Don't Forget Your Toe Flexors!

By Dr. Cathlin Fitzgerald, PT, DPT, CSCS

Plantar fasciitis can be a frustrating, nagging running injury. It can range across a wide spectrum of pain; maybe more annoying most of the time, but it can be completely debilitating after a hard run or getting out of bed in the mornings.

There have been cases as short as a few weeks and some as long as a year. Plantar fasciitis recovery typically occurs on our usual time vs improvement graph; a big jump in improvement over a short period of time, then smaller incremental improvements over longer periods of time, with little bumps along the way.

As a result of this, we are constantly looking at ways to improve and expedite the treatment of plantar fasciitis. A number of things have been proven as effective treatment,  including calf strengthening, adequate calf muscle length (flexibility), and toe flexor strength (a specific muscle of the foot intrinsic muscle group). “Foot intrinsics” is an umbrella term you’ll often hear in physical therapy.

An article from German researchers made an excellent point about how we typically focus on toe flexor strengthening. You’ll often see exercises such as “doming” (lifting your foot arch with your foot flat on the floor) and towel scrunching (standing on a towel and scrunching it up closer and closer with your toes) used in physical therapy. These are exercises work well and are great for certain things, but there are better ways to strengthen the toe flexors for runners.

As runners, we use our toe flexors when we push off of the ground. The key here is that you’re on your toes; the foot is in a plantarflexed (pointed) position. The plantarflexed foot position puts the toe flexors in a lengthened (stretched out) position for when they push and do their work. So for runners it makes sense that the toe flexors need to be strengthened in a plantarflexed position, not when the foot is flat on the ground in doming or towel scrunching exercises.

The study showed dramatic increases in toe flexor strength after 7 weeks of strength training in a plantarflexed position, ranging from 60-70% strength improvements.

The takeaway here is that if you want to strengthen your toe flexors, do it in an efficient and effective way. Trying propping your heels up so that they’re higher than your toes before doing your towel scrunches. Or better yet, work up to standing on your toes and doing the towel scrunches! Work smarter, not harder!

Goldmann JP Sanno M Willwacher S et al.  “The potential of toe flexor muscles to enhance performance”. Journal of Sport Sciences. 2013; 31(4): 424-433.