Stability starts at the ankle...Part II

Black Nike high tops. A young teenager comes running down the basketball court during practice. As she proceeds to the other end of the court, she has control of the ball with her right hand. She reads the court and considers the time she has to assume a layup upon arrival at the basket. She times her steps and proceeds to lead off her left foot only at the moment that she would explode off the hardwood up toward the basket, instead her ankle rolls under her as she falls to the ground with the ball not making it to its intended destination. No sooner did she find herself laying on the ground did she soon after, find herself walking with crutches and a new air cast on her left ankle. As a result of this ankle injury, she missed out on practice, and the initial part of the eight-grade basketball season. In this short synopsis of my eight-grade year, I was young, healthy, and in the company of appropriate shoe wear for my given sport at the time. Yet I still managed to roll my ankle. I my case, I remember it being just a sprained ankle involving only the ligaments however not knowing the anatomy of the ankle at the time, I now consider other structures were likely also overstretched. One of those structures I would like to discuss is the fibularis longus muscle of the lateral compartment of the lateral leg. Remembering from the last post, the leg is composed of anterior(front), posterior(back), and lateral(side) compartments. The fibularis longus is the largest muscle of the lateral compartment.

The fibularis longus arises from the lateral aspect of the fibula and attaches on the first tarsometatarsal joint. In regular speak that is to say it attaches from the outermost aspect of the fibula, and courses down the leg and proceeds to the underside of the big toe.  Along with the anterior tibialis, the big muscle in the front of the lower leg, the fibularis longus helps to provide stability to the big toe. In addition, the fibularis longus also crosses the tibialis posterior muscle as a means of supporting the medial longitudinal arch (primary arch of the foot), but to a small degree. According to Anoop et al, the fibularis longus tendon, with an oblique orientation, is able to help support the transverse arch by increasing the arches stiffness by about 40%, which can help to reduce flat foot deformities that tends to occur in those over the age of 40 years. This deformity can be due to weakness in the arches of the foot, degeneration of the posterior tibialis, or by rupture of the plantar aponeurosis. Beyond these roles, the fibularis longus, in addition to the fibularis brevis, are the primary everter's of the foot, helping the bring the outside part of our foot out and up. When weak, a person can be at risk for developing chronic ankle laxity and instability.

Regarding lateral ankle injuries, an article by Mendez-Rebolledo et al, reported that lateral ankle sprains not only affect about 2 out of 1000 but lateral ankle injuries can have a high occurrence leading to residual symptoms. In this article, it was noted that postural control deficits can be a risk factor for lateral ankle sprains and that a delay in the response of the fibularis muscles can be a cause for ankle instability. Those with instability tend to have a longer reaction time of the ankle musculature and a reduced posture control.

With my current practice, feet are a challenging structure to treat. Given the nature of all of our body weight on our feet, being dependent most of the time, the nature of not always allowing our feet to fully engage with the ground nor allowing our feet to function as feet, this combination can make for potential foot breakdown and a slow recovery. One recommendation is to treat the feet like any other body part. Clean them, inspect them, exercises them, rest them. And when wearing footgear, wear good foot wear for your foot/feet.

Exercises

1.     Long sitting with a block between the knees and band at ankle

2.     Single leg Stance with progressive overload

3.     Banded Side Steps with band at forefeet

4.     Heel Raises

Reference:

1)     Neuman, DA. Kinesiology of the Musculoskeletal system: Foundations for Rehabilitation. 3rd Ed.

2) Anoop S. Sumal, Gavin E. Jarvis, Alan R. Norrish, Cecilia Brasseett, Robert H. Whitaker. The Role of the ankle of the Fibularis Longus Tendon in the Foot Arch Support. 28 September 2020

3)     Guillermo Méndez-Rebolledo,Eduardo Guzmán-Muñoz, Valeska Gatica-Rojas, Hermann Zbinden-Foncea: Longer reaction time of the fibularis longus muscle and reduced postural control in basketball players with functional ankle instability: A pilot study