Everywhere you look someone is telling us the benefits of exercise. Of course, exercise can help our hips and gut, but could it also be the answer to foot and ankle pain and problems?
Anecdotal reports from people who regularly engage in barefoot activity—particularly barefoot running—reveals that exercise can improve abnormal biomechanics in our feet and ankles. Many barefoot runners claim that they have actually seen the arches of their increase in height.
Dr. Nirenberg “Experiments” on Himself
Fascinated with these claims, I decided to do a simple “experiment” on myself. I took a weight-bearing x-ray of the side of my foot prior to embarking on barefoot running and then after a few weeks, took another x-ray. Before I talk about what I discovered, I want to touch on some other important points.
Podiatrists Debate Benefit of Exercise
The debate on whether strengthening and/or stretching foot muscles can affect the biomechanics of the foot was reinvigorated in recent days in the podiatry community. Within this group of doctors, there are those who advocate muscle-strengthening activity, those who don’t, and those who fall inbetween. As a result, the arguments can be very heated.
Dr. Stephen Pribut, Past President of the American Academy of Podiatric Sports Medicine and writer of the blog 98.6, was interviewed for the Jewish Exponent article, Is Barefoot Better for the Sole. Pribut stated that over-pronation–or excessive rolling inward of the foot–happens because of bone structure and will not be corrected by strengthening the feet. In reply, Dr. Ray McClanahan, inventor of Correct Toes and president of Northwest Foot & Ankle, posted a lengthy reply on PM News.
McClanahan asserts that shoes are the cause of some biomechanical – not the cure. He explains that as shoes push the great toe inward (toward the other toes), pronation is increased. He advocates moving the great toe outward (away from the foot) to limit pronation. To achieve this McClanahan recommends avoiding shoes which taper inward at the big toe and using Correct Toes, a device he invented to move the big toe outward. Read his full article HERE.
(McClanahan has said that scientific proof is not required to prove his theory (that moving the great toe away from the foot limits pronation) because it is easily observable by simply trying it on your foot.) I commend McClanahan for thinking out-of-the-box and having the courage to pursue a new, cheap device that may prove more beneficial than expensive, complex orthotics.
Pribut replied by explaining that his quote in the article was essentially a sound bite and that this complicated subject matter does not lend itself to sound bites. He explained that injuries in runners he believes are multi-factorial with overuse being the primary cause of injury. Read his full reply HERE. (Pribut has taken a rational, middle of the road approach based on known factual science while recognizing a potential possible benefit of foot strengthening.) As of this writing, this debate continues to rage on.
A common argument against muscle strengthening exercise is that the there is not enough scientific proof of the benefits of exercise or barefoot activity. This is true, but initial research is leaning in the direction that muscle strengthening is beneficial.
Preliminary Research Leans in Favor of Muscle Strengthening Exercise
In 2008, breakthrough research was published that proved muscle fatigue (or muscle weakness) results in a lower arch. Specifically, fatigue of the plantar muscles of the foot cause flattening of the foot (worsening pronation) (Headlee et al).
Further, Dr. Benno Nigg, one of the world’s foremost experts on biomechanics of the foot, has said that strengthening muscles can, in principle, increase the arch of the foot, though he hasn’t seen a clinical study to prove this yet.
In my own foot I noticed changes with barefoot running. Clinically, the arch of my foot increased. The foot looked stronger, more robust. I then took an x-ray of the side of my foot while bearing weight and compared the x-ray with the one I took before barefoot running–the height of the arch had not changed.
Is this proof barefoot activity fails to increase the height of the arch? Not at all. In fact, this little “experiment” is not proof of anything. Interestingly, there were other radiographic changes on the side-view x-ray of my foot: my foot shortened in length ever so slightly. Specifically, the metatarsals (the bones in my forefoot) had become more angled downward (more plantarflexed) and as a result my foot shortened. This finding has occurred with other barefoot runners and was documented in a research paper by Steven Robbins as an incidental finding in a barefoot-related paper.
Final Thoughts on Foot Strengthening
Without the strength of our foot muscles, the mechanical stress of walking is borne solely by our bones, ligaments and connective tissue, and without good muscular support, these structures become more likely to sustain injury: foot or ankle strain or sprain. An alternative to maintaining strong, supportive muscles is using a strong supportive arch support, shoe or orthotic.
The scientific literature recognizes the value of orthotics and arch supports, and is starting to recognize the value of foot strengthening exercises. In 2006 Jam states: Efforts should be made to address the dynamic control of pronation through neuromuscular exercises rather than purely through mechanical means. In 2003 Fiolkowski et al and Franco in 1987 advocated: Strengthening of the intrinsic and extrinsic muscles may help to increase muscular support of the arch.
If you are going to start barefoot activity or foot exercise, be sure to start slow and build up gradually. Feel free to peruse some introductory foot exercises HERE.
Fiolkowski P, Brunt D, Bishop M, Woo R, Horodyski M. Intrinsic pedal musculature support of the medial longitudinal arch: an electromyography study. J Foot Ankle Surg. 2003 Nov-Dec;42(6):327-33.
Headlee DL, Leonard JL, Hart JM, Ingersoll CD, Hertel J. Fatigue of the plantar intrinsic foot muscles increases navicular drop. J Electromyogr Kinesiol. 2008 Jun;18(3):420-5. Epub 2007 Jan 8.
Robbins SE, Hanna AM. Running-related injury prevention through barefoot adaptations. Med Sci Sports Exerc. 1987 Apr;19(2):148-56.