View Full Version : Toe training coupled with balance perturbation training

Gerrard Farrell
10-13-2016, 12:19 PM
With regard to Dr Mickles work on toe flexors (see ref below ) it might be said that strengthening these muscles gives the body more effective tools for foot related tasks .

Balance perturbation studies have shown that balance perturbation training may have the potential to reduce falls in older people . That is , perturbation training may improve the bodies ability to use the tools available to it to resist falls .

What would happen if you ran together Dr Mickles program for toe flexor strengthening and balance perturbation training ? That is ,improve the tools AND the ability to use them .

Might there be a synergistic effect ?


Efficacy of a progressive resistance exercise program to increase toe flexor strength in older people (http://dx.doi.org/10.1016/j.clinbiomech.2016.10.005)Available online 7 October 2016

Karen J. Mickle | Peter Caputi | Jan M. Potter | Julie R. SteeleReduced toe flexor strength is an independent predictor of falls in older people. However it is unknown whether strengthening programs can restore toe flexor strength in older individuals. The aim of...

Any thoughts ?

Gerrard Farrell
10-20-2016, 12:08 PM
With regard to measuring toe flexor strength I believe it is important to considered measuring toe strength with the toes in a dorsiflexed ,toe off like position . This is particular true if toe strength is to be looked at in the context of falls prevention .
The following method ,which would use a pressure mat/force plate combination to measure generated forces ,may allow this type of measurement .
Use of the system would require the direction of a suitably qualified examiner for accuracy and safety and it would not be attempted by an individual at home or injury may result .

The method would simply involve the subject standing with one arm out stretched touching a wall and with the reference foot in an late stance position on the pressure mat /force plate so that the ankle is plantarflexed but the toes dorsiflexed .The subject would then be asked to push forwards against the arm/wall by flexing the rear toes . This might give a more accurate idea of the strength of the intrinsics .
The stance would also involve having the shoulder of the extended arm positioned behind the forward foot placement .
For clarity , the front foot would be about 2 feet in front of the rear or reference foot .The method might give the most functionally accurate idea of intrinsic toe strength particularly as it relates to the establishment of a stable position after a balance perturbation such as a trip .

The extrinsic toe flexors are thought by some to function isometrically during gait so this is probably the best way to measure their capacity .
Again all that is required is the mat/plate and a wall . The idea is to measure the force that can be applied THROUGH the toes and not applied BY the toes .

The test subject stands with the test foot on the pressure mat but now with there back to a wall . The heel of the test foot would be about 6 inches from the base of the wall . The non test foot is moved fowards about a 40 cm and makes light contact with the ground to avoid loss of balance . With their lower back touching the wall the subject now leans forwards at the waist till the COG is just over the MTFI of the test foot (. The forward foot keeps this stable ) . The subject is asked to stay in a forward lean but drive through their test foot toes to push their lower back against the wall as hard as possible .
The result would give a good Idea of the max force that could be exerted THROUGH the toes to avoid forward progression of the COG over them and hence of the combined intrinsic and extrinsic toe strength .

The rational of the positions is that in a trip situation position 2 represents the foot acting as a lever arm against which the muscles of the body can act to slow the forward progression of the COM and also allow the contralateral hip to slow in absolute terms but accelerate relative to the contact side allowing any necessary additional strides to be taken in time to avoid a fall .
Once forward progression of COM has been stopped the COM will be either directly over the blocking or forward foot but will most likely be behind this foot . This means that the COM will begin to move backwards and inwards unless the posterior leg can stop this movement and achieve equilibrium . This is were the 1 position is relevant .

A pressure mat system would be placed on top of a force plate and secured to it via, for example ,a temporary glue . This would allow both vertical and horizontal force components to be measured and collated .
With regard to the above it might also be reasonably assumed that if the two named measuring position are valid then these would also be valid isometric strengthening positions .
Any thoughts ?

DISCLAIMER -- As far as I am aware the measurement and strengthening positions mentioned in the text above are untested and it is important to note that I am not recommending their use but merely putting them up for discussion .
The author accepts no liability for any injury resulting from using the positions mentioned in the above text.
Unsupervised use of the said positions may result in injury .

Gerrard Farrell


Gerrard Farrell
11-02-2016, 04:59 AM
Further to the previous two posts in this thread, but particularly to the first and Dr Karen Mickles work on toe flexor strength ,I thought the following might be of interest .

I recently came across a very interesting BSc thesis by a gentleman called Jonathan W .Wallace . The paper is titled
"Vestibular modulation of the abductor hallucis and abductor digiti minimi muscles in response to changes in head position, visual cues, and cognitive demand " and can be read in full by following the link given below .
Not much I can really add to the quotations from the paper given below other than to say that if the intrinsic foot muscles are significantly atrophied then their contribution to upright standing balance control will likely be reduced .
Strengthening the atrophied intrinsics of older people may therefore improve standing balance control .


from abstract -
"The purpose of this experiment was to determine if
intrinsic foot muscles are modulated by vestibular activity and to elucidate any changes in the association between the vestibular stimulation and electromyography (EMG) responses in response to changes in head position, visual cues, and cognitive demand "

page 7
"Muscles which are tonically active, but not involved in
maintaining balance do not exhibit a vestibular myogenic response (Britton et al. 1993;
Forbes et al. 2015). Therefore, it appears that vestibular-evoked muscle responses only occur in those muscles important to maintaining the upright postural task. "

page 38
"The findings of this study demonstrate that the vestibular system is able to
modulate activity in the abductor hallucis and abductor digiti minimi during standing. "
" The abductor hallucis and the abductor digiti minimi are likely important
contributors to upright standing balance control and they are capable of dynamic
vestibular responses which can be modulated by other sensory feedback as well as by cortical activity. "

PAPER -----
Presented to the Department of Human Physiology
and the Robert D. Clark Honors College
in partial fulfillment of the requirements for the degree of
Bachelor of Science
June 20
VESTIBULAR MODULATION OF THE ABDUCTOR HALLUCIS AND ... (https://scholarsbank.uoregon.edu/xmlui/handle/1794/20383)

by J Wallace - ‎2016
7 days ago - The purpose of this experiment was to determine if intrinsic foot musclesare modulated by vestibular activity and to elucidate any changes in the association ...
Gerrard Farrell

scotfoot (https://podiatryarena.com/index.php?members/scotfoot.15859/), Saturday at 11:56 AM