Sunday, August 22, 2021

Foot Strengthening To Prevent Running Injuries?

We had a 16 year old patient who came in with footshin and knee pain this week. She had been prescribed orthotics and had been wearing them for the last ten years. Every time she tried running, her knees and shin start to hurt during and the day after her run. Somehow, the orthotics did not seem to help with the pain.

She also mentioned that she wore her running shoes (with orthotics) everywhere she went as she was told that other footwear and slippers were 'bad' for her.

You have read from a previous post that contrary to several long held beliefs, most biomechanical and structural factors are not reliable at predicting running related injuries. Naturally, I was interested when a recent study investigated whether foot muscle strengthening reduced the incidence of injury rates over a one year follow up. Especially since I wrote that my patient (plus myself included) would be bored doing foot strengthening exercises.

Researchers had 118 runners who ran between 20-100 km a week for their study randomized into two groups. The foot muscle strengthening (FMS) group received 8 weeks of 12 foot-ankle exercises done once a week supervised by a physiotherapist and 8 foot-ankle exercises done three times a week at home with remote supervision.

A second control group (CG), did a 5 minute placebo static stretching protocol three times a week with weekly feedback from a physiotherapist. 

After the 8 week intervention, both groups were instructed to continue their respective exercises three times a week until the end of a 12 month follow up while recording their adherence.

The researchers suggestion that a stronger foot will better dissipate excessive and cumulative loads appears supported as foot strength gains were correlated with time to getting injured. 

Altogether, 28 runners ended up with a running related injury, 20 (32.8%) from the CG and 8 (14%) from the FMS group. The results showed that runners in the CG were 2.42 times more likely to suffer a running related injury compared to those in the FMS group. 

The researchers also found that the larger gains in foot strength over the 8 weeks of training correlated with the runners taking a longer time to get injured. They also reported that by the fourth month of follow-up, differences in cumulative running related injury risk were evident between the 2 groups and suggested that 4-8 months of the regime may already be effective.

However, each runners response to foot strength improvement and how this relates to different injury types or sites will require further investigation.

My thoughts are that this foot muscle strengthening regime is exactly the same as wearing the Vibram Five Fingers shoe. Remember them? They were really popular before the thickly cushioned or maximalist shoes became the rage.

In the study, the foot strengthening program takes 20-30 minutes to complete. This time commitment may be a consideration. As a physiotherapist, I should not be writing his, but if I had extra 30 minutes, I'd rather run outside than do foot strengthening exercises. 

I'm just being honest here. There are plenty of demands on my time being a father to 2 young boys, physiotherapist, business owner and trying to find time to exercise. Probably some of you who are also pressed for time would agree.

Back to our patient. I suggested that she remove her orthotics from her running shoes and gradually increase time walking with them first before attempting to run. The toe spring from her shoes and orthotics would lead to her having weaker intrinsic foot muscles and increase her chances of getting pain in her footshin and knees and possibly getting injured.


Taddei UT, Matias AB and Duarte M (2020). Foot Core Training To Prevent Running-related Injuries: A Survival Analysis Of A Single-blind, Randomized Controlled Trial. AJSM. 48(14): 3610-3619. DOI : 10.1177/0363546520969205.

My own minimalist version of the Vibrams that I use to walk around with and lift weights to strengthen my intrinsic foot muscles. My calfs get too sore when I run with them. My brother bought a few pairs for me when he was working in Shanghai for $RMB 30 (or S$6) , much cheaper than Vibrams ($149-$209 here in Singapore).

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