Current Exercise Approaches in Foot and Ankle Pathologies

Abstract

The foot performs its main functions, including bearing body weight, shock absorption, adaptation to different ground surfaces, storage and return of elastic energy, and modifying its rigidity throughout gait, thanks to the arches present in its structure. In this section, the structures supporting the foot arches and their training are explained through the concept of the foot core system. The foot core system consists of passive, active, and neural subsystems. In the active subsystem, which can be developed through exercise, the specialized functions of the plantar intrinsic and extrinsic muscles are emphasized. Training of intrinsic foot muscles, with the short foot exercise being the most studied, is reported to be effective in correcting foot alignment and improving foot and ankle function and dynamic balance in long-distance runners, adults with foot and ankle conditions such as flatfoot, plantar fasciitis, chronic ankle instability, and diabetic foot, as well as in adults with normal foot posture. Moreover, for common foot problems, including Achilles tendinopathy, chronic ankle instability, and plantar fasciitis, exercise methods specifically recommended for each problem and proven to be effective are also explained. Exercise rehabilitation is considered the primary approach for the conservative management of Achilles tendinopathy, with the loading of the tendon through eccentric exercise standing out. In the rehabilitation of chronic ankle instability, strength training, balance training, and joint mobilization are prominent in the current literature, with strength training reported as the best choice for improving joint position sense. Strengthening the peroneal muscles, the main evertors of the ankle that provide lateral ankle stability, is essential in exercise rehabilitation. For plantar fasciitis, a combination of stretching and extracorporeal shock wave therapy is suggested to provide better results compared to either alone. The most studied exercises for plantar fasciitis are plantar fascia stretching and Achilles tendon or calf stretching exercises, with plantar fascia stretching suggested to be better. This section contains illustrated explanations and exercise prescription recommendations for the mentioned exercises.