Video Tutorial #201 Can You Pass The Foot Ankle Toe Raise Alignment Test? (Posterior View)


Dr. James Stoxen DC of Chicago IL, USA and 
Dr. Amir Majidi Dc of  Toronto, Ontario, Canada
April 29, 2012 at a park
Kuala Lumpur, Malaysia

The Foot Ankle Alignment Test (back view)


Today I am going to help you evaluate if your Human Spring Suspension System muscles are weak by doing the Foot and Ankle Alignment Test.

Dr. Amir Majidi Dc from Toronto, Canada, my research assistant will be demonstrating for you how to execute the test.

This is the sister test to the Foot-Ankle Toe Raise Alignment Test (Front)

Video Tutorial #200 Can You Pass The Foot Ankle Toe Raise Alignment Test? (Front View)

The Foot Ankle Alignment Test (Anterior) and (Posterior) are two of the tests in Anthony Field’s book, How I Got My Wiggle back.  You can get the book from or purchase it at your local bookstore.

Yes, I did these tests on Anthony Field and…  he failed both tests miserably!  

So don’t be discouraged because if you read the book you will find:

Field, the creator and a founding member of the world’s most successful musical groups for young children, The Wiggles, was handicapped by chronic pain, chronic, chronic fatigue, misdiagnosed fibromyalgia and depression during his 20 years on the road.  I am proud to say, I was able to assist him.

It covers our consultation in detail and provides a comprehensive, plain-English explanation of the drug free approach, and the results, that helped him get in the best shape of his life.

Excerpt taken from the book, How I Got My Wiggle Back, page 127, 

The Foot – Ankle Alignment Test (back view), Turn around so your back is facing the mirror. If you can look over your shoulder and see the back of your feet we’ll proceed, otherwise get a friend in here with a camera and get them to take a snapshot of the back view of your legs. Yes, yes I know, it must be a trusted friend.

Draw an imaginary line from the feet, through the heel one, and up to the back of the knees. Again, check to see if it’s straight. 

The above test will give you a good indication whether your arch spring is locked, weak, or stiff. Even if you only have one “issue” it’s quite possible that over time it will start to limit your exercise and daily leisure activities and cause damage to your joints. 


  1. Raise up on your tip toes
  2. Try to maintain a proper alignment with your second toe, ankle and shin bone
  3. Try to balance and see how long you can stay in the aligned position
  4. If you cannot maintain straight alignment you failed the test
  5. To see what that means read on….

Dont worry if you failed, because…

  1. I have resistance lever exercises for you to improve to 1x bodyweight strength at the end of this article
  2. I have  impact spring exercises or you to improve to 1.25x bodyweight – 3/4x bodyweight and more impact drills for you to practice at the end of this article

Mild to Moderate Foot/Ankle Misalignment

Pictured above is mild to moderate misalignment of the foot/ankle. This is cause to work on strengthening the spring suspension system muscles.

Moderate to Severe Foot/Ankle Misalignment

Pictured above is moderate to severe foot/ankle alignment which means you should work on strengthening your spring suspension system muscles.

To give you a better idea to compare good alignment vs misalignment I have put the graphic models side by side above. click on the picture to enlarge

If your foot goes out of alignment  and turns out then that means you have a weakness in the spring suspension system muscles.

If one foot can go up in alignment and the other one turns out and cannot go up then you have a weakness on one side.

supportive cuff muscles close- up

The Muscles of the Pronation Supination Cuff

If you look closely at these illustrations of the feet, (If you look closely at these illustrations of the feet, (click here to open a separate page with this diagram to study while you read)) you will see that the pink and purple tendons ( peroneus longus (also known as fibularis longus) is a superficial muscle in the lateral (outside) compartment of the leg.  It acts to counter that abnormal turn out of the leg or evert the leg.

Just look at how the tendon of the peroneus longs (pink tendon) extends under your arch and attaches to your your big toe.   These are the muscles that are not engaging or weak in your suspension system muscle group.

The muscles of the spring suspension system of the foot and ankle consist of the tibialis posterior, tibialis anterior, peroneus longus, and peroneus brevis.

As you can see the peroneus longus coming from the lateral aspect of the foot cross over to add some support to the first ray because this is where the foot usually collapses and locks.

The Peronæus longus also everts the sole of the foot, and from the oblique direction of the tendon across the sole of the foot is an important agent in the maintenance of the arch.

The Tibialis Posterior Muscle

This is the tibialis posterior (blue tendon) that supports the first metatarsal-cuneiform, second and third. You can also see the tibialis posterior (blue tendon) which attaches at the mid-arch  at the first second and third metatarsal cuneiform joints where the spring action happens on impact.

If this joint area is stiff or locked then the tibialis posterior cannot contract maximally against this joint. It’s impossible if the joint is locked.I find this muscle to be the weakest of the cuff.

They even have a syndrome named for it:

Posterior Tibial Tendon Dysfunction

Posterior tibial tendon dysfunction is the most common cause of acquired flatfoot deformity in adults. Although this term suggests pathology involving only the posterior tibial tendon, the disorder includes a spectrum of pathologic changes involving associated tendon, ligament, and joint structures of the ankle, hindfoot, and midfoot.

Early recognition and treatment is the key to prevention of the debilitating, long-termconsequences of this disorder. Conservative care is possible in the earliest stages, whereas surgical reconstruction and eventually arthrodeses become necessary in the latter stages. The purpose of this article is to review the symptoms, physical examination, radiological examination, classification, and treatment of posterior tibial tendon dysfunction. / Orthop Sports Phys Ther 2000;30:68- 77. 

The blue tendon represents the tibialis posterior muscle and tendon.  This muscle stabilizes the arch from the medial aspect.

This test can give you a good evaluation of the strength of your spring suspension system up to your bodyweight ONLY!

It is important to have strength in your foundation to protect your body from impacts as well as help with balance, agility and coordination.

The muscles which support the foot and ankle in this position are the achilles as a primary however the tibialis anterior, tibialis posterior, peroneus longus and brevis stabilize the foot with respect to preventing rotation and lateral motion.

The trick is to test them for how long they can maintain this position to measure “static” strength endurance.

Here is the math:

You are testing the muscles acting on a lever system which is actually 50% body weight force you are lifting as 1/2 of the body on each foot.

  • 50% Bodyweight Foot-Ankle Toe Raise Alignment Test (above) – This evaluates the strength of the muscle groups with 50% of the bodyweight on each limb.
  • 100% Bodyweight Foot-Ankle Toe Raise Alignment Test – You can do a variant of this test that measures the strength and static strength endurance by having them stand on one foot in the same test position
  • 50% Bodyweight Bosu Ball Foot-Ankle Toe Raise Alignment Test – is this same test while attempting to balance your body on a Bosu ball. You cannot use any assistive devices to hold yourself on the ball. You can practice by hanging onto something to practice letting go periodically to challenge your muscles. Its not easy! Ultimately you attempt to do the test, with a straight limb and not a lot of motion.
  • 100% Bodyweight Bosu Ball Foot-Ankle Toe Raise Alignment Test – This is the same test as the one above except with one leg. This is an extremely challenging test that most top athletes have difficulty with.

You are testing the muscles acting as on the body as a lever. So, the forces are no more than 1x bodyweight because there is no movement (walking or running) so no impact.

So what does this mean if you cannot pass the test?

If you cannot do a single Foot-Ankle Toe Raise and maintain proper alignment with 50% of your bodyweight on either limb then we know for sure you won’t be able to walk without your foot and ankle misaligning at the impact point and through the loading of your bodyweight into the human spring.

Why do we know that?

Walking is 1.25 x bodyweight impact force per step.

This is one contraction of 50 % of your bodyweight!

So, if you have conditions related to excessive strain on tissues then that is a sign that your spring mechanism could have fatigued, dropped and locked and/or it is too weak to absorb the impacts by springing your bodyweight off the ground and instead the bodyweight is banging into the ground.

Banging your bodyweight into the ground obviously stresses your tissues more than springing off the ground.

Also springing off the ground is more efficient movement than banging into the ground!

Lets see…

Banging into the ground instead of springing off the ground…  

What is the effect on the body?  

Banging into the ground means little to no protection during impacts and a locked spring which is compressive stress on the weight bearing joints.

This can manifest as any of a number of conditions related to an overstress of tissues or bone such as:

  • plantar fasciitis
  • heel pain
  • heel spurs
  • calf cramps
  • shin splints
  • meniscus tears
  • knee pain and chondromalacia or cracking knees
  • hip pain
  • herniated discs
  • herniated discs that don’t heal

If your body works as a lever instead of a spring due to weakness in the spring suspension system your gait is not as efficient.  You move by pushing your bodyweight instead of bouncing or springing your bodyweight forward burning vital energy.

This is called chronic fatigue!

When you test and train as a lever mechanism, you are getting stronger and able to stabilize your limbs over the foot in the safe range between supination and pronation better during walking.

We call this chronic pain and some doctors can confuse this misdiagnosing your condition as fibromyalgia!

Inflammatory Diseases of Aging

Dont forget, if your body is stiff and sore all over because its locked or too weak to absorb impacts of walking speed or running speeds then your body is accumulating inflammatory chemicals (cytokines) which are damaging to your health if they remain chronic.  Go to the pub med search page and put – cytokines inflammation depression – in the search box and see how many articles come up referencing depression and its connection to chronic inflammation!

If the maximum resistance you can get doing resistance exercises with your bodyweight is 1.0 x bodyweight and impacts of walking are 1.25 x bodyweight you have to add weight to your body when doing resistance exercises or introduce progressively greater impact forces into your spring to strengthen your spring suspension system enough to handle impacts of walking safely.

Running involves using your body as a spring

Walking involves 1.25x bodyweight impact forces which is greater than the 100% Bodyweight Foot-Ankle Toe Raise Alignment Test.  

So the next progression is to do this test while walking checking the alignment of the foot-ankle-shin complex at impact and through the loading of the bodyweight mass into the spring suspension system or mechanism.

I suggest you do this test while being videotaped from the front and back.  Simply walk towards the camera, turn around and walk away from the camera.  Try to walk the second time as fast as you can.

That adds speed to the formula F = M x A which means you are checking the suspension systems ability to maintain the foot in the safe range between supination and pronation at a higher force of impact

How To Train the Suspension System to Handle Greater Impact Forces

If you would like to increase strength of the supination pronation cuff (landing muscles) or spring suspension system muscles then you have to move from training as a lever and begin to introduce progressively greater impact forces.

If you want to train to maintain your foot in the safe range between supination and pronation during impacts such as walking, running and the participation of sports to avoid over pronation and over supination at foot strike you have to train with progressive greater force impacts.

This means you have to start with walking speeds training these muscles in all angles such as inversion, eversion, abduction, adduction, pronation and supination.

F = M x A

So if you understand Newtons Law the force of your impact is determined by your mass x acceleration or speed of running. Since your mass stays the same the way to progressively increase force is to run faster.

I recommend barefoot zig zag runs, side shuffle runs, carioca, ricochet, and lateral bounds, hops, etc

Phase I Release the Spring Mechanism

This involves removing all joint play stiffness and/or locking by releasing locked joints and muscle spasms in the weight bearing joints from head to toe nail.  This is done by hand and I have excellent self help tutorials for you to learn how to do this yourself!

Search for Video Tutorials 77 – 89 to find them or find them on this page where all of my video tutorials are located!  View all video tutorials here… 

 Click the links below to strengthen and supercharge the spring suspension muscles system muscles:

Phase II Strengthening:

Video Tutorial #148 Bosu Ball Foot Training, click here to view 
Video Tutorial #76 Bosu Ball Lateral Step, click here to view
Video Tutorial #177 Side Lunge With Cable, click here to view
Video Tutorial #105 Foot Eversion Exercise, click here to view
Video Tutorial #106 Foot Inversion Exercise, click here to view
Video Tutorial #107 Ankle Exercise Training, click here to view
Video Tutorial # 108 Cable Hip Adduction And Foot Inversion, click here to view
Video Tutorial #109 A Great Hip Adduction Exercise click here to view
Video Tutorial #109 A Great Hip Abduction Exercise click here to view
Video Tutorial #110 Dr. James Stoxen DC loses An abdominal Exercise Competition By One Rep click here to view
Video Tutorial #111 Rectus Abdominal Cable Crunch Pull Downs, click here to view
Video Tutorial #112 Abdominal Oblique Exercise  click here to view
Video Tutorial #176 Improve Your Balance With Half Foam Roll Exercises, click here to view

Phase III Supercharging:

Video Tutorial #149 Figure 8 Runs, click here to view
Video Tutorial #133 Circle Walk, Jog, Run And Sprint, click here to view
Video Tutorial #90 Obstacle Course, Combining Exercise Drills, click here to view
Video Tutorial #136 Double Leg Cone Jump or hop, click here to view
Video Tutorial #137 Why Plyometric Jumping Or Impact Exercises Increase The Level Of Human Performance  click here to view
Video Tutorial # 142 Improve Your Jumping Ability And Supercharge The Human Spring With Speed Bounds, click here to view
Video Tutorial #147 Single Leg Hop, click here to view
Video Tutorial #150 8-Point Step, Lunge, Hop or Bound, click here to view
Video Tutorial #152 Ricochet Box Jump, click here to view
Video Tutorial #167 Side Shuffle, click here to view
Video Tutorial #178 High Skip – Vertical And Horizontal, click here to view
Video Tutorial #179, 45 Degree Zig-Zag Hop, Jump Or Run, click here to view
Video Tutorial #151 Lateral Cone Jumps, click here to view

Learn how to test the front view by viewing
Video Tutorial #200 Can You Pass The Foot Ankle Toe Raise Alignment Test? (Front View), click here to view 

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