Short Foot Exercises (SFE) is nothing new in the realm of allied health rehabilitation. Like many modalities a new paper, cultural event or social commentator brings the practice to a front and once again the ethics, efficacy and practicality of the intervention are widely debated.
That which has hindered the implementation of short foot exercises in recent years has been the attachment of the barefoot running popularism – not to be confused with barefoot training which is a different discussion all together. In this article we will look at current evidence and theory of short foot exercises, supply some examples and discuss which exercises supply the best bang for your buck. We previously investigated the benefits of exercises for injury prevention and barefoot training in the following articles:
– Strength Training for Long Distance Runners
– StrongFeet with Tim Branson
To best understand the effectiveness of Short Foot Exercises we need to take a step back and re-establish our knowledge of the intrinsic foot muscles:
|Extensor Digitorum Brevis||Dorsal aspect of calcaneus||Proximal dorsal aspect of phalanges 2,3 &4||Deep Fibula Nerve||Extends digits 2 to 4|
|First Plantar Layer (superficial)|
|Abductor Hallucis||Medial process of calcaneal tuberosity||Base of 1st phalanx of hallux||Medial plantar nerve||Abducts hallux|
|Flexor Digitorum Brevis||Calcaneus||Phalanges 2-5||Medial plantar nerve||Flexion of digits 2-5|
|Abductor digiti minimi||Plantar aponeurosis||5th phalanx||Lateral plantar nerve||Flexions and abduction of the 5th|
|Second Plantar Layer|
|Quadratus Plantae||Calcaneus, long plantar ligament||Flexor digitorum longus||Lateral plantar nerve||Flexion of DIP joints|
|Lumbricals||Medial borders of long flexor tendons||Proximal phalanges and extensor tendons of 2-5||Medial and plantar nerves||Flexes MTPJ and extends IPJ|
|Third Plantar Layer|
|Flexor Hallucis Brevis||Plantar aspect of the cuneiforms||Medial sesamoid and lateral sesamoid||Medial plantar nerve||Flexors hallux|
|Adductor Hallucis||Proximal middle 3 met heads||Lateral side of 1st phalanx||Lateral plantar nerve||Adducts hallux|
|Flexor Digiti Minimi Brevis||5th metatarsal||Proximal phalanx of 5th||Lateral plantar nerve||Flexion and adduction of the 5th|
|Fourth Plantar Layer|
|Dorsal interosseus||Base of metatarsal 1-5||Proximal phalanges||Lateral plantar nerve||Abduct toes|
|Plantar Interosseus||Metatarsals 1-5||Proximal phalanges||Lateral plantar nerve||Adduct toes|
What the evidence says:
When addressing the immediate affects of short foot exercises on balance in people with pronated feet (Su-Kyoung, Kyoung, & Moon, 2013) found using the “short foot” exercise (see below) in both a seated and standing position for 3 reps over 5sets with 2min rest in between sets improved participants balance. Using the short foot exercises was shown to significantly (Sulowska, Olesky, Mika, Bylina, & Soltan, 2016)improve covered surface area to corresponding values prior to the intervention (p<0.05) in the Limit of Stability Test (LOS) and entire surface are of the centre of pressure also increased significantly after the intervention.
The use of short foot exercises in conjunction with conventional therapy exercises in patients with stroke has been found to statistically significantly improve muscle tension in the affected muscles and improve velocity over 10m in participants compared to conventional therapy exercises alone (Lee, Moon, & Hwang, 2016).
** see toe yoga below**
Sulowska, Olesky, Mika, Bylina, & Soltan, 2016, found that the use of short foot exercises improve foot posture and functional movement when completed over 6 weeks with 2 x 15min sessions taking place each day.
When investigating the impact of short foot exercise and support insoles on dynamic balance and navicular drop in patients with flexible flat foot (Kim & Kim, 2016) found an improvement in Y-Balance test for both interventions, however, there was a statistically significant difference when comparing the short foot exercises to the support insoles affect of balance directly. Short foot exercises were found to improve participants navicular drop compared to support insoles over the 5-week period.
Short Foot: Slide the ball of the foot toward the heel then slowly allow the foot to slide back – hold each position for 10sec x 10reps.
Doming: Holding the ball of your foot in one position aim to lift the arch using the intrinsic and extrinsic muscles to lift the arch and hold for 5sec, complete for 10 reps.
Ankle Inversion with Theraband: Place a theraband around the ball of the foot and turn the foot down and in.
Toe Yoga: Aim to lift the big toe from the ground without lifting the smaller toes from the ground or rolling the ankle outward. Then lift the 4 smaller toes keeping the big toe planted and not rolling the ankle inward complete 10 reps.
Ankle Eversion with Theraband: Place the theraband around the ball of the foot and turn the foot up and out.
Ski Jumpers: Stand up straight with the feet hip distance apart and parallel. Lean forward until the toes begin to grip at the ground and hold for 10sec, complete for 5 reps.
In conclusion, like any implemented exercise program the intervention provided should be specific to the requirements, ability and goals of the individual patient. Ensuring correct assessment and diagnosis of a complaint as well as identifying deficits that need to be addressed creates the basis for which exercises give the biggest bang for buck. Additionally, exercises when appropriate only make up a portion of your overall management plan. Don’t forget to modify aggravating activity, offload the identified tissues and treat the soft tissue around the area of concern.
In my next article due to be published in mid-October we will take a look at Shockwave Treatment in practice.
Until Next Time,
Director/ Chief Editor
Kim, E.-K., & Kim, J. S. (2016). The Effects of SHort Foot Exercises and Arch Support Insoles on Improvement In The Medial Longitudinal Arch and Dynamic Balance of Flexible Flat Foot. The Journal of Physical Therapy Science , 3136 – 3139.
Lee, P., Moon, J.-K., & Hwang, B.-Y. (2016). Short Foot Exercise Incorporating the Foot Core System Paradigm on Clinical Trials for the PAtients with Stroke. Neuropathy , 43 – 52.
Su-Kyoung, L., Kyoung, K., & Moon, D.-c. (2013). Immediate Effect of Short-Foot Exercise on Dynamic Balance of Subjects with Excessively Pronated Feet. The Jounal of Physical Therapy Science .
Sulowska, I., Olesky, L., Mika, A., Bylina, D., & Soltan, J. (2016). The Influence of Plantar Short Foot Muscle Exercises on Foot Posture and Fundamental Movement Patterns in Long-Distance Runners, a Non-Randomized, Non-Blinded Clinical Trial. PLOS ONE , 1-12.