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:

Dorsal Aspect
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.

Basic Exercises:
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,

Jackson McCosker

Director/ Chief Editor

 

References

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.