The foot is composed of 26 bones held together with ligaments that form two crossing arches of the foot. The intrinsic foot muscles provide local stability to the arch, while the extrinsic foot muscles provide movement of the foot for ambulation. When the intrinsic foot muscles are not functioning properly, the foundation of the foot becomes unstable, misaligned, and abnormal movement of the foot ensues. This misalignment and abnormal movement eventually causes foot-related problems. Plantar fasciitis, posterior tibialis tendon dysfunction, metatarsalgia, and claw toe deformity are some of the foot conditions that can develop.
Current clinical guidelines for many of these foot disorders include the use of orthotic devices, but often do not consider exercises to strengthen the intrinsic muscles of the foot. It would make sense to attempt to correct the deficits in foot strength and stability rather than compensate for them with the use of passive supports such as custom orthotics. Treatment of most other musculoskeletal disorders (knees, shoulders, spinal problems, etc.) all employ strengthening exercises to correct the disorder, but somehow the foot has been excluded?
Assessment of intrinsic foot muscle weakness is lacking gold standards. Most tests employ testing toe flexion strength either manually or through dynometry or assessment of foot atrophy though imaging studies. More recently the intrinsic foot muscle test has been proposed as a functional assessment of a patient’s ability to maintain a neutral foot posture and medial longitudinal arch height during single limb stance.
Traditionally rehabilitation strategies to increase foot intrinsic muscle strength utilize towel gathering and marble pick up exercises. Currently, core foot stabilization programs involving the use of a maneuver called the “short foot exercise” are being advocated. These programs are being compared and modeled after core stabilization programs commonly used in the rehabilitation of many spinal disorders. The short foot exercise can be viewed as a foundational exercise for foot and ankle rehabilitation similar to how the abdominal drawing in maneuver or pelvic tilting maneuvers are fundamental to trunk/core stability exercise programs.
The short foot exercise (see video below) has been described as a means to isolate contraction of the plantar intrinsic muscles. The foot is ‘shortened’ by using the intrinsic muscles to pull the first metatarsophalangeal joint towards the calcaneus as the medial longitudinal arch is elevated. Emphasis should be placed on the patient learning to sense subtalar neutral with the calcaneus and the metatarsal heads on the ground and the toes neither flexed nor extended. The short foot exercise can be progressed from sitting, to standing, to single leg standing positions, and eventually functional activities such as squats and single leg hops for the higher level patient.
Studies have demonstrated that 4 weeks of performing the short foot exercise program increases arch height, improves balance, great toe flexion strength, and self-reported ankle/foot function.
McKeon, P. O., Hertel, J., Bramble, D., & Davis, I. (2015, March 1). The foot core system: A new paradigm for understanding intrinisic foot muscle function. Br J sports Med, 49(290), 1-9.
Don Stover PT
husband and father
PT in private practice
TKD black belt (retired)
hapkido black belt (retired)
outdoor cooking fanatic
hot tub soaker
Thanks for visiting my blog page. My name is Don Stover. I am a seasoned physical therapist in Oklahoma City OK. with over 20 years in the biz. I have a lot of knowledge and training in orthopedic PT and spine care. I will be sharing my thoughts on physical therapy for orthopedic problems such as spinal pain, extremity joint pain, sports injuries, health/fitness, and life in general. I hope you enjoy reading!
Forward Thinking PT
Evidence In Motion
The Naked Physio
The Sports Physio