Great article on the role of foot intrinsic muscles. I think explaining foot intrinsics to patients as the “core of the foot” will help patients to have a better understanding of the role of the foot intrinsic muscles as it relates to foot dysfunction. Would you address foot intrinsic strengthening with every pt. that presents with a foot/ankle dysfunction?

The article provided supporting evidence for the short foot exercise as an effective strengthening exercise for improving intrinsic foot muscle strength. I’ve prescribed this exercise as well as the towel scrunch exercise to patients for foot intrinsic strengthening; however, after reading this article, the evidence suggests that the short foot exercise is more effective.

The article also mentioned barefoot/minimalist walking and running as a means for strengthening foot intrinsic muscles. If a patient presents to the clinic with foot/ankle dysfunction and one of the primary goals initially is to strengthen the foot intrinsic muscles, should we recommend the patient walk around (in their home) barefoot? Thoughts?

Kyle–what is the toe yoga exercise?

•The table describing the functional quality and descriptions of the intrinsic foot muscles was really helpful.

•Kyle- I’m with Michelle, I’ve never heard of toe yoga exercises either. Please explain, haha.

•Michelle- I don’t think it’s probably necessary to cover intrinsic strengthening with every foot/ankle patient. Just as you wouldn’t perform stabilization/TA exercises on every low back patient. I think it would be important to classify the patient as far as their dysfunction and treat from there. Just me thinking- certainly room to discuss further ideas with this.

•I also thought the point they made about the significant improvement in single limb postural stability between barefoot and a thin sock was interesting. I certainly could imagine a difference between barefoot compared to shod however not simply between barefoot and a thin sock. So that was interesting information to read. I guess I will have more patients walk around barefoot rather than in socks. So Michelle, I’m with you on educating patients to walk around barefoot at home- that is if they don’t have diminished sensation.

•Since working at our clinic, I’ve probably spent more time with this patient population on performing short foot exercises than I may have in the past due to my own ignorance. Just like TA’s, I find it a very difficult exercise to cue patients on. For one, I can barely do it myself, so demonstration doesn’t really help much in that respect. Also, it is a great building block to progress the patient with in exercise- short foot with star excursion balance, short foot with bilateral squats, single leg squats, ect.

Great thoughts/posts/discussion.

I agree; we should not be having everyone do TA activation with LBP; so intrinsic foot muscle activation exercises are not appropriate for every foot/ankle patient either.

Just like having various ways to teach/educate TA activation; experiment with various ways to educate patients on how to activate intrinsics.

“Toe Yoga” is just a stupid name for : alternating First Ray stabilization, lift lateral 4 digits; lift first ray, stabilize lateral digits. Focus of exercise typically should be stabilize base of first MTP with lifting lateral 4 digits, keeping STJ/mid foot in neutral position – think terminal stance for push off when 60% of weight should be on 1st ray with adequate rear/mid foot stabilization, for 1st MTP DF without varus/valgus loading.

Who would be those “classification category” patients to use “intrinsic foot muscle activation” exercises with?

Thanks for the clarification on toe yoga exercises Eric. Interesting.

I’m currently utilizing intrinsic strengthening with short foot exercises for a patient I’m seeing with bilateral plantar fasciitis. He presents with increased midfoot hypermobility which appears to overload his plantar fascia. Therefore the goal is to increase the intrinsic strength of the muscles in his foot for improved support of the midfoot and achieve a more effective lever at push-off.

Great article to discuss and steal the term “foot core”. I thought their results after 4 weeks was pretty vague- I had to remember that they did not mention a functional change (i.e. SEBT, hop to stabilization, figure 8 hop test time) after strengthening of the “foot core” but saw a “framework” in which foot core may assist with this (granted I did not read all of the other articles). As far as categorizing who may need these exercises, I would say patient’s with plantar fasciitis, CAI, achilles tendinopathy/itis, post surgical ankle/foot/knee- really any patient who is allowing for prolonged or too quick of a deformation of the medial longitudinal arch and has goals for prolonged walking, hiking, running, etc. The short foot exercise is tedious to cue, however, plays an active role in further advancement of NMR or ther ex especially when we are working on dynamic stability/balance whether young or old.

Great article! I’ve been using short foot a lot in the clinic for the common lower extremity injuries that a lot of ya’ll have mentioned and it has been really effective. Since starting residency training, I have gotten a lot better at looking at the big picture with all of my patients (at some point). I’ve found a lot of people with SIJ issues/low back pain and hip pain to have deficits all the way down the chain and these can really be beneficial for them as well. Especially for people on their feet a lot- I feel like it helps to address “the cause” of some of their pain by treating the movement dysfunction. You’ve got to think that the foot is the interface between the body and the ground and if we aren’t moving well there, we probably are compensating somewhere else. I find it surprising how many people are weak here but it makes since considering the sedentary nature of a lot of jobs.

I found what they said about barefoot running to be interesting as well. My instinct is to avoid that type of activity in someone with a weak foot until they can “stabilize” and have them run shod only. However, it might be worth trying TM jogging for athletes barefoot in a controlled environment to improve their strength/control. It’s an interesting thought- will definitely try it.

As far as cueing, I’ve found it helpful to have patients try to “pull the ball of the foot towards the heel” without it coming off the floor. Also, a colleague of Myra’s cues patients to pretend there is a marble under their arch. I have had success with both. And when someone is really struggling, it helps to do the uninvolved or less involved side first. They can usually at least grasp the idea and then have more success on the involved side.