The most hyped concept that keeps resurfacing year after year is foot training for sport. While I believe that rehabilitation can help restore foot function, expecting specific foot exercises to help you become the next star athlete is a pipe dream. I feel that mobility and foot strength can be developed, but I am tired of athletes being misled to believe that training the feet is a panacea for their ailments.I feel that mobility and foot strength can be developed, but I am tired of athletes being misled to believe that training the feet is a panacea for their ailments, says @spikesonly. Click To Tweet
In this article, I cover a very comprehensive research study—almost a review of a review, if you will—for coaches and sports medicine professionals. Also included are orthotics and carbon fiber technology, areas that aren’t exercises, but that we must discuss, as they interact with the muscles and joints of the foot. It doesn’t matter if you are a recreational runner trying to keep healthy for the next 10 years or a sports podiatrist looking for a coach’s perspective on foot health, this blog post will surprise you.
Foot Training – A Good Idea on Paper
For decades, we have seen the same guarantee that doing exercises, usually barefoot, will create a training effect that keeps athletes healthy or improves their performance. On paper it sounds promising, just as training other joint systems of the body has promise, so why not train muscles below the ankle, such as the intrinsics? Over the last few years, several pundits have promoted training systems to enhance foot function, and boy, has this been a problem. My favorite example is a “high-performance manager” who literally wrote a book on barefoot training but lost a basketball player to a fifth metatarsal fracture and struggled to manage a plantar fasciitis case.
I can tell more cautionary tales, but it’s important to summarize problems with clear language so it doesn’t polarize the reader. I believe some exercises and therapeutic interventions can help with foot health and athlete performance, but the reality is the quality of care to do this is difficult to find locally, and the process is a massive burden that has left me jaded and frustrated. In most cases, foot training is a waste of time or too little too late. I have spent a small fortune trying to decode the complexity of the foot, and so far, it has only helped in a few situations. It has saved careers, but most of the time I have seen more harm than good.
Recently, a very informative and extremely valuable paper was published on foot strength in athletes. I was excited to see a nice summary of what we can do, but I was left concerned after reading it that coaches would skim the review and make a lot of assumptions. The paper reviews the tests and exercises on athlete performance, and its results are anemic at best if you carefully review the papers they showcased. If you jump to the conclusions section, you may falsely believe that the interventions were potent enough to dedicate a lot of time to training them.
I strongly caution coaches to slow down and read the studies that were reviewed, not just glance at the charts and assume the outcomes were very effective. If you look carefully, only 5 of the 18 study populations were actually sport athletes and the rest were basically patients. Second, the studies showed tests that were not true performance tests but more like assessments of the characteristics of foot performance.
One study did some field tests of note, such as 50-meter sprints and vertical jump assessments, but that was with a recreationally trained group. Subjects like those don’t train comprehensively like advanced athletes, so outcomes are always inflated. I could go on and on, but it’s better to break down the research into parts that coaches care about, such as the following:
- How does a professional evaluate foot strength properly?
- Does barefoot running help with the general preparation of athletes?
- What tools and instruments help scientists and medical professionals see changes that are meaningful?
- What about joint mobility and range of motion testing?
- Do foot exercises and therapeutic interventions work with orthotics and shoes?
I plan to share my experience and what the available science tells us to further help decipher the research and practice. I have paid outsourced experts and wasted enough cash on courses to advise you not to spend money on foot training systems. Some resources are helpful, but generally speaking, the bigger the promise, the more likely you will be disappointed.
Let’s get started with the frequently asked questions with regard to foot training.
Foot Testing in the Lab and in the Field
Now for the tests that researchers and athlete support staff use. Remember that, for some reason, foot strength is seen as a sports medicine responsibility, similar to the neck when an athlete is hurt. I personally believe that a strength or qualified team coach can prescribe any type of strength training, provided it doesn’t interfere with an ethical or expertise requirement.
Foot testing is a way to see if an exercise is improving a specific quality according to the device or evaluation. This is complicated, because we have to judge what an exercise does specifically to the foot with mitigating and controlling forces, and if the test indeed tests what it’s supposed to test. Since more foot exercises exist than tests, the goal of this section is to combine the needs to both review the strategy of foot muscles and critically examine the tests. Because this is a blog post, I can’t review every exercise for foot strength, such as the short foot exercise and the dreaded towel pulls.A major problem is that most coaches think light therapeutic exercises will be able to handle the violence of the reactive demands of sport, says @spikesonly. Click To Tweet
Starting with foot exercises ranging from simple balance motions to more demanding explosive movements like plyometrics, the foot adapts specifically to the loading. If you have a particular loading input, the output will reflect what you give to the anatomy and physiology. A major problem I see is that most coaches think light therapeutic exercises will be able to handle the violence of the reactive demands of sport, and that is the primary error in thinking.
A coach can misinterpret the concept that exercises that strengthen the foot have no value, or think that I am attacking the foot core theory popularized by Irene Davis. I visited Dr. Davis, and she was very open and generous with her time, as I asked her a million questions. While the foot core may help activities of daily life for your grandma, it’s not going to restore the diminishing height of LeBron James’s dunks due to aging. Again, it may help restore a quality, but it won’t enhance a healthy foot.
The main reason is that intrinsics are designed to control motion, not act as propulsion. If you were to look at the body, most of the superficial and large muscles are for propulsion, and the internal and smaller ones are synergists and stabilizers, not prime movers. The small intrinsic muscles of the feet are there to help control motion, not making an athlete even more explosive. Extrinsic muscles are more powerful, but they are still more centric to the ankle than to the foot joints underneath. Generally speaking, I focus on enhancing extrinsic muscles so that appropriate mechanical loading falls into place with intrinsics.
Foot strength tests usually classify the ability to “maintain an arch,” and this is very conflicting in more dynamic motions. The foot has multiple arches and sub-structures that act like recoiling structures. The plantar fascia and other tissues all provide elastic contributions to running and sprinting, but very few exercises and methods actually make an athlete faster. Usually, artificial interventions such as a track spike or carbon plate can enhance speed, not low-level remedial exercises.
The identification of foot posture, navicular drop, and arch types or scores is too isolated to see if the changes transfer to athlete performance. The tests are fine to help move the needle, but we need more telling assessments, as changing navicular drop in a balance test may not do much for jumping higher, cutting quicker, or sprinting faster. Perhaps the tests can be used for postsurgical and post injury return to play testing, but beyond that, I have no confidence.
Barefoot Running as Training – Still Not Effective
A lot of coaches love the concept of keeping things natural or pure, but barefoot training is very limited in helping an athlete’s performance and can, unfortunately, injure an athlete. Barefoot training has risks, such as cuts and lacerations, all the way to fractures. Fears that “maximalist” shoes will turn intrinsic foot muscles to mush are slightly inflated, so we need a middle ground.Walking around barefoot or in a minimalist shoe has differences, but it doesn’t have training effects that show up later in sprinting & jumping with highly trained athletes, says @spikesonly. Click To Tweet
The fair question coaches ask about whether barefoot training can help improve foot function is worth addressing, and that means running and jumping. Walking around barefoot or in a minimalist shoe has differences, but it doesn’t have training effects that show up later in sprinting and jumping with highly trained athletes.
I will cover the transfer of foot training in general with regard to performance, but for now I will lower expectations and see if it helps with notable changes that may theoretically help an athlete either keep the body healthy or reduce gaps in performance, such as weak links. Training barefoot to help your deadlift or single leg balance during a squatting pattern is not the same as using barefoot training to help running.
Remember, if we don’t see significant changes after two months with running economy or velocity at a given effort, then adaptations from barefoot lifting won’t show up. We can talk about ground reaction forces, rear versus midfoot strikers, and even the windlass mechanism, but if it doesn’t improve absolute performance, we can’t claim it as a solution for athletes. I do believe that some of the training has merit from a teaching perspective, but the research isn’t supportive of barefoot exercise as a way to improve performance.
Does the Training Transfer to the Court, Track, or Field?
If you don’t run faster, jump higher or farther, and/or change direction better, what is the point? Sure, training a specific way often helps a balance test or similar, but those outcomes don’t always help in sport-specific conditions in the real world. I don’t care if my navicular drop score improves unless it is shown to dramatically reduce injuries and help an athlete dunk in traffic.
Based on what I see, nearly all research available fails to help absolute performance. Proprioception from a balance pad during a single leg squat is hardly the same stratosphere as a sprinter or athlete adjusting their body at ground contact times of a few milliseconds. More importantly, highly trained populations are almost never used in the studies. Someone—a healthy volunteer, for instance—will likely improve due to them being sedentary, so perhaps we can make an argument that foot exercises may help an athlete after a layoff or injury.
I do agree that we can use the foot tests above to connect to performance if the exercise specifically helps an athlete with a muscle, but athletic field tests are the end game. Testing arm flexion strength is interesting, but a medicine ball throw or bench press is likely more useful information for determining upper body strength. I love force plates, but adding video and/or other measurements such as motion capture and electromyography is especially valuable at times.The foot was designed to be adaptable, but additional changes are very minor with regard to muscle and proprioception, says @spikesonly. Click To Tweet
My main point here is that the huge amount of force that the foot must manage is unholy—far more than any other joint of the body. It’s a fantastic joint system and, unfortunately, the foot looks more bony than muscular for a reason. Connective tissue and bone seem to be more effective than having massive muscle below the knee. Outside of the gastric soleus complex, anything south of the knee is tendon and small strips of muscle. The foot was designed to be adaptable, but additional changes are very minor with regard to muscle and proprioception.
Can Foot Mobility Actually Help?
Manual therapy and self-therapy are super popular, but most of it is a waste of time. My biggest pet peeve is dorsiflexion exercises and ankle mobility. Some does help, but most of it only restores, and few exercises actually enhance the motion, due to bone structure. I wrote about it a few times and even dedicated an entire article to why ankle mobility is mostly hype.
With the foot being extremely complicated and composed of nearly a quarter of the joints of the body, we could spend all day debating which joints need range of motion and which do not. The joint-by-joint approach proposed by Gray Cook may have some merit upstairs, but it is nearly useless below the ankle, as the system is horizontal and far more complex than an alternating pattern of stability and mobility. Still, I love the classification and elegance of Cook’s proposal that some observational patterns should be explored and supported. It was the functional movement screen that got us away from static table tests for flexibility as being the only option, so it’s time to see how we can evolve with what Cook outlined and look at options for smaller joint systems.
Take the medial and lateral column of the foot and the first ray. Turf toe is a severe sprain to the first metatarsal and usually creates a long-term restriction with football and other athletes. Deion Sanders had a bad case in his career, and it was interesting to see how he voiced the impairment it causes with athletes. In fact, a New York Giants study using pressure mapping showcased how propulsion during gait is disturbed.
Unfortunately, even undiagnosed turf toe will not hold back an athlete from competing, and while it may slow them down a bit, they still play at a very high level. I mentioned LeBron James earlier, and it’s interesting to see his knee history and foot structure, especially the first ray range of motion supported by an orthotic. Small ranges of motion in the foot have purpose, and it’s up to the medical community to map them out better for health and longevity. It’s fine to have medical professionals help restore range of motion after an ankle sprain, but additional exercises likely just burn time better spent elsewhere.
What About Shoes and Orthotics?
I personally hate orthotics or very heavy shoes with massive amounts of technology. This is probably surprising coming from someone who loves technology, but personally I hate adding more moving parts to a complex equation. Still, I have to always address the intricacies of podiatry, as we still have athletes wearing cleats and sneakers in sport.
One sports medicine professional posted a meta-analysis of orthotics and running economy as evidence of the poor outcomes of orthotics. He was right at the superficial level, but after I asked if he had read the articles reviewed individually, the discussion stopped there. Orthotic prescription is perhaps the most arcane part of sports medicine today. Very few sports podiatrists are able to make changes that show up as meaningful outcomes in sport. Ironically, I am a raging fan of foot function and encourage every athlete to see a podiatrist for evaluation. I don’t recommend athletes get orthotics unless it’s proven to manage an issue with secondary and tertiary measurements I trust.Custom orthotics do not necessarily mean personalized prescription, so be careful how you interpret podiatry research, says @spikesonly. Click To Tweet
So why do we see mixed results with orthotic research? Mainly because the concept of prescription versus custom orthotics is confusing. Just because a cast (mold) or scan of your foot is done, it doesn’t mean the appliance has a goal to rectify pathomechanics. For example, this published orthotic study with muscle activity and muscle cross-section analysis (sonography) unfortunately used an attack on podiatric intervention. Looking at the thesis, which is an expanded version of the study, the data could have been interpreted as a sign of efficiency rather than “the more activation and muscle size the better.” Sort of like customizing a pizza based upon taste preferences, such as type of toppings, it doesn’t mean the pizza has a prescription based on nutritional needs.
I have always used the history of blood transfusions as an example of why we see mixed results, because it wasn’t until we really knew how to identify specific blood types and test blood properly that the process was safe and effective. Today, based on the crude foot evaluations I see, we are somewhere between the Civil War and World War I with technology and science with podiatry, if we extend the analogy further.
Now for shoes, such as the new carbon fiber marathon models, modern cleats, and even spikes of today and yesterday. Many of those shoes are similar to over-the-counter orthotics (OTCO), as they have contours and elevations. Add in various foot motions and design elements that are far from “natural,” and every athlete is wearing an artificial device regardless if they see a podiatrist.
It’s not that shoes are especially dangerous, it’s that many coaches inflate the design or overlook the importance of comfort and proper fit. Generally, as the athlete ages and the performance demands increase, shoes start to matter more. For me, it’s appropriate to use the timeless analogy of the car alignment lesson that’s helpful when concepts are opaque. A driver can overcome pulling or drifting on roads (running) or feel nothing in a parking lot (walking), but when on a highway (sprinting) many issues are exacerbated.
Due to the difficulty and limitations of motion capture and interpretation of medical imaging, mechanical relationships are tough to summarize accurately. The foot is arguably the hardest joint to solve, but in the next few years I expect more and more research to use the right approaches, and this will improve outcomes for interventions in both studies and the real world.
Prove Me Wrong
I don’t think that what I have written will close the chapter on foot training. While I am skeptical about foot training, I do still have athletes run on the grass a bit without training shoes and recommend manual therapy and specific foot training. Those modalities, along with selective electrical muscle stimulation and similar interventions, are just complementary to what Mother Nature provides. Sometimes a change of footwear and orthotic can save an athlete from injury, but a poorly prescribed set of appliances and cleats could ruin a career.Sometimes a change of footwear and orthotic can save an athlete from injury, but a poorly prescribed set of appliances and cleats could ruin a career, says @spikesonly. Click To Tweet
Remember that you must take all of the above factors into consideration, as someone who tells me foot exercises will improve sports performance needs to follow the train of thought illustrated above. Again, the state of sports podiatry is murky and very practitioner-driven, due to the lack of knowledge and technology that seems primitive and dated. If you have ideas that seem to work empirically, work with someone who can create at least a pilot or case study so we can progress the field. Foot training has some merit, but it will likely only restore an athlete back to health, not take them to the next level.
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