shown in Figure 2,Gagné says that the rotation of the upperleg bones causes the lower back to archexcessively, a condition that increases therisk of lower back injury as the spine losesmuch of its ability to absorb shock.

In the past, valgus feet was a relative-ly rare occurrence – the only attention itseemed to merit was as a diagnosis thatcould excuse someone from military

service. However, Gagné says that nowapproximately 75 percent of Americanssuffer this condition to some degree. Thereason so many of us have flat feet is thatwe wear shoes. “The arch of the foot wasnot meant to be in constant contact witha surface such as the arch of a shoe. Theskin on the feet has very sensitive recep-tors, and the constant pressure on thearch will cause the muscles of the arch torelax, in effect to become lazy.”

To correct valgus feet, the most com-mon solution is to wear orthotics, such as

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Figure 1: Valgus feet causes the upper and lower leg bones to internallyrotate, placing excessive stress on the knees.

Figure 2: Valgus feet results in not only a buckling of the knees but also anexcessive arching of the lower back.

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those shown in Figure 3. However, thesedo nothing to strengthen the muscles ofthe arch, says Gagné. “First, you need tosee a foot doctor who can assess you todetermine if you need orthotics – justgoing to a local drugstore and picking up acheap pair of arch supports may make theproblem worse. And if orthotics are pre-scribed, they should be worn only whenperforming a sport, and when performingplyometrics or lifting heavy weights, toensure proper positioning of the foot.

“Take, for example, the squat,” saysGagné. “If an athlete with a valgus footsquats and does not have a good archsupport in their shoes, it can be hard onthe knees because the foot will rotate out-ward and the knees will buckle in. It’s notthat the squat is a bad exercise but thatthe weakness of the muscles of the feetcan predispose an athlete to injury whenperforming this exercise. The same holdstrue for plyometrics, perhaps even moreso, as the forces in these activities can befar greater than those that occur in squat-ting and other weight training exercises.”

Although Gagné sees the benefit ofusing orthotics during athletics and con-ditioning, he doesn’t believe they shouldbe used continuously: “Unless a doctor

prescribes otherwise, orthotics shouldnot be used in your regular shoes becausethey are like a crutch – your feet becomeused to having the support, and the arch-es get weaker. What can be used in placeis a special type of therapeutic posturalinsole [Figure 4] that will stimulate thereceptors of the feet to reform the arch[Figure 5], but these should only be pre-scribed by a foot doctor or someonetrained in posturology.”

In addition to appropriate use oforthotics and therapeutic insoles, Gagnébelieves it’s also important that athletesperform specific exercises to ensure maxi-mum prevention of ankle injuries.

STRENGTH TRAINING FOR

ANKLES

Just as athletes perform weight train-ing exercises to strengthen the majormuscles used in their sport, they shouldalso direct adequate attention to specialexercises for the feet and ankles. “Thepurpose of these exercises is not only tostrengthen the muscles of the feet thathave become weakened through the useof shoes but also to increase the proprio-ception, or awareness, of the lowerextremities,” says Gagné.

Although Gagné says that it’s best toconsult a posturologist as to the bestapproach to correcting foot problems, hewas willing to share a few of the exerciseshe uses to correct valgus feet. Gagnécredits his colleague Dr. Guy Voyer fordeveloping many of these exercises. Here

are three of the exercises Gagné uses: asingle-leg support, a Hex bar deadlift anda step-up with the big toes lifted.

Single Leg Support. Although thisappears to be a simple exercise, it can beextremely difficult for many individuals toperform; therefore, beginners should per-form it while standing next to a wall. SaysGagné, “Even if you perform it correctly,you will be pretty wobbly; and being ableto rest one hand on a wall will help yourbalance.”

Standing next to the wall, with onehand resting on the wall for support,bend your right knee so that it is nottouching the floor. Now tighten your left glute muscle, then lift only your bigtoe off the floor, pressing the other toesto the floor. Hold for 30-60 seconds,then repeat with the other leg. When thisbecomes easy, perform it without touch-ing the wall, but instead hold your armsout to the side. The next progression is toperform it with your hands at your sides,then with your eyes closed. After you’vemastered this exercise, repeat thesequence (with wall, without wall, etc.)but with your working leg slightly bent.

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50 | BIGGER FASTER STRONGER MARCH/APRIL 2006

Figure 3: Orthotics

Figure 4: Postural Insoles

Figure 6: Single-Leg Support,Beginner’s Version

Figure 5: Anexample of theimprovement thatcan occur to dys-functional feetafter 10 months oftraining and prop-er foot care.

Hex Bar Deadlift, Big Toes Up. Thisexercise is simply the standard BFS Hexbar deadlift, but performed with your bigtoes off the floor. As you perform theexercise, you’ll find that lifting your bigtoes dramatically increases the tension onthe arches of the feet.

To save time, an athlete can performthis variation as part of their regular Hexbar deadlift program. Simply performthe same weight, sets and reps as younormally would, but lift the big toes onthe first or second warm-up sets.

Low Step-Up, Big Toes Up. Thisexercise is performed on a low, sturdyplatform. Because of its stable pyramiddesign, a 10-inch Readiness Plyo Box isperfect for this exercise. Also, its solidbase will prevent the athlete from catch-ing the foot of the non-working legunder the top of the platform.

Stand in front of the platform andplace one foot on top of it, with the footpointed straight ahead. Place the otherleg against the edge of the platform. Inthis starting position and throughout theentire exercise the posture is upright,keeping the hips under the shoulders asmuch as possible, with the chin heldslightly up. To ensure proper neck align-ment, the eyes should be focused on a

point on the wall that is slightly higherthan eye level.

To begin the exercise, lift up the toesof the trailing leg; this will prevent youfrom pushing off with the back leg. Nowlift the big toe of the forward leg andstand up until the knee is straight, thenreturn to the start. Rather than thinkingabout stepping up with the trailing leg,focus on pushing down with the frontleg. It is not necessary to place the foot ofthe trailing leg on the platform, and youshould keep this leg slightly flexed, aslocking it can make it too difficult to bal-ance. Perform this as you would anystandard auxiliary exercise, such as 2-3sets of 10 reps with each leg.

Finally, Gagné says that it’s impor-

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The reality is that ankle injuries needto be taken seriously, not just for theireffect upon performance but alsobecause they can increase the risk ofother injuries.

Figure 7: Hex Bar Deadlift, Big Toes Up

Figure 8: Low Step-Up, Big Toe Up

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FINISH

tant to stretch the calves to prevent ankleinjuries (Figure 9), as these muscles affectthe biomechanics of the foot. Standing onone of the side platforms on a BFS Plyoramp (first with both legs straight to workthe upper calf, then with the legs the slight-ly bent to work the lower calf ) is a goodstretch, as is the calf stretch used in the BFSReadiness program. However, with the wallstretch Gagné recommends you occasionallyvary the exercise by pointing the front footoutward and then inward.

You can also increase the effectivenessof the stretch by lifting the toes of the trail-ing leg up and by tightening the glute ofthat leg; however, you should be very con-servative with these variations for the first

several weeks (such as by only taking thestretch to a 5-level on a scale of 10), as theincreased intensity of these variations caneasily cause injury. Stretching the calvesshould be performed daily, as it can be diffi-cult to increase the flexibility of calves andmaintain it as well.

Next issue we’ll conclude our currentlook at preventing ankle injuries. Hopefully,the ideas presented in this two-part serieswill encourage you to devote serious atten-tion to posture and the proper training forthe muscles of the feet and ankles.

Part II of this series will explore manymore-advanced exercises that can be performedto not only prevent ankle injuries but also dra-matically improve athletic performance.

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52 | BIGGER FASTER STRONGER MARCH/APRIL 2006

The models selected for this article areMary Beth Lofgren (above, right) and Chloe VanTussenbroek (above, left), both gymnasts whotrain at the Olympus School of Gymnastics inSandy, Utah. They are coached by Mary Wright,the owner of Olympus, who meticulouslydetails every aspect of her athletes’ trainingand conditioning. Coach Wright showed me heryearlong periodization program – it was socomplex it made my brain hurt!

Mary Beth and Chloe are among the bestgymnasts in Utah, and they train about 30hours a week. I wanted to use gymnasts forthis article because the stresses associatedwith their training make these athletesextremely susceptible to ankle injuries, andas such their training includes specific exer-cises to help condition this area. In fact,when I asked Chloe to perform a single-legsquat, she whipped out several reps effort-lessly with an expression that seemed to

convey, “Like, is this supposed to be hard?”Mary Beth is an 8th grader who attends

Wasatch Junior High School in Salt Lake City,Utah, where she carries a 4.0 GPA. Last yearMary Beth was the 2005 Utah State Level 10Junior Champion. She took the silver medal inthe Region 1 Championships and also compet-ed in the Junior Olympic NationalChampionships, where she placed 22nd in theall-around. Her nicknames are “Biz” and “MB.”

Chloe is an 8th grader who attends WestJordan Junior High School in West Jordan, Utah.Chloe took up gymnastics upon the recommen-dations of doctors to correct benign hypermo-bile joint syndrome, a medical condition inwhich joints easily move beyond the range ofmotion usually associated with those joints. Anatural dancer whose floor routine captivatesaudiences, Chloe won her first Utah statechampionship when she was seven years old,and has won that title annually ever since.

Figure 9: Stretching the calvescan be performed with one leg infront of the other, or on the edgeof an angled box. To stretch theupper calf, the knees should bestraight; to stretch the lower calf,the knees should be slightly bent.

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