Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic funct

NewsBot · May 4, 2013

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Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic function
Edward P. Mulligan, Patrick G. Cook
Manual Therapy; In Press

A specific training program emphasizing the neuromuscular recruitment of the plantar intrinsic foot muscles, colloquially referred to as “short foot” exercise (SFE) training, has been suggested as a means to dynamically support the medial longitudinal arch (MLA) during functional tasks. A single-group repeated measures pre- and post-intervention study design was utilized to determine if a 4-week intrinsic foot muscle training program would impact the amount of navicular drop (ND), increase the arch height index (AHI), improve performance during a unilateral functional reaching maneuver, or the qualitative assessment of the ability to hold the arch position in single limb stance position in an asymptomatic cohort. 21 asymptomatic subjects (42 feet) completed the 4-week SFE training program. Subject ND decreased by a mean of 1.8 mm at 4 weeks and 2.2 mm at 8 weeks (p < 0.05). AHI increased from 28 to 29% (p < 0.05). Intrinsic foot muscle performance during a static unilateral balancing activity improved from a grade of fair to good (p < 0.001) and subjects experienced a significant improvement during a functional balance and reach task in all directions with the exception of an anterior reach (p < 0.05). This study offers preliminary evidence to suggest that SFE training may have value in statically and dynamically supporting the MLA. Further research regarding the value of this exercise intervention in foot posture type or pathology specific patient populations is warranted.
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NewsBot · Feb 20, 2018

The effect of additional activation of the plantar intrinsic foot muscles on foot dynamics during gait
KazunoriOkamuraaShusakuKanaibMasakiHasegawabAkiraOtsukacSadaakiOkib
The Foot Volume 34, March 2018, Pages 1-5

What is already known
•The plantar intrinsic foot muscles contribute to the support of the medial longitudinal arch.
•The activities of the plantar intrinsic foot muscles increase with increasing gait velocity and ground reaction force.
•The relationship between the hypofunction of the plantar intrinsic foot muscles and plantar fasciitis has been suggested.
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What this study adds
•The additional activation of the plantar intrinsic foot muscles during gait caused a delay in the timing for the navicular height to reach the minimum value, and a reduction of the vertical ground reaction force (2nd peak).
•The plantar intrinsic foot muscles most likely contribute to shock absorption and facilitate efficient foot ground force transmission during gait.
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Background
The plantar intrinsic foot muscles (PIFMs) contribute to support the medial longitudinal arch. But the functional role of the PIFMs during dynamic activities is not clear. The purpose of this study was to examine the change in the foot dynamics during gait accompanied with the change in the PIFMs activity to determine the functional role of the PIFMs during gait.

Methods
Twenty healthy male subjects were randomly assigned to the electrical stimulation group (ESG) or control group (CG). In the ESG, the electrical stimulation to the PIFMs was provided from mid-stance to pre-swing using surface electrodes to simulate reinforcement of the PIFMs. The foot dynamics during the stance phase of gait was measured using a 3D motion analysis, and the amount of change from baseline (electrical stimulation was not provided) was compared between groups using an independent sample t-test.

Results
In the ESG, the timing for the navicular height to reach the minimum value was significantly later, and the vertical ground reaction force (2nd peak) significantly decreased more. There were no group differences in the amount of change from baseline on gait velocity, stance phase duration, minimum navicular height and ground reaction force in other directions.

Conclusion
Results from this study showed that the functions of the PIFMs most likely include shock absorption and facilitation of efficient foot ground force transmission during the stance phase of gait.
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NewsBot · Aug 10, 2023

EXERCISES AND NEUROMUSCULAR ELECTRIC STIMULATION FOR MEDIAL LONGITUDINAL ARCH: CLINICAL TRIAL
André Setti Persiane et al
Acta Ortop Bras. 2023 Jun 9;31(spe2)

Objective: The extrinsic muscles, such as the posterior tibialis and long flexor of the hallux and the intrinsic of the foot, are part of the active subsystem of the central system of the foot and play an essential role in the control of the medial longitudinal arch resulting from difficulty in contracting the muscle, neuromuscular electrostimulation (NMES) becomes a resource combined with strengthening and recommended for rehabilitation. T this work aims to evaluate the effectiveness of NMES associated with exercise in deforming the medial longitudinal arch.

Methods: This is a randomized blind clinical trial. 60 asymptomatic participants were divided into three groups: NMES, exercise and control. The NMES and exercise group performed seven exercises for the intrinsic and extrinsic muscles twice a week for 6 weeks, and the NMES group used an NMES associated with five exercises. Navicular height and medial longitudinal arch angle were taken before and after the intervention period.

Results: No statistically significant differences existed between groups for navicular height and medial longitudinal arch angle.

Conclusion: NMES associated with exercise does not change the characteristics of the medial longitudinal arch in association with asymptomatic
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NewsBot · Nov 9, 2023

Morphological and mechanical characteristics of the intrinsic and extrinsic foot muscles under loading in individuals with flat feet
Takumi Kobayashi et al
Gait & Posture; 4 November 2023

Background
The intrinsic and extrinsic soft-tissue structures that apply force and support the medial longitudinal arch (MLA) have been implicated in the development of flat feet. However, the relationship between the changes in MLA height under increasing load and the morphological and mechanical properties of individual intrinsic and extrinsic foot soft tissue structures is not fully understood.

Research question
To examine the morphological and mechanical characteristics of the soft tissue structures in flat feet when subjected to loading.

Methods
This study consisted of two studies focusing on the extrinsic foot muscles (10 normal feet/11 flat feet) and intrinsic foot muscles (14 normal feet/13 flat feet). Images of the extrinsic and intrinsic foot muscles and plantar fascia (PF) under 10, 50, and 90% body weight conditions were obtained using ultrasound-based shear-wave elastography.

Results
The cross-sectional area (CSA) of the peroneus brevis was larger in the flat-foot group than in the normal-foot group under all loading conditions. The CSAs of the intrinsic foot muscles (abductor hallucis, flexor digitorum brevis, and quadratus plantae) and thickness of the PF in the flat-foot group decreased significantly with increasing load. As for mechanical characteristics, the stiffness of the flexor digitorum longus and abductor hallucis was higher in the flat-foot group than in the normal group under high loading conditions. In addition, flat feet with greater flexibility tended to exhibit a greater decrease in PF thickness and smaller increase in stiffness.

Significance
Excessive stretching of the intrinsic foot muscles and PF occurs in flat feet, and excessive contraction of the flexor digitorum longus may counteract the excessive lowering of the foot arch. Therefore, it is necessary to promote the contraction of the intrinsic foot musculature in feet with greater flexibility of the MLA during loading.
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NewsBot · Dec 17, 2023

CHARACTERISTICS OF INTRINSIC FOOT MUSCULATURE IN INDIVIDUALS WITH ASYMPTOMATIC FLEXIBLE FLATFOOT AND THE EFFECT OF EXERCISE THERAPY A RANDOMIZED CONTROLLED TRIAL
Raf Dejonghe, Yani Van Den Bossche and Miquel Van Den Driessche
Source

Background: Flatfoot is a foot deformity that is common in the adult population. Flatfoot deformity encompasses a variety of pathologic etiologies in various lower extremity overuse injuries. The foot core, including the intrinsic foot muscles (IFM), plays an important role in normal foot function and lower extremity function. Therefore, training the IFM to avoid excessive pronation may help prevent some of these injuries and pathologies. However, the effects of IFM training are not clear. Study objectives: This study aims to investigate two study objectives. 1: Evaluate IFM function and strength in subjects with asymptomatic flatfoot and controls (neutral foot). 2: Evaluate the effect of IFM strengthening in subjects with asymptomatic flatfoot. Study design: Randomized controlled trial Methods: Participants were asked to come to the laboratory for initial testing. On the basis of the results of the first two tests: Foot Posture Index (FPI) and navicular drop test (NDT), they were assigned to the study group (asymptomatic flatfoot group) or the control group. After this allocation, the following tests were performed: 1. The Lower Quarter Y-Balance Test (YBT-LQ) to evaluate dynamic balance; 2. Handheld dynamometry (HHD) to measure the toe flexor strength; 3. Thickness and cross-sectional area (CSA) measurements of IFM by the use of ultrasound. Participants randomized to the intervention-study group performed two exercises, the short foot exercise (SFE) and extend toes, daily over a period of six weeks. After the intervention period of six weeks, all participants of the intervention-study group and the control-study group were asked to return for subsequent testing. Results: At baseline, the control group had a significantly higher toe flexor strength (HHD) and M. Quadratus plantae (QP) thickness compared to the study group. For toe flexor strength (HHD) between baseline and week six in the intervention-study group, a significant difference was found. In the control-study group there was a significant difference for the thickness of the M. Flexor halluces brevis (FHB) between baseline and week six. No significant differences were found for YBT-LQ, HHD, thickness and CSA of the IFM between intervention-study group and control-study group at week six. Conclusion: This study provides some evidence for both study objectives. There is still a low level of evidence, so more research with larger study populations and longer time of intervention is needed in the future.
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NewsBot · Apr 16, 2024

The impact of intrinsic foot muscle strengthening exercises in asymptomatic athletes with normal foot structure: A systematic review
Maha Ahmed et al
Clinical Epidemiology and Global Health; Volume 27, May–June 2024, 101597

Highlights
•Intrinsic Foot Muscle (IFM) exercises improve foot strength and morphology in athletes, supporting injury prevention.
•All the studies showed an improvement in IFM strength.
•The clinician assessed motor performance and morphological assessments showed considerable improvements.
•Improved vertical running propulsive forces were reported, though the running economy showed no changes.
•Findings suggest that IFM exercises may be incorporated in sports rehabilitation.
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Purpose
The intrinsic foot muscles (IFM) are crucial to the passive, active, and neurological subsystems that compose the foot core, and their weakness may predispose to various foot pathologies, systemic diseases and musculoskeletal conditions. Strengthening of IFM is an effective intervention in clinical conditions, but its role in sports and clinical rehabilitation is still inconclusive. Thus, this review aims to evaluate the effects of IFM strengthening exercises in athletes with normal feet.

Methods
An electronic database search was conducted using Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (WoS), Scopus, MEDLINE, PubMed, and the Physiotherapy Evidence Database (PEDro). The Cochrane risk of bias tool was used for assessing bias in the included studies.

Results
Four studies were included for qualitative review. The meta-analysis was not possible due to the heterogeneity of measuring units of outcome measures in the included studies. All the studies showed an improvement in intrinsic foot muscle strength, though the training protocols used by them were only roughly equivalent. One study reported no significant differences in MLA stiffness after 8 weeks of intervention. The clinician assessed motor performance and morphological assessments showed considerable improvements. Improved vertical running propulsive forces were reported, though the running economy showed no changes.

Conclusion
Findings suggest that IFM exercises effectively improve outcomes such as foot morphology and function, strength, running mechanics and subjective function in athletes and may be incorporated in sports rehabilitation. These conclusions should be considered with caution due to bias in included studies.
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NewsBot · Jul 21, 2024

Effects of a newly developed toe exercise program combined with the intrinsic and extrinsic muscle trainings on toe function: a case series
Kota Watanabe et al
J Sports Med Phys Fitness. 2024 Jul 18

Background: Foot and toe function is important for not only sports performance but also preventing and treating musculoskeletal disorders. Although strengthening training specific to intrinsic and extrinsic muscles has been recommended, insufficient information is available in toe exercises in their variation and evidences compared to shoulder or lumbopelvic training strategies. The aim was to examine the effects of a newly developed foot muscle exercise program on toe function in individuals during the growth period. This is a single-group, pretest-posttest case series.

Methods: Both feet of seven male patients in their growth period with sports-related overuse injuries of the lower extremities (mean age, 11 years) underwent a four-week strength exercise of the toes, consisting of intrinsic and extrinsic muscle-targeted exercises. Main outcome measures were as follows: 1) flexion force of each toe; 2) compression force of each toe; 3) dexterity of the toes evaluated using the "rock-paper-scissors test"; 4) toe loading during single-leg squat exercise. An F-scan system was used to measure 2 and 4.

Results: All patients performed the program appropriately and completed the program for four weeks. Significant improvements were observed in the outcome measures of 1 to 4.

Conclusions: The combined exercise program for the intrinsic and extrinsic muscles of the foot effectively improved toe strength, dexterity, and loading during dynamic motion and could be easily performed in individuals during the growth period.
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NewsBot · Jul 25, 2024

Effects of a 12-week intrinsic foot muscle strengthening training (STIFF) on gait in older adults: a parallel randomized controlled trial protocol
Lydia Willemse et al
BMC Sports Sci Med Rehabil 2024 Jul 20;16(1):158. doi: 10.1186/s13102-024-00944-z.

Background: Falling is highly prevalent among older adults and has serious impact. Age-induced mobility impairments, such as gait modifications, are strongly associated with increased fall risk. Among fall prevention interventions, those including exercises are most effective. However, there is an urgent need to further improve these kinds of interventions. Strengthening the plantar intrinsic foot muscles might benefit mobility in older adults, which may contribute to the reduction of fall risk. The aim of this paper is to provide a protocol to investigate the effect of a plantar intrinsic foot muscle strengthening training versus no training on gait and intrinsic foot muscle function in older adults who are involved in a functional exercise program.

Methods: For this assessor-blinded RCT, older adults (> 65 years) are recruited who are involved in a group-based functional exercise program. Eligibility criteria include: being able to ambulate 10 m barefoot without using a walking aid and reporting to have either fear of falling or experienced a fall in the previous 12 months or have difficulties with mobility, gait, or balance in daily life. Participants are randomly assigned to an intervention and a control group. The intervention group follows a 12-week plantar intrinsic foot muscle strengthening training. The training consists of isolated and functional foot exercises to be performed 5 times a week, each session lasting approximately 20 min. The training is supervised once a week and the intensity gradually increases based on the participant's progression. Both groups keep a diary to report physical activities, fall incidents and movement related discomfort. The control condition is limited to keeping this diary. Data are collected at baseline and post-intervention. The trial outcomes are the between group differences in the mean change from baseline in maximum gait speed (primary outcome measure), capacity and strength of the plantar intrinsic foot muscles, foot and ankle biomechanics during gait, and various other fall risk-related variables. ANCOVA's are used to analyze the trial outcomes.

Discussion: The results of this RCT will offer recommendations, related to plantar intrinsic foot muscle strengthening, to existing fall preventive exercise programs.
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NewsBot · Aug 20, 2024

Classifications Based on Dynamic Navicular Drop during Gait and Characteristics of Flat Foot Muscle Morphology.
Fukuda, K.; Okamura, K.; Ikeda, T.; Egawa, K.; Kanai, S.
Preprints 2024, 2024081240.

This study investigates the collapse of the medial longitudinal arch (MLA) as a risk factor for medial tibial stress syndrome (MTSS), hypothesizing that overuse of extrinsic foot muscles to prevent MLA collapse can lead to disability. Twenty healthy adults (39 feet) with a foot posture index score below 6 and no recent lower extremity orthopedic history participated. Ultrasonog-raphy measured foot muscle cross-sectional areas, while three-dimensional motion analysis us-ing VICON assessed foot kinematics during gait, focusing on navicular height at initial contact (ICNH) and dynamic navicular drop (DND) during the stance phase. Hierarchical cluster analy-sis based on ICNH and DND compared muscle cross-sectional areas between clusters using ANOVA or Kruskal–Wallis test. The analysis indicated that ICNH was lower in clusters 1 and 3 than in cluster 2, and DND was smaller in clusters 1 and 2 than in cluster 3. Although there was no significant difference in muscle cross-sectional area between the clusters, the flexor hallucis longus tended to be thicker in cluster 1 than in cluster 3 (p = 0.051). The findings suggest that the flexor hallucis longus may help prevent MLA compression during loading, indicating that over-use of extrinsic foot muscles may contribute to MTSS development.
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scotfoot · Aug 20, 2024

NewsBot said: ↑

Classifications Based on Dynamic Navicular Drop during Gait and Characteristics of Flat Foot Muscle Morphology.
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Quote
"The findings suggest that the flexor hallucis longus may help prevent MLA compression during loading, indicating that over-use of extrinsic foot muscles may contribute to MTSS development."

Makes sense !
Some time ago, a research group anaesthetized the intrinsic foot muscles to see how this affected gait. From memory, toe off was adversely affected, but not navicular drop .

Lack of increased navicular drop led some to speculate that this taught against the idea of an intrinsic muscle regulated foot core ( educational bias ?).

The paper above suggests that in a situation where the intrinsics are making a reduced contribution, the extrinsics can help out ,but at the cost of poor biomechanics and shin splints.

Some time ago a group of female, professional, marathon runners with medial tibia pain ( shin splints), were the subject of a research paper . All were found to have reduced strength in the intrinsic foot musculature compared to a group of similarly aged female nurses . Strengthening exercises where introduced for the runners and the pain went away .

NewsBot · Oct 14, 2024

The impact of intrinsic foot muscle strengthening exercises in asymptomatic athletes with normal foot structure: A systematic review
Maha Ahmed et al
Clinical Epidemiology and Global Health; Volume 27, May–June 2024, 101597

Highlights
•Intrinsic Foot Muscle (IFM) exercises improve foot strength and morphology in athletes, supporting injury prevention.
•All the studies showed an improvement in IFM strength.
•The clinician assessed motor performance and morphological assessments showed considerable improvements.
•Improved vertical running propulsive forces were reported, though the running economy showed no changes.
•Findings suggest that IFM exercises may be incorporated in sports rehabilitation.
Click to expand...

Purpose
The intrinsic foot muscles (IFM) are crucial to the passive, active, and neurological subsystems that compose the foot core, and their weakness may predispose to various foot pathologies, systemic diseases and musculoskeletal conditions. Strengthening of IFM is an effective intervention in clinical conditions, but its role in sports and clinical rehabilitation is still inconclusive. Thus, this review aims to evaluate the effects of IFM strengthening exercises in athletes with normal feet.
Methods
An electronic database search was conducted using Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (WoS), Scopus, MEDLINE, PubMed, and the Physiotherapy Evidence Database (PEDro). The Cochrane risk of bias tool was used for assessing bias in the included studies.
Results
Four studies were included for qualitative review. The meta-analysis was not possible due to the heterogeneity of measuring units of outcome measures in the included studies. All the studies showed an improvement in intrinsic foot muscle strength, though the training protocols used by them were only roughly equivalent. One study reported no significant differences in MLA stiffness after 8 weeks of intervention. The clinician assessed motor performance and morphological assessments showed considerable improvements. Improved vertical running propulsive forces were reported, though the running economy showed no changes.
Conclusion
Findings suggest that IFM exercises effectively improve outcomes such as foot morphology and function, strength, running mechanics and subjective function in athletes and may be incorporated in sports rehabilitation. These conclusions should be considered with caution due to bias in included studies.
Click to expand...

NewsBot · Oct 29, 2024

Strengthening the Intrinsic Muscles of the Foot and Its Action on Foot Posture and Self-Reported Function in Individuals With Lower Limb Injuries: Systematic Review and Meta-Analysis
Paulo Márcio Pereira Oliveira et al
Source

Objective
The aim of this study was to systematically review the influence of the intrinsic foot musculature on lower limb injuries, with regard to improving foot posture and self-reported function, and to point out the biomechanical effects of strengthening the intrinsic foot musculature.
Methods
A comprehensive literature search using National Library of Medicine (Medline-PubMed), Scopus, Web of Science, Pedro, SportDiscus, and Cochrane was undertaken. Selection Criteria: A literature search was peformed using: Clinical trials of patients with injuries in the lower limbs, and with alterations in the intrinsic musculature of the foot were included and published in the period up to and including April 2023. Data Synthesis: Data analysis was measured as standardized mean difference and confidence interval was set at 95%. Random effects model was used.
Results
A total of 1,051 studies were found, but, after evaluation, only 4 were included in the present study. The effect of intrinsic foot musculature strengthening improved medial longitudinal arch height in studies included in the meta-analysis (P < .00001).
Conclusion
Based on this systematic review, it is possible to conclude that increasing the strength of intrinsic foot muscles proved to be effective in promoting positive biomechanical changes in the longitudinal arch of the foot of these patients
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NewsBot · Nov 20, 2024

Reliability of direct and indirect measures of intrinsic foot muscle strength in adults: A systematic review
Nicolas Haelewijn et al
Clinical Biomechanics 17 November 2024, 106378
Highlights
•Dynamometry shows moderate to high reliability (ICC: 0.66–0.99).
•Direct methods struggle to isolate intrinsic foot muscle strength.
•Ultrasound gains prominence, showing consistently strong agreement with MRI.

Background
The aim of this systematic review was to summarize the existing literature on evaluation methods developed to measure intrinsic foot muscle strength in both symptomatic and asymptomatic individuals. The specific objectives was to provide an overview of the evaluation methods with their protocols and reliability.
Methods
Five databases (PubMed, Embase, Web of Science, Cochrane Library and SPORTDiscus) were searched up to August 2023. Studies reporting direct or indirect measures of intrinsic foot muscle evaluation with no limitation to sex, BMI or ethnicity were included. The inclusion criteria were applied systematically, and the methodological quality of the selected articles was assessed using The Downs and Black Checklist.
Findings
Sixteen studies provided results of direct measures of intrinsic foot muscle strength, while indirect measures were reported in 19 articles. Direct measurement methods such as dynamometry (ICC 0.75–0.99) and plantar pressure (ICC 0.75–0.95) show high reliability. Among the indirect methods, both MRI (ICC 0.99) and ultrasound showed mostly high (ICC 0.66–0.99) reliability values.
Interpretation
Direct methods like dynamometry and plantar pressure show excellent reliability, but validity is uncertain. MRI is considered gold standard among indirect measurement techniques. However, portable ultrasound devices have gained popularity due to their strong agreement with MRI.
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NewsBot · Dec 8, 2024 at 11:58 PM

Quantifying lower limb skeletal muscle activity changes after 3 months of intrinsic foot muscle training: a randomized controlled trial
Tomoyuki Kanayama et al
J Sports Med Phys Fitness. 2024 Dec 2

Background: Foot rock-paper-scissors and towel-gathering exercises are widely used for isometric strengthening of intrinsic foot muscles. An initial trial demonstrated that foot rock-paper-scissors and towel-gathering exercises affected skeletal muscles associated with the medial longitudinal arch and toe pressure force, respectively. However, no quantitative reports of interosseous muscle activity after continuous training exist. We aimed to quantitatively assess and compare the impact of foot rock-paper-scissors and towel-gathering exercises on skeletal muscle activity in university athletes over a 3-month period using FDG-PET 3 imaging.

Methods: This randomized controlled clinical trial was conducted in a university hospital with pre- and post-training PET measurements of muscle activity changes. Eight healthy university athletes were subjected to two 3-month-long exercise regimens: foot rock-paper-scissors and towel-gathering. Skeletal muscle activity changes were quantitatively evaluated using FDG-PET imaging. We defined regions of interest across 25 specific muscles and conducted measurements of toe pressure strength and vertical jump height.

Results: The foot rock-paper-scissors exercise initially impacted medial muscles and later intrinsic foot muscles, including lateral longitudinal arch muscles. The towel-gathering exercise improved toe pressure force and vertical jump. Therefore, each exercise targets specific muscle groups differently.

Conclusions: Foot rock-paper-scissors and towel-gathering exercises have distinct effects on skeletal muscle activity. The former primarily enhances medial intrinsic muscles, while the latter improves toe pressure force and vertical jump ability. This highlights the importance of selecting specific exercises for targeted muscle training in athletic and rehabilitation settings. Further research is suggested to extend these findings to broader athletic populations and clinical applications.
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Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic funct

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Effects of fatigue on the plantar fascia

Effectiveness of physical therapy treatment in addition to usual podiatry management of plantar heel

Effectiveness of Foot Orthoses Versus Corticosteroid Injection for Plantar Heel Pain

Effects of a contoured foot orthosis and flat insole on plantar pressure and tibial acceleration whi

Effects of water immersion on sensitivity and plantar skin properties

Effect of debridement of plantar hyperkeratoses on gait in older people

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Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic funct

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scotfoot Well-Known Member

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Effects of fatigue on the plantar fascia

Effectiveness of physical therapy treatment in addition to usual podiatry management of plantar heel

Effectiveness of Foot Orthoses Versus Corticosteroid Injection for Plantar Heel Pain

Effects of a contoured foot orthosis and flat insole on plantar pressure and tibial acceleration whi

Effects of water immersion on sensitivity and plantar skin properties

Effect of debridement of plantar hyperkeratoses on gait in older people

The effectiveness of conservative treatments for plantar heel pain

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