Clinical Pilates in Practice: Toe Flexor Strength & Mobility

This study sought elucidate the influence that foot posture has on the relationship between toe flexor strength and functional performance in older adults. The authors recognise the study's limitations: the study cohort was limited to women, and did not measure body kinematics or muscle activity.

Kusagawa, Y., Kurihara, T., Imai, A., Maeo, S., Sugiyama, T., Kanehisa, H., & Isaka, T. (2020). Toe flexor strength is associated with mobility in older adults with pronated and supinated feet but not with neutral feet. Journal of foot and ankle research, 13(1), 55. https://doi.org/10.1186/s13047-020-00422-y

Key Points: Toe Flexor Strength & Mobility In Older Adults

• Both pronated and supinated foot postures influence rearfoot frontal plane motion, plantar pressure distribution, and muscle activity in the lower limb during gait.

• Individuals with pronated feet require increased intrinsic muscle activity to stabilize the transverse tarsal joint, which enhances the generation of propulsive force.

• Individuals with supinated feet have a decreased peak rearfoot eversion angle and midfoot eversion angle during gait.

• Previous studies show that reduced toe flexor strength appears to be a risk factor for falls in older adults; toe flexor strength therefore determines mobility in older adults.

Reduced toe flexor strength appears to be a risk factor for falls in older adults; toe flexor strength therefore determines mobility in older adults.

• In older adults with pronated or supinated feet, toe flexor strength is significantly correlated with comfortable walking speed.

  → This is likely a compensatory strategy for altered lower limb biomechanics that occur as a result of foot pronation or supination.

  → Older adults with neutral feet do not exhibit a correlation between toe flexor strength and walking speed.

Clinical Pilates in Practice

• Increased toe flexor strength is a compensatory strategy in older adults, and thus toe flexor strengthening without consideration of the underlying biomechanics changes at the foot may not be an optimal treatment goal.

• If not already part of your studio repertoire, consider the Toe Gizmo or the Foot Corrector.

  → Both pieces of equipment can be easily replicated with bands and half-balls.

• In standing, ensure weight distribution over the tripod of the foot.

  → Standing Arm Springs at the Tower.

  → Standing Leg Press at the Wunda Chair.

• Build intrinsic foot muscle strength with the foot in as-close-as-possible to a neutral position.

  → Joint mobilisations and soft tissue techniques may be indicated.

  → Reformer, Cadillac, and Wunda Chair footwork with neutral rearfoot and midfoot positioning.

  → Parakeet.