Disclaimer: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
“What’s wrong with your leg?” This is the most common question I’ve gotten throughout my life. Even with a high level of success as an athlete and after going to the Olympics twice, this question has been more regular than “how much do you lift,” or “what were the Olympics like,” or “did you win a medal?”
It’s an understandable question and one I’ve come to welcome; a topic I have a strong desire to speak about. You see, I was born with clubfoot. Clubfoot is a birth defect where one or both feet are rotated inward and downward, usually requiring surgery and casting. For me it was my right foot of which I had surgery on shortly after birth, and then wore a cast for the first year of my life. As is typical, this left me indefinitely with an atrophied right calf (this is the easily observable part that sparks the curiosity), as well a significant imbalance in ankle mobility and leg strength compared to the left side.
As I write all this out now, I realize I should have taken the opportunities to be more creative with my responses: perhaps “It’s from eating too much sugar” or “It’s my Pinochio curse” could have offered some self amusement or even a lesson to the asker. But, I have enjoyed the reactions following my go-to answer of “I was born with a clubfoot” and then defining it: “Wow, you made it to the Olympics in spite of that, amazing!” Another understandable AND appreciated remark, but the truth is that I made it BECAUSE of the deformity and deficiency and NOT in spite of it. So not to get too sappy and inspirational here, let’s leave that conversation for another time. For now, for those of you also born with clubfoot (on one or both sides), I want to work on your response to that question.
I don’t want you to have to say, “I was born with a clubfoot so I’ve never been able to play sports as well or as much as I’d like,” or “My leg/legs are weak and immobile so I cannot squat or perform the Olympic lifts very well.” I want you to surprise people because I know you can – I want you to surprise yourself! When someone asks the question, “What’s wrong with your leg?” I want you to be able to answer with honest conviction, “It’s REALLY strong!”
The truth for me is that my right leg HAS become really strong and beyond USABLE as an athlete (let me remind you I’m an Olympian and Masters World Record Holder in Weightlifting, a sport that requires a tremendous amount of mobility, strength, and balance through your entire body!). So, how can you make yours as strong and usable as possible? How can you work towards overcoming the physical limitations and reach your goals?
First and foremost you must treat your leg/legs as “normal” in your mindset of trying and tackling physical tasks (sports, squatting, weightlifting, etc.), completely IGNORING the limitations. This means that you DO NOT hold back in any way because you “already know you’re not going to be able to do it,” or “there is always” this certain compensation. You MUST go all in. Run as HARD as you can. Jump as HIGH as you can. Explode as VIOLENTLY as you can with the Olympic lifts. This is a foot that you stand and walk on everyday, “it takes a licking and keeps on ticking” (sorry I couldn’t help myself). It is far tougher than you might think, and so are YOU (ok so I guess I’m not going to be able to dial back the inspirational messages as much as I’d hoped!).
When I was in junior high we had a kid that was one grade ahead of me move in. It didn’t take me long to notice that he was also born with clubfoot. His legs looked almost identical to mine, even the natural shape of his “healthy” leg, the atrophied shape of his “weak” leg, and the amount of size difference between the two. But his clubfoot was on the left – I thought maybe we could just swap out one leg and we would both have two matching legs, ha. He was much more open and seemingly accepting about the deformity and size difference part of it than I was and I envied that; I wanted to be ok with it like he was. But when it came time to physically use it, I noticed he also accepted the limitations. During the athletics period he would quickly place his legs together to show and remind the coaches – and everyone else – of the size and capability differences in his legs as the reason why he would not be able to take part in the drill or exercise like the “normal” kids. One day we were doing speed and calisthenic drills on the stadium bleachers: sprinting up, high knees up, jumping up, etc. When it came time for the single-leg jumps, like clockwork there he was with his now very practiced demonstration. It was those moments that made me realize that maybe I shouldn’t look up to him after all. As I turned around and hopped up those stairs – not only as well, but BETTER than most of the other kids – on my right, “weak” leg I knew that his left leg was only weak because he allowed it to be. So, perhaps we’ll always have to work on accepting that our legs will never look normal, but we should work even harder on NOT accepting the limitations.
A part of the UN-acceptance is giving ABNORMAL effort in fighting the mobility and strength limitations and imbalances with extra drills and exercises on the foot/leg or feet/legs in question. This means doing something almost every day that will benefit movement on your ankle and with that leg. You might need to progress into this over time and that is ok, starting off with 3 days/week and building up to 6 for example. This will also allow your leg/legs to ease into this extra work. In any case, frequency is critical. Even for me, to this day, if I go just a few days more than usual with anything less than exaggerated activity (stretching, squatting, etc), it begins to tighten back up. This means doing 5 minutes per day, 6 days per week is far more powerful and beneficial than doing an hour of work, 1 day per week.
We need to make this work routine; create a habit of performing this work over and over again. You can do this by picking ONE drill to start with, performing 2-3 sets for 3-4 days/week; whatever frequency you can wrap your mind around. Apply this for 4 weeks then re-evaluate and try to add frequency. The best drill to put this in motion is a basic ankle rock. Perform this with the following steps:
- Face a wall and rest both hands against it at about chest height.
- Place the foot of the ankle you need to stretch about 1 foot-length away from the wall and ensure the toes are pointing straight ahead.
- Place the toes of the other foot in line with the heel of the foot you are stretching hanging there on your tippy toes (heel is off ground) so that more weight is on the leg you are working. Ensure that this back foot is straight as well, with the rest of your body square.
- While keeping the heel of the stretched leg solid on the ground, take your ankle as far forward as possible, holding at end range each rep (the goal is not to touch the wall here so don’t worry about whether you can or cannot; we just need to get the ankle to its end range whatever that may be). Be sure that you are directing the middle of the knee cap over the middle toe for at least most of your reps, but you can and should work it in all directions depending on how your ankle is most tight. (Mine is most tight straight on, and I’m most flexible to the outside so I spend my time going straight.)
- One set of this will be 10 slow reps holding 2 seconds on reps 1-9, and 10 seconds on rep 10. During the holds, try to relax your shin and calf muscles so that you are “resting” at end range as much as possible.
SEE the Ankle Rock demo video here.
As you might realize, this drill can be performed anywhere and requires no equipment other than a solid upright of some sort. I’ve gotten to where at least a few times/day I’ll randomly perform 10 reps of this; I’ll just lean up against a wall and get to work (on top of the other work I do in the warm ups for my workouts). Also, do these barefoot as much as possible. For that matter, do your warm ups in the gym barefoot, and walk around barefoot as much as you can. For example, I regularly coach barefoot, I don’t ever wear shoes while I’m at home, I perform all my general warm ups barefoot, and make myself do the first 2-3 sets of any weighted exercise in my program for the day barefoot (this might be squats, snatches, etc.). These are good general recommendations for any human/athlete, but especially for the clubfoot these will help strengthen and toughen the foot/leg further. As a bonus to the barefoot warm ups, these will create a sense of greater ease and help the athlete with clubfoot on one side feel more even throughout their movement once shoes are on and the workout is going (especially when squatting/receiving snatches and cleans in a squat).
Some other drills and concepts I’ve used through the years to help balance out as much as possible are calf raises, weighted ankle stretches, and overloading my right side slightly with some of my squats and pulls.
When I was a kid and fixated on trying to make that leg grow so that my legs could maybe, just maybe one day be the same size, I did a lot of calf raises. Every night before bed (for years) I would pull out a 2×4 from underneath my bed and get to work. I don’t remember how many reps specifically, I think I would just pick a number and get it done. Well, the leg never grew BUT I KNOW my leg got stronger. I could feel it in my daily life, as I ran, as I played, etc. Also, for reasons I’m uncertain of other than it just felt good, I would stretch that calf and ankle when I was done (with guess what, the ankle rock). Maybe I supernaturally knew that I was someday going to take on the sport that is proven to have athletes that are the 2nd most flexible in the Olympics (1)? I’m not sure, but I do know once again that years of that frequent, nightly work made a difference (perhaps ALL the difference, the base of what set me up to be able initially perform the Olympic lifts to the level I could, and then build on top of that).
My go-to weighted stretch that I used within every workout for the first handful of years I was training Olympic lifting was with a loaded bar over the top of my knees (at the suggestion of my Coach, Richard Flemming). I would sit in a squat, pick up the bar that had 20 or 25 kilogram plates on each side, place it on top of my knees, and shift it as far to the right as I could so that I was weighing down that right leg as much as possible (start lighter than this and increase as able and ultimately 15 or 20 kilogram plates should be sufficient). I would force my knee as far forward and directly over the toes as possible without the heel lifting and hold for 10-15 seconds, then I would let my heel come off the ground as much as needed to match the forward knee amount of the other leg and hold for 10-15 seconds, then place the heel back down and hold for 10-15 seconds. This always led to noticeable extra range in that right side.
NOTE: If implementing this before your workout, then perform barefoot for the 1st set and with weightlifting shoes for a 2nd set. If implementing this after your workout, then perform the 1st set with weightlifting shoes and a 2nd set barefoot.
Somewhere along the way, through watching videos of myself and looking at pictures, I noticed in every position the bar was tilted down slightly to the right side. This means just standing holding the bar at the hip, in back rack, in front rack, overhead, at extension, etc. It is especially noticeable as my body is fully extending in the snatch, clean, and jerk just before my body begins to go under the bar since I also cannot extend my right ankle nearly as much as my left. So, also at the suggestion of Coach Richard Flemming, I would add 1 to 2.5 kilograms (or 2.5 to 5 pound plates) to the right side of the bar on 3-4 warm up sets of any squats, deadlifts, or pulls in my program (snatch and clean pulls are performed by finishing a deadlift with a shoulder shrug and extending up onto the toes to mimic extension with the actual snatch and clean). I would then finish out the rest of the sets with a better chance of being even, on top of the extra work on that right, weaker side I continued to collect.
Even though none of this completely balanced me out or made me the model of symmetry I wished I could be, it was the constant aim and pursuit of perfection that helped me be the best I could be in those regards, and significantly increasing my overall potential. In a sense, it has given me “Superpower!”
This power is real and something you can and should tap into by executing frequent and relentless specific work as mentioned above, but there is more you need to know and consider. My body has adapted and adjusted to the specific imbalances that are still there to an extent, because I have very good mobility and balance throughout the rest of my body (balance meaning strength and mobility from side to side, front to back, and upper body to lower body). So, you are going to need to look at everything; if you are limited anywhere else it will compound the difficulty and compensations up from the leg. For example, if the hips are tight, you’ll have an inability to push the knees out sufficiently in the bottom of the squat from a stable foot position. The feet will want to jump out wide and turnout excessively in compensation which is the same compensation for tight ankles – double trouble!
So, though you should keep working your clubfoot like it will change completely and gain the flexibility of the other leg (remember, mindset; we should not put a specific limit on the range of motion one might be able to find with the ankle of a clubfoot), what else can you do to improve your overall abilities? Well let’s recap, simplify, and give you some actionable steps to take:
- Be aggressive with your overall movement in whatever athletic task you are trying to perform; un-hesitant in jumping, landing, running, etc. on the clubfoot. Hesitation is keeping it weaker than it and you could be. Free your mind of the fear. Easier said than done I know, but you can work on doing this by learning to “be in the moment” while you are executing a movement, or “zone in” to the task at hand. Try thinking of something random (like what are you going to have for dinner) or focus on your breathing (notice your breath going in and out slowly for 3-4 breaths) just before you perform a lift (or any other physical task). In the moment of the lift, FEEL a few key actions while you’re executing instead of thinking ahead or dwelling on the end result (or worrying about your leg). For now, you may not believe that you are going to achieve your goals or be able to move better overall in spite of your clubfoot (it’s not easy to just flip that switch and say yes I now believe), but just know that it is going to be ok, and it is in fact POSSIBLE for you to change and improve. I’ve done it and so can you. Maybe it happens and maybe it doesn’t, but you are going to try and keep fighting; that can be CERTAIN!
- Perform the ankle rock for 2-3 sets, 3-4 days/week. This is easiest to remember and get consistent with if you just make it the biggest part and emphasis of your daily warm up. Apply this and only this with an initial commitment of 4 weeks. At that point we’ll move onto the next step.
- After the initial 4 weeks, add calf raises to your ankle rock work. Do this by performing 10 reps just before each ankle rock set you perform. If you are comfortable and consistent with that, start experimenting with overload on the clubfoot side (if you have clubfoot on only one side) and the weighted bottom squat ankle stretch after each workout. For the post-workout ankle stretch, perform 2 sets of 10 seconds with heel down, then 10 seconds with heel up, then 10 seconds with heel down. Once again, let’s commit to another 4 weeks with this.
- Now it is time to begin looking at the rest of your body. Are there any other limitations that you have that you can simply and slowly add to the work you are doing for your clubfoot to give you the best chance overall of moving better and achieving your goals? We’ll start this with a bottom position mobility assessment (your ability in the lowest point of your squat) which will look at every part of your body from the feet to the hips, up through the t-spine that might be working against your squat, ability to receive a snatch and clean, and any other athletic movement. The goal with this assessment is to find an athlete’s two biggest limiters so we can then create an individualized protocol to help them address and overcome those specific limitations and create more overall potential. One of yours will most certainly be continuing to work the ankle of your clubfoot, so we are really just looking for the other one you’ll need to hammer on. To best understand the assessment and get the most out of it, you’ll need to start here to get yourself up to speed, then into the assessment here. Just simply follow the instructions through from there and keep fighting!
Just a heads up on a few other tools you’ll see and potentially use in the assessment and assignment:
- There is of course an ankle mobility test that you’ll be taken through. With this you’ll be able to truly measure and know the difference in your ankles or the complete extent of the limitation on both if you have clubfoot on both sides. This is something I initially hesitated to do because I did not want to know what the measured truth was; I was afraid of the disappointment, further frustration, and helplessness I would feel. I knew that it was a lot and I needed to keep working it and I thought that was enough. More useful than comparing it to the other side was comparing the results from when I’m cold (or before mobility drills) to the results after any of the mobility drills I perform. This is always encouraging and motivating for me to keep going (I can gain up to 2 inches of range on the test). This will make more sense to you once you see and try the assessment but my initial or cold results are always with my knee about 4 inches from the wall (with my big toe placed 5 inches from the wall) compared to my other leg where I can easily touch the wall with my knee. Keep in mind that any amount of improvement you can get here to take into your workout is GREAT!
- In the assignment post you’ll see other ankle drills that you can switch the regular ankle rock out with and begin to apply. I believe these will be more powerful for you (they have been for me) BUT don’t skip the step of using the regular ankle rock FIRST to learn the appropriate action of the ankle rock and help build up your tolerance. There are also some foot-strengthening exercises included that some of you might find are needed as one of the two major drills you need to apply. To this day, I have a little less balance with standing on my right leg versus my left – if that balance is significantly off through the strength of the foot, a little bit of drilling and awareness here will be critical and go a long way in increasing your overall ability.
The ankle and foot drills mentioned above are newer to me (meaning I did not use them any at all through the heyday of my career) but I certainly wish I would have started using them sooner as I have been able to find new ranges and greater comfort in applying them today. So, it’s never too late to find something new that’s more beneficial OR to start in the first place. So, enough talk! It’s time to get going. I’m confident this information can help you along your journey but it’s up to YOU to apply it. Use this “deficiency” to drive you to keep chipping away. Remember, you have greater potential than you might think – go find it!
Until next time,
2-Time Olympian, USAW
Dr. Aaron Horschig, PT,
DPT, CSCS, USAW
- Drechsler A. (1998) The Weightlifting Encyclopedia: A Guide To World Class Performance