Emphasizing Physical Therapy Exercises For The Feet

As a result of my background in athletic training, I recognize the importance physical therapy can have for our patients. One of the concepts that I stress in my practice is when patients perform exercises to strengthen the foot or lower extremity, they should do the exercises without their shoes on. The analogy that I use with my patients is that of a simple mitten. One would not chose to play a guitar or sign their name with mittens on, so why do we as a society think that we must perform every activity that we do with our feet with shoes on?

I think we as foot specialists need to remember that there are muscles in the lower extremity that cross the ankle, subtalar, midfoot and metatarsophalangeal joints and are crucial to functioning. The minute we place tight socks on our feet and jam our toes into a shoe, we significantly reduce the function of our toes and ultimately of the muscles. 

I would encourage practitioners to reach out, if you have not already, to your fellow physical therapists to discuss foot exercises and how patients are performing them in their clinics. We all become so busy in our practice that it is easy just to write a prescription for physical therapy and not educate our patients on performing simple tasks with their shoes off to strengthen the foot.

One of the simple tasks I educate my patients on is introducing barefoot activities of daily living at home. For example, I will have patients function for 30 minutes a day without shoes at home. I instruct them to gradually increase this time barefoot every week. I emphasize standing with their feet shoulder width apart and shifting weight toward both feet on the forefoot to engage the toes as opposed to standing and shifting weight from leg to the other.

I have also adopted a popular calf strengthening program in which the patient stands barefoot and grasps a towel with the toes and performs calf raises. One study found this strengthening activity to be superior to calf stretching exercises in patients suffering from plantar fasciitis.¹

In a ongoing randomized, controlled trial that will reportedly involve 111 healthy, long-distance runners, researchers will be examining the impact of a therapeutic exercise program focused on the foot and ankle, and assess the impact of the exercises on lower limb muscles and biomechanics.² It will be interesting to see the results of this trial as it relates to the incidence of running-related injuries in the lower limb.

References

1. Rathleff MS, Mølgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, Aaskov S, Olesen JL. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015;25(3):e292-300.

2. Matias AB, Taddei UT, Duarte M, Sacco IC. Protocol for evaluating the effects of a therapeutic foot exercise program on injury incidence, foot functionality and biomechanics in long-distance runners: a randomized controlled trial. BMC Musculoskelet Disord. 2016;17(1):160.