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Short Foot Muscle Exercises and Foot Posture in Runners

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Jun 24, 2016.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    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
    Iwona Sulowska, Łukasz Oleksy, Anna Mika , Dorota Bylina, Jarosław Sołtan
    PLoS One. 2016 Jun 23;11(6):e0157917
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Re: Short Foot Muscle Exercises on Foot Posture in Runners

    Fail.
    Multiple comparisons and no Bonferroni adjustment because of that. They did not find what they claimed they did.
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Added it to my table on short foot exercise
     

    Attached Files:

  5. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    just realized that the results they claim they got ( but didn't as they did not do the adjustment for the multiple comparisons) was a within groups analysis and not an analysis of comparison to the other group or even non-existent control group. Another fail. Next.
     
  6. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effect of corrective exercises programme among
    athletes with flat feet on foot alignment factors

    S Sivachandiran and Dr. G Vinod Kumar
    International Journal of Physical Education, Sports and Health 2016; 3(6): 193-196
     
  7. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Not randomised. Fail.
    No data on characteristics of each group. Fail.
    Most of analysis was within groups and not between. Fail.
    Multiple comparisons with no Bonferroni adjustment. Fail.
    Next.
     
  8. scotfoot

    scotfoot Well-Known Member

    If the short foot exercise changes foot posture does it also change plantar pressures during gait ? If it causes reduced pressure under the pads of the toes during gait then is it a sound exercise ?
    I ask these questions because I can't find any studies which provide answers .
    Studies which look at the short foot exercise and balance , navicular height and other measures yes , but gait and plantar pressures, no .
    What am I missing ?

    Gerry
     
  9. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    No one has done those studies; and those studies that have been done on the short foot exercise are really badly done (see above).
     
  10. scotfoot

    scotfoot Well-Known Member

    Regarding the study above "Effect of corrective exercises programme among
    athletes with flat feet on foot alignment factors" p
    age 196 contains a series of figures under the heading -

    Figures of Pre and Post Test on Angle of Arch Foot (AAF),
    Navicular Height (NAH) and Medial Longitudinal Arch
    (MLA) Of Flat Feet Athletes

    Its anecdotal on my part but the top figure appears to show a print of a foot (before and after ) with a more defined MLA after the exercise protocol . But look at the prints left by the toe pads in the after picture . It looks to me like less pressure is being applied by the toes .Which may mean higher plantar pressures elsewhere .If carried over into gait is this a good thing ? Should exercise protocols that change foot posture not also take into account the effect these changes have on plantar pressures during gait .

    Gerry
     
  11. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    You are probably right; it just reflects just how much we do not know about the SFE
     
  12. scotfoot

    scotfoot Well-Known Member

    My understanding of the short foot exercise is that it involves moving the MTFJ' s towards the heel by contracting the plantar intrinsics . The exercise further involves keeping the ball of the foot on the ground and the toes straight and "relaxed " .
    However ,one of the principle roles of the plantar intrinsics is the plantar flexion of the toes and so it seems to me that if these muscles are activated and the plantar pressure under the toes is not increased (causing the ball of the foot to lift from the ground especially when the exercise is carried out in a seated position ) then a second group of muscles must be in play contributing to the shortening of the foot but resisting toe plantar flexion . In my opinion this muscle group can only be the toe extensor muscles .

    So is the co- activation of the toe flexors and extensors something that is usually seen during gait in a person not habitually using the short foot exercise . Zelik et al 2015 (1) ,below , seems to suggest not .

    I would suggest therefore , that the short foot exercise might sacrifice function for posture and cause undesirable plantar pressure changes under the toes (reduced ) and ball of the foot (increased ) during gait .


    (1)
    Coordination of intrinsic and extrinsic foot muscles during walking.

    https://www.ncbi.nlm.nih.gov/pubmed/25420444
    by KE Zelik - ‎2015 - ‎Cited by 9 - ‎Related articles
    Eur J Appl Physiol. 2015 Apr;115(4):691-701. doi: 10.1007/s00421-014-3056-x. Epub 2014 Nov 25.Coordination of intrinsic and extrinsic foot muscles during ...

    Gerry
     
  13. scotfoot

    scotfoot Well-Known Member

    In general ,and with regard to the complex structure that is the foot , do neuromuscular re-education exercises re-educate or do they re-task muscles away from their original function/s ? Are such exercises really just borrowing from Peter to pay Paul ? At the risk of repeating what has already been said on this thread , plantar pressure oriented gait studies seem to me like a good way of evaluating these types of exercises . Even just one !

    Gerry
     
  14. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Can Foot Exercises Alter Foot Posture, Strength, and Walking Foot Pressure Patterns in People with Severe Flat Foot?
    Jeff Houck, PhD, PT, Lacey Seidl, DPT, Austin Montgomery, DPT, ...
    Foot & Ankle Orthopaedics September 18, 2017
     
  15. scotfoot

    scotfoot Well-Known Member

    Interesting results (above ) .
    So , from the abstract , the short foot exercise did not produce significant results in the paper pull test (toe plantar flexor strength) but did increase ankle strength . So the short foot exercise is primarily an ankle exercise ?
     
  16. scotfoot

    scotfoot Well-Known Member

    From post #10 " I would suggest therefore , that the short foot exercise might sacrifice function for posture and cause undesirable plantar pressure changes under the toes (reduced ) and ball of the foot (increased ) during gait . "

    If you look at the pre and post exercise data in Fig 1 of the study " Can Foot Exercises Alter Foot Posture, Strength, and Walking Foot Pressure Patterns in People with Severe Flat Foot? " that is what seems to have happened . Is additional pressure on the ball of the foot under the met heads a good thing ?

     
  17. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    THE INFLUENCE OF PLANTAR SHORT FOOT
    MUSCLE EXERCISES ON FOOT POSTURE
    AND GAIT PARAMETERS IN LONG-DISTANCE
    RUNNERS

    Iwona Sulowska, Anna Mika, Łukasz Oleksy
    JKES 78 (27): 75-86, 2017
     
  18. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    No control group
    No blinding of assessors
    Multiple comparisons

    next
     
  19. scotfoot

    scotfoot Well-Known Member

    Just came across the video below and the "alternate towel curl ",featured about 30 secs into the video , looks and feels interesting . It's not so much about toe curling as movement of the toes around the MTFJ and it certainly seems to engage the intrinsics . I'm still not convinced the short foot exercise is a good idea .

    Video
    Foot strengthening - YouTube
    upload_2018-4-19_11-57-54.jpeg ▶ 0:50

    17 hours ago - Uploaded by Liza the Physio
    We are focusing on the small muscles on the bottom of the foot also called theintrinsic foot muscles. These ...
     
  20. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Efficacy of plantar short foot muscle exercise among middle distance runners: A single blind randomized controlled, pilot study
    Selvaraj Sudhakar, S. Veena Kirthika, K. Padmanabhan, S. Ramachandran, C.V. Senthil Nathan, G. Mohan Kumar, J. Vasantha Kumari, V. Anuradha, Asir John Samue
    Article in Press
     
  21. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effect of Intrinsic Muscle Training on Balance in Bharatanatyam Dancers:
    Randomized Control Trial

    Dr. Nilesh Andhare et al
    International Journal of Science and Healthcare Research
    Vol.3; Issue: 4; Oct.-Dec. 2018

     
  22. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Influence of Plantar Short Foot Muscle Exercises on the
    Lower Extremity Muscle Strength and Power in Proximal
    Segments of the Kinematic Chain in Long-Distance Runners

    Iwona Sulowska et al
    BioMed Research International 2 January 2019
     
  23. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effect of electromyographic biofeedback on learning the short foot exercise
    Okamura, Kazunoria et al
    Journal of Back and Musculoskeletal Rehabilitation, vol. Pre-press, no. Pre-press, pp. 1-7, 2019
     
  24. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Effect of a Foot Exercise Protocol on Intrinsic
    Muscle Volume

    Ulisses T. Taddei, Alessandra B. Matias, Fernanda IA Ribeiro,
    Irene S. Davis, FACSM, Isabel CN Sacco
    ACSM ANNUAL MEETING
    May 28 – June 1, 2019 – Orlando, Florida

     
  25. scotfoot

    scotfoot Well-Known Member

    Interesting . I wonder what exercises they used .
    Also , it would be helpful if someone in academia could define the doming exercise and the short foot exercise and explain any differences .
    Even among learned individuals the two terms are sometimes regarded as being synonymous when in fact they are not .

    Here is a link to a short paper ( 1 page + 2 photos ) on the doming exercise which seems to improve performance in distance runners . It's worth looking at .

    https://journals.lww.com/acsm-csmr/..._of_Foot_Doming_for_Increasing_Dynamic.3.aspx
     
  26. scotfoot

    scotfoot Well-Known Member

    Whoops .

    . Re the above post , I initially read the article and looked at the pictures of the exercise advocated , and it is the doming exercise . In this exercise the ball of the foot leaves the ground as the toes are pressed down . On closer inspection of the paper the authors , Vincent and Vincent , have referenced only papers about the short foot exercise where the ball of the foot stays in contact with the ground and the toes are not pressed down . Confusion reigns !

    Use of Foot Doming for Increasing Dynamic Stability and Injury Prevention in Runners and Athletes
    Vincent, Kevin R., MD, PhD, FACSM, FAAPMR; Vincent, Heather K., PhD, FACSM
     
  27. scotfoot

    scotfoot Well-Known Member

    With regard to the short foot exercise , the deeper you dig the more confused things become .

    Here is a quote about the way the exercise was carried out in a recent study (1) -
    "In the Short Foot Exercise, participants were instructed to shorten the foot in the anteroposterior direction by attempting to bring the heads of metatarsal bones towards the heel without toe flexion, and then – in shortened position, balance loading of the three support points of the foot. During the exercises, feet were kept on the ground and the toes were relaxed. "

    Question .How can the toes be relaxed in an exercise designed to strengthen the toe flexors ?

    I am not trying to single out any individual groups here just point out that ,when it comes to studies on the short foot exercise , there is no clear consensus on what the exercise actual is .


    (1)
    The Influence of Plantar Short Foot Muscle Exercises on the Lower ...


    https://www.hindawi.com/journals/bmri/2019/6947273/
    by I Sulowska - ‎2019 - ‎Related articles16 Dec 2018 - Participants in Group 2 achieved lower values in each 35-metre run time and ...Exercises strengthening short foot muscles may improve energy ..... Probably, after strength training,toe flexor muscles depressed the toes
     
  28. scotfoot

    scotfoot Well-Known Member

    So in the previous post I asked as follows --

    "In the Short Foot Exercise, participants were instructed to shorten the foot in the anteroposterior direction by attempting to bring the heads of metatarsal bones towards the heel without toe flexion, and then – in shortened position, balance loading of the three support points of the foot. During the exercises, feet were kept on the ground and the toes were relaxed. "

    Question .How can the toes be relaxed in an exercise designed to strengthen the toe flexors ?

    I now have my answer courtesy of the video below .It shows the arch being raised and met heads and heel being more closely approximated using the tib post, tib ant and perionials . The toes are being affected by neither plantar flexors nor dorsifleors .
    The plantar intrinsics play no intended role in the exercise.

    If the interpretation of the Janda short foot exercise as shown in this video is correct , and although I can't access Janda's original text it seems likely to me that it is , then a large number of people who thought it was about the intrinsic have got it wrong . Its about the extrinsics .


    Mystery solved
    Video .
    Performing The Short Foot Exercise Properly - YouTube



    upload_2019-5-21_19-24-45.jpeg ▶ 0:54
    26 Jul 2014 - Uploaded by CPCinfoThe ability to perform this short foot exercise is an important factor when learning how to use the entire foot ...
     
  29. scotfoot

    scotfoot Well-Known Member

    In 2011 a paper was published by DY Jung et al which found that muscle activity was high in the abductor hallucis during the short foot exercise . Looking at the video above , the explanation for this seems likely to be that the exercise tested was not the short foot exercise but closer to the short foot exercise done "improperly" (as also illustrated in the video ) .

    As the lady in the video points out ,the short foot exercise takes a while to learn and requires good midfoot flexibility . Lack of either of learning time or midfoot flexibility in test subjects will produce an untestable , hybrid exercise .

    https://www.ncbi.nlm.nih.gov/pubmed/21256447
    by DY Jung - ‎2011 - ‎Cited by 100 - ‎Related articles15 Sep 2010 - A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch angle during toe curl and short foot exercises.
     
  30. scotfoot

    scotfoot Well-Known Member

    If the foot is placed flat on the floor , contraction of the tibialis posterior ,tibialis anterior and the peroneals will produce dorsiflexion of the proximal section of the arch of the foot and plantar flexion of the distal aspect . This will cause the distance between the met heads and the heel to reduce and the arch to increase in height or "dome" . That is the essence of the short foot exercise .

    The short foot exercise has been shown to improve many aspects of foot function including medial arch dynamics . However , this is not due to improved plantar intrinsic performance but improved extrinsic performance , particularly in the tibialis posterior .

    In my opinion , the idea that the short foot exercise strengthens the intrinsics without involving extrinsics or " prime movers " is incorrect .

    " The short foot exercise done improperly " as shown in the video above , will be less effective at targeting the extrinsics but better at exercising the intrinsics . It's also easier to do .
     
    Last edited: May 23, 2019
  31. scotfoot

    scotfoot Well-Known Member

    Some podiatrists seem to have abandoned the " proper " short foot exercise and gone for the" improper" version ,where the tips of the toes are pressed into the ground causing the ball of the foot to lift .

    The "improper " version , shown in this video (below) by a lady called Dr Schipal is , in my opinion , the way the exercise should actually be done .
    A better name for the exercise might be " full length doming " since the ball of the foot leaves the ground .

    RunInjuryFree! Short Foot Activation - YouTube



    upload_2019-5-25_11-8-15.jpeg ▶ 2:39
    3 Jul 2014 - Uploaded by EBFAFitnessRun Injury Free! is EBFA's video series on preventing running related injuries from the ground up. This video .
     
  32. scotfoot

    scotfoot Well-Known Member

    In Janda's short foot exercise then , the foot is placed on the floor with the heel and met heads on the ground . The tibialis anterior , tibialis posterior and peroneals are then contracted which , in closed chain , will act to dorsiflex the proximal part of the arch and plantarflex the distal aspect giving an overall greater arch height . It would appear that Professor Janda was unaware of the arch raising /supporting role of the foot extrinsics in closed chain .

    The better you are at Janda's version of the exercise the less the intrinsics are involved . It is a prime mover or extrinsic muscle exercise . If you are not convinced please see post # 28 .
     
    Last edited: May 26, 2019
  33. scotfoot

    scotfoot Well-Known Member

    A paper was recently published which looked at the effects of foot exercises on the function of flat feet (below 1 ) .

    The researchers used the short foot exercise to strengthen the foot and the paper grip test to measure toe flexor strength .
    Here is how they described the paper grip test .

    ". Although techniques to assess foot muscle strength [4,22] are evolving, this study used force during an established clinical test, the PGT [4,9]. The paper grip test asks participants to hold a piece of paper placed between the big toe and the floor while the examiner attempts to pull the paper out. Participants were seated in a chair with their backs touching the back of the chair, arms crossed over their chest, feet resting on the floor, and were required to keep their feet on the floor during the test. Participants sat with the pad of their big toe on an embedded force plate (AMTI, Watertown, MA). The sensitivity of the force plate was adjusted so that the range was 0 to 350N. "

    So the researchers used an electronic version of the paper grip test to measure " first metatarsophalangeal joint (MTP) flexion strength."

    Question . If pressing the toes down and noting the force with which this can be done is an established clinical test for the plantar toe flexors , then how can you exercise these muscles using the short foot exercise without pressing the toes into the floor ?

    As I understand it , Janda seems to have advocated a version of the short foot exercise in which the toes are relaxed , but also claims this strengthens the plantar intrinsics .That makes no sense .

    Paper 1

    Can Foot Exercises and Barefoot Weight Bearing Improve Foot ...


    https://crimsonpublishers.com/oproj/fulltext/OPROJ.000567.php
    3 Jul 2018 - The home exercise program included: short foot (foot doming), toe spreading, ... The paper grip test asks participants to hold a piece of paper placed between the big toe and the floor while the examiner attempts to pull the paper out. ... their backs touching the back of the chair, arms crossed over their chest, ...
     
  34. scotfoot

    scotfoot Well-Known Member

    How do you you strengthen the foot including the intrinsics and extrinsics ?

    Actually ,and possibly without knowing it , that is exactly the problem that Brigham Young University cracked decades ago . Scientists at Brigham Young devised a digit exerciser , that in terms of the foot ,was designed to strengthen the toe flexors . What they appear not to have realized is that the device ,which improved several measures of athletic performance , would have had almost the same strengthening effects on the tibialis posterior and peroneal muscles as it would on the toe flexors .

    If researchers were to get a test subject to use the device near max capacity they would find the EMG values in the peroneus longus would be near the values associated with max voluntary contraction for that muscle ,as measured during forceful eversion .

    How do I know this . Test results from a pilot study (n=1 ) carried out years ago at a UK University .
     
  35. scotfoot

    scotfoot Well-Known Member

    Here is a link to a new measurement/exercise device aimed at the toe flexors . Using the device would undoubtedly strengthen the toe flexors but it would also strengthen the tibialis posterior and peroneals .
    (see previous post )


    Link to new device (see figure 3)
    Repeatability and accuracy of a foot muscle strength dynamometer ...


    https://www.sciencedirect.com/science/article/pii/S1350453319300463
    by A Garofolini - ‎2019 - ‎Related articlesAdequate foot muscle force application is imperative for efficient performance of sport and activities of daily living. •. Here we developed a custom-made toe ...

     
  36. scotfoot

    scotfoot Well-Known Member

    It strikes me that potentially the best method of performing the short foot exercise , or one of its variants , is to take a piece of planking or the like , which is a bit longer than the foot to be exercised ,then secure the foot to the base with a leather strap which passes around the plank and foot , and across the midfoot area . You would then try to lift the midfoot against the strap by pressing the toes into the plank , giving an isometric exercise . In my opinion this exercise would strengthen the foot in a more comprehensive manner than Janda's short foot exercise .

    The problem with this exercise however , and the reason way it could not , in my opinion , be recommended in it simplest form ,is that overexertion might lead to injury . You would need to build something like a force plate into the length of wood so that when the toes are pressed into the plate /pressure pad , feedback is provided to avoid over exertion . Here is a link to such a set up (see figure 1 ) .

    Link
    atrophy and strength loss of foot muscles and plantar pressure ...


    https://isbweb.org/images/conferences/isb-congresses/2013/.../cb-clinicalfoot.01.pdf
     
  37. scotfoot

    scotfoot Well-Known Member

    Just for the sake of argument let's take the set up in Hohne's paper and look at the muscles involved . When the toe flexors are activated the toes are pressed down on the toe plate . At the same time the peroneals ,tibialis anterior and tibialis posterior are activated and these 3 muscles act to plantarflex the forefoot on the rearfoot . This leads to a tendency of the midfoot to rise and the foot to shorten , actions which are prevented by the restraining strap .

    Now back to Kelly et al 2014 . This group of researchers found that electrical stimulation of the flexor digitorum brevis , abductor hallucis and quadratus plantae produced a reduction in the length and an increase the height of the LA.

    They concluded " These findings demonstrate that these muscles have the capacity to control foot posture and LA stiffness and may provide a buttressing effect during foot loading. This active arch stiffening mechanism may have important implications for how forces are transmitted during locomotion and postural activities as well as consequences for metabolic energy saving. "

    But is this conclusion correct ? Might it be that stimulation of the intrinsics in question caused a response in the tib ant tib post and peroneals and it is this response that produced the arch shortening /increase in height .
    Intrinsic foot muscles have the capacity to control deformation of the ...

    https://royalsocietypublishing.org/doi/full/10.1098/rsif.2013.1188
    by LA Kelly - ‎2014 - ‎Cited by 88 - ‎Related articlesThe plantar intrinsic foot muscles possess origins and insertions that are contained within the footwith the three largest muscles, abductor hallucis (AH), flexor digitorum brevis (FDB) and quadratus plantae (QP), having muscle–tendon units that span the length of the LA [11–13].
     
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