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Teaching foot exercises.

Discussion in 'Biomechanics, Sports and Foot orthoses' started by scotfoot, May 27, 2023.

  1. scotfoot

    scotfoot Well-Known Member


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    So after thinking around the subject for 13 years plus, I seem to have finally figured out how to teach the "doming" foot strengthening exercise .( Note that I am not a foot health care professional)

    The key was getting people to use the tibialis anterior and the toe flexor muscles separately at first, and then both together . It must be remembered that both the short foot exercise and the doming exercise involve many muscles around the foot and ankle.

    Here is a link to a 10 sec video that explains things. Of course toe flexion exercises are not suitable for everyone but, where they are advisable, I have found people pick "doming" up in about 30 seconds.

     
    Last edited: May 27, 2023
  2. scotfoot

    scotfoot Well-Known Member

    There is a clearly identified need to identify an easy to learn and execute foot exercise and the short foot exercise isn't it . Nor are exercises like "toes spread out" or "towel curls" .

    In an effort to try and find a way of strengthen the foot, clinicians have come up with a number of devices and have even begun circling back towards the old dogmas of " the foot will be strengthened by whole body exercises" . ( The foot can be strengthened by everyday usage of more minimal shoes over a number of months, but this is not without it drawbacks )

    Doming is easy to teach when you now how .

    Below are some extracts from a paper about a recently devised "doming training machine". The researchers are headed in the right direction in as much as they are trying to teach doming, but I do not think the device is now necessary. If the researchers see this thread ,they may come to the same conclusion.

    I am not trying to be a smarty pants here ,it took me 13 years to figure out the teaching sequence.

    Feasibility of the Archercise biofeedback device to strengthen foot musculature

    Journal of Foot and Ankle Research volume 13, Article number: 43 (2020) Cite this article
    Abstract

    Background

    Foot muscle weakness can produce foot deformity, pain and disability. Toe flexor and foot arch exercises focused on intrinsic foot muscle strength and functional control may mitigate the progression of foot deformity and disability. Ensuring correct exercise technique is challenging due to the specificity of muscle activation required to complete some foot exercises. Biofeedback has been used to improve adherence, muscle activity and movement patterns. We investigated the feasibility of using a novel medical device, known as “Archercise”, to provide real-time biofeedback of correct arch movement via pressure change in an inflatable bladder, and foot location adherence via sensors embedded in a footplate during four-foot exercises.

    [​IMG]

    [​IMG]
     
  3. scotfoot

    scotfoot Well-Known Member

    Ok, so the basic doming movement takes about 30 seconds to teach and maybe 5 mins for a subject to perfect, but how do you progress the doming exercise?

    Well, some authorities suggest using bodyweight to make things more challenging ( the movement is the same but the ball of the foot might never break contact with ground, just become " unweighted " as the toe flexors and tib anterior contract), but there are other ways .

    That brings us to doming against an inelastic, leather band fixed across the top of the foot and research has already been carried out into this.

    The paper is
    Functional assessments of foot strength: a comparative and repeatability study 2019
    Dustin A. Bruening, et al

    Here are a couple of images from the paper




    TOE CURL .................................. TOE PRESS........................................DOMING.................. [​IMG]

    [​IMG]


    The take away from the paper is that doming against an inelastic resistance ( set up C ) , placed across the top of the foot, is a highly effective isometric exercises but can it take a few sessions, over a couple of days , to master . This learning process is likely not required if the simple drill I outlined in post 1 is taught before using the device shown in figure C .
     
  4. scotfoot

    scotfoot Well-Known Member

    Doming is an effective intrinsic foot muscle exercises then, especially when there is resistance to the arching of the foot caused by contraction of the tibialis ant, per longus, and tib post proximally, and the toe flexors more distally . Such resistance might be provided by bodyweight .

    Below is a birds eye view of "doming" on youtube which clearly shows that the exercise does not just involve the toe flexors which span the arch but also the toe flexor muscles which flex the toes and pull the met heads together, for example the adductor hallucis. This probably makes doming the most effective targeted exercise for treating hallux valgus.

     
  5. scotfoot

    scotfoot Well-Known Member

    Looking at the very recent trend of a drift back towards whole body resistance exercises to strengthen the intrinsic foot muscles, you would expect the old tried and tested calf raise machine to be great for the intrinsics, after all you can use this device to put a very big load on the foot, if the foot is viewed as extending from the heel to the ball of the foot.

    Unfortunately, if you use a calf raise machine such as the one shown in the video (which most will be familiar with), the muscles of the calf will fatigue long before you start to tire the intrinsics because the intrinsics have only a limited input to medial arch support . Putting blocks under the heel and forefoot and then loading said foot through the tibia/ fibia is probably a non starter when it comes to strengthening the intrinsics and heel raises don't target them either . Papers following this path are not making advances IMO, but are going back in time . Sorry, but this is important .

     
  6. scotfoot

    scotfoot Well-Known Member

    The paper at the bottom of this post is much cited when it comes to foot strengthening . However, the authors did not take into account the fact that the intrinsic muscles, that they feel support the MLA ,act to flex the toes, and that pressure under the toes during loading or electrical stimulation of IFM will produce changes in COP.

    Here is a link to an experiment that shows what happens when you stimulated the IFM electrically . You can see the toes plantarflex and the ball of the foot lift. The video clip is by
    Romain Tourillon and is found on twitter. @r_tourillon


    https://twitter.com/i/status/1624819118464503808



    Intrinsic foot muscles have the capacity to control deformation of the longitudinal arch


    Luke A. Kelly,
    Andrew G. Cresswell
    ,
    Sebastien Racinais
    ,
    Rodney Whiteley
    and
    Glen Lichtwark
    Published:06 April 2014https://doi.org/10.1098/rsif.2013.1188
    Abstract

    The human foot is characterized by a pronounced longitudinal arch (LA) that compresses and recoils in response to external load during locomotion, allowing for storage and return of elastic energy within the passive structures of the arch and contributing to metabolic energy savings. Here, we examine the potential for active muscular contribution to the biomechanics of arch deformation and recoil. We test the hypotheses that activation of the three largest plantar intrinsic foot muscles, abductor hallucis, flexor digitorum and quadratus plantae is associated with muscle stretch in response to external load on the foot and that activation of these muscles (via electrical stimulation) will generate sufficient force to counter the deformation of LA caused by the external load. We found that recruitment of the intrinsic foot muscles increased with increasing load, beyond specific load thresholds. Interestingly, LA deformation and muscle stretch plateaued towards the maximum load of 150% body weight, when muscle activity was greatest. Electrical stimulation of the plantar intrinsic muscles countered the deformation that occurred owing to the application of external load by reducing the length and increasing the height of the LA. 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.
     
  7. scotfoot

    scotfoot Well-Known Member

    Can doming help prevent plantar plate/transverse ligament injuries ?

    Well, once you know how to teach the exercise it takes people about 60seconds to learn.

    It certainty targets the muscles which help pull the met heads together. Perhaps sports podiatrists, helping prevent injuries in runners, fast bowlers etc , might consider an exercise that certainly seems to target the adductor hallux .

    I suspect this type of thinking may be easier for more recently qualified foot health care professionals to accept than more senior clinicians. It's hard to change your mind about things.

    Here is a link to a short video of doming taken from above . Note how plantarflexing the toes also draws the met heads together .

     
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