Foot Focused: The Importance of a Strong Foot Core System

Whether you are a school-aged child with chronic ankle injuries, a competitive athlete wanting to improve your skills, a “stand all day” hard worker with lingering back pain, or a retired grandparent concerned about changes in your balance, there is potentially a shared quality among you: a weak foot core system.  Too often, the strength of the foot is completely neglected in exercise training programs.  Recent research has pushed to bring attention and understanding to the importance of foot strength in treating musculoskeletal injuries and balance impairments.

The foot is a complex structure that serves many diverse functions. It is rigid, dynamic, and flexible in adapting to the frequently changing demands.1-3 Researchers equate the foot core to the well-known lumbopelvic core, proposing that the concept of core stability can be extended to the arch of the foot.1   Of the foot’s 29 muscles, 20 are categorized as intrinsic muscles that control movements in the foot.2 These intrinsic muscles are the local stabilizers that run along the foot’s bottom or plantar surface, making up four core layers. Without proper functioning of these muscles to provide stability, the foundation becomes unstable and misaligned, resulting in abnormal movement of the foot, ultimately leading to foot-related1 and lower extremity-related problems.2

Foot core training has been found to have positive benefits for reducing the risk of injury and improving performance.  Variations in foot posture correlate with pelvic alignment, lumbopelvic muscle activation during walking, and transmission of force during running, all of which can lead to low back pain.4   Foot core training has resulted in increased performance in 1-legged jump distance, greater vertical jump height, and shorter 50-meter dash time.5   Furthermore, foot strengthening can alter running performance by increases in quadriceps activation6, muscle volume, and vertical impulse.2

Another essential role of the foot core is the system of sensory receptors located in the plantar fascia, ligaments, joint capsules, muscles, and tendons. The sensory system of the foot is critical to gait and balance. The alignments of the intrinsic muscles along the plantar surface provide immediate sensory information via a stretch response about changes in the foot’s posture.1  Specific training of these muscles via a short foot training program over the course of 4 weeks has resulted in reduced arch collapse or flattened arch and improved dynamic balance.7  Research suggests that foot and ankle strength exercise training may improve balance and functional ability and reduce the risk of falls in older adults.8  In younger populations, 4-week training of intrinsic strength during balance exercise demonstrated improved function in those with chronic ankle instability.9

Continued research introduces promising interventions for foot core training, offering substantial benefits to several populations with various conditions and goals. Excel Physical therapy can help you begin to stand strong on your feet by providing an individualized program based on your specific needs using research-proven evidence.

Jessica Hoerr, PT, DPT

  1. McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015; 49:290. Doi: 10.1136/bjsports-2013-092690.
  2. Taddei UT, Matias AB, Ribeiro FIA, Bus SA. Effects of a foot strengthening program on foot muscle morphology and running mechanics: a proof-of-concept, single-blind randomized controlled trial. Phys Ther Sport. 2020;42:107-115.
  3. Tas S, Unluer NO, Korkusuz F. Morphological and mechanical properties of plantar fascia and intrinsic foot muscles in individuals with and without flat feet. J Ortho Surg. 2018;26(1):1-6. Doi: 10.1177/2309499018802482.
  4. Mentz HB, Dufour AB, Riskowski JL, et al. Foot posture, foot function and low back pain: the Farmingham foot study. Rheumatology. 2013;52:2275-2282.
  5. Hashimoto T, Sakuraba K. Strength training for the intrinsic flexor muscles of the foot: effects on muscle strength, the foot arch, and dynamic parameters before and after the training. J Physc Ther Sci. 2014;26:373-376.
  6. Kean CO, Behm DG, Young WB. Fixed foot balance training increases rectus femoris activation during landing and jump height in recreationally active women. J Sports Sci Med. 2006;5:138-148.
  7. Lynn SK, Padilla RA, Tsang KK. Differences in static- and dynamic-balance task performance after 4 weeks of intrinisic-foot-muscle training: the short-foot exercise versus the towel-curl exercise. J Sport Rehabil. 2012; 21:327-33.
  8. Spink, MJ, Fotoohabadi MR, Wee E, Hill, KD, et al. Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults. Arch Phys Med Rehabil. 2011;92:68-75.
  9. Sauer LD, Saliba SA, Ingersoll CD, et al. Effects of rehabilitation incorporating short foot exercises on self-reported function, static and dynamic balance in chronic ankle instability patients. J Athl Train. 2010;45:S67.

View our flipbook for the full article, Excel PT: Foot & Ankle Pain


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