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"Foot core" strengthening and calf raises; a magic bullet for injury prevention in runners and athletes generally ?

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  • "Foot core" strengthening and calf raises; a magic bullet for injury prevention in runners and athletes generally ?

    Could the Holy Grail for injury prevention in distances runners be something as simple as foot strengthening ? Things are starting to point that way .

    Foot Core Training to Prevent Running-Related Injuries: A Survival Analysis of a Single-Blind, Randomized Controlled Trial

    Show all authors
    Ulisses T. Taddei, PhD, PT, Alessandra B. Matias, MSc, PT, Marcos Duarte, PhD,
    First Published November 6, 2020 Research Article Find in PubMed



    Running-related injuries (RRIs) are a pervasive menace that can interrupt or end the participation of recreational runners in this healthy physical activity. To date, no satisfactory treatment has been developed to prevent RRIs.


    To investigate the efficacy of a novel foot core strengthening protocol based on a ground-up approach to reduce the incidence of RRIs in recreational long-distance runners over the course of a 1-year follow-up.

    Study Design:

    Randomized controlled trial; Level of evidence, 1.


    The participants, 118 runners, were assessed at baseline and randomly allocated to either an intervention group (n = 57) or a control group (n = 61). The intervention group received an 8-week training course focused on the foot-ankle muscles, followed by remotely supervised training thereafter. Assessments consisted of 3 separate biomechanical evaluations of foot strength and foot posture and a weekly report on each participant’s running distance, pace, and injury incidence over 12 months.


    The control group participants were 2.42 times (95% CI, 1.98-3.62) more likely to experience an RRI within the 12-month study period than participants in the intervention group (P = .035). Time to injury was significantly correlated with Foot Posture Index (P = .031; r = 0.41) and foot strength gain (P = .044; r = 0.45) scores. This foot exercise program showed evidence of effective RRI risk reduction in recreational runners at 4 to 8 months of training.


    Recreational runners randomized to the new foot core strengthening protocol had a 2.42-fold lower rate of RRIs compared with the control group. Further studies are recommended to better understand the underlying biomechanical mechanisms of injury, types of injuries, and subgroups of runners who might benefit maximally.


    NCT02306148 ( identifier).

  • #2
    This paper from Taddei et al 2020,will come of nothing of a surprise to those familiar with the work of Susan Mayes ,head physio over at Australian Ballet .For the past 20 years she has successfully used intrinsic foot muscle exercises and calf raises as a staple for injury prevention among this group of athletes . Within the ballet world she has become a bit of a legend with top class dancers from around the world seeking her help .

    Here is a bit more about her :
    1. Here is some information on Sue Mayer which might be of use if you are interested in injury prevention ;

      Susan Mayes is a physiotherapist who heads up a medical team which has drastically cut the number of injuries among the members of the Australia Ballet group . Their methods have been have been noted by the global ballet community and in one instance ,a prominent dancer from the US was given his career back by their treatment .
      Among a number of other measures , Mayes focuses on the strength of the calf musculature and the strength of the intrinsic foot muscles , and dancers do supplementary exercises in these areas . That's worth noting ; athletes who are dancing for many hours a day , often explosively and in minimal shoes ,benefit from targeted intrinsic muscles training which seems to help prevent injury .

      This is one factor that puts Mayes years ahead of researchers who believe that training in minimal shoes will strengthen the intrinsics and lead to injury reduction . She found that even among dancers trained from an early age ,insufficiently strong intrinsics and minimal shoes can lead to injury . Specific strengthening seems to be required through exercises such as doming .

      .From a recent article in The Australian from an article titled "Is this Elite sports top physio " by Emma Sandall , around Dr Sue Mayers and her work with the Australian Ballet .

      "Mayes also emphasises the importance of strengthening the calf and intrinsic muscles in the foot for all athletes. One study has shown that the foot can generate 17 per cent of power through the body.
      “If you don’t pay attention to strengthening it, you can waste all that potential power,” says Mayes. “Not to mention its potential for injury prevention and management.”
      End quote

      Put simply Mayes seems to be better at prehab and rehab than anyone else when it comes to the foot and ankle .The results looked at over about 20 years ,with 180 professional athletes/dancers , bear that out .

      It's all in the feet: Intrinsic foot strength in dancers | Dance ... › health › its-all-in-the-feet-in...
      4 Sep 2019 - Grouped together, they are called the 'Intrinsic muscles', named because their origin and insertion is within the foot. They work specifically across ...


    • #3
      So what sort of exercise protocol did Taddei et al use ?

      Well ,it's an extensive set of exercises , probably because of the difficulty that strengthening the foot intrinsics presents.
      The authors will no doubt be aware of the possibility of targeting all of the relevant muscles with a single exercise (see Bruening et all 2019 ,figure c ) and this might cut any exercise program down to 10 mins x2 a week .

      Going back to Mayes and Australian Ballet it should be noted that specific targeted foot exercises are likely to be carried out more diligently by professional dancers than by recreational runners .

      Also worth considering is the following .
      Mayes's methods over the last 20 years will have been very much judged on results .
      It doesn't matter if she has great patter , a string of letters after her name or even if she is married to the company director or the Australian Prime Minister .If what she does doesn't work ,out she goes . Injuries cost money and the bean counters see only the figures .

      Clearly ,to have lasted so long in one place in what could be called professional athletics ,she must be doing things better than possible replacements .

      If you are involved in prehab/rehab with athletes , why are you not doing what Mayes does ?

      Bruening et al link tudy


      • #4
        Re the Taddei paper ,an injury reduction rate of 50% just by strengthening the feet sounds unlikely . However the paper linked to below ,by Farris et al 2019 ,demonstrates that without properly functioning intrinsic foot muscles push off is impaired in both walking and running , necessitating altered gait strategy with obvious and significant knock-on effects throughout the lower body .

        The functional importance of human foot muscles for bipedal ... › content

        17 Jan 2019 — The Nerve Block. Measurement of the peak-to-peak M-wave response of the flexor digitorum brevis (FDB; Fig. ... Foot power was calculated as per Takahashi et al. (28) and ... Kelly LA,; Farris DJ,; Lichtwark GA,; Cresswell AG.
        by DJ Farris ‎2019 ‎Cited by 52Related articles