The effect of interventions anticipated to improve plantar intrinsic foot muscle strength on fall-related dynamic function in adults: a systematic review. Willemse, L., Wouters, E.J.M., Bronts, H.M., Pisters, M.F., Vanwanseele, B. J Foot Ankle Res 15:3 (2022) 

Below is the second review summary in this series. We recommend reading the entire article to get a deep understanding of the literature, which can be accessed for free here.

There is only limited evidence that strengthening of plantar intrinsic foot muscles improves falls-related foot function 

Every year, approximately one third of all adults over 65 sustain a fall at least once, with one third of all falls resulting in serious injury. Altered gait and balance deficits are common and a strong determinant of falling in older people. One factor that is believed to contribute to altered gait and balance is the decreased force-producing capacity of plantar intrinsic foot muscles in older adults. Strengthening of the plantar intrinsic foot muscles has been found to be effective in the treatment and prevention of conditions such as plantar fasciitis. However, it is not known how such a training program may influence falls related dynamic activities. 

This systematic review by Lydia Willemse and colleagues aim to provide insight into the evidence related to strengthening of plantar intrinsic foot muscles on balance and gait. 



An initial search of the literature found 9198 records which was subsequently reduced to 11 studies that met the inclusion criteria. The overall quality of the included studies was low, and only five studies were of adequate quality to allow for data to be included in the review. This indicates that little is known about the effects of plantar intrinsic foot muscles strengthening on fall-related dynamic function.  

The data that was able to be included was from studies with small sample sizes, and generally included strength training programs performed by young participants. The data revealed low certainty evidence for the beneficial reduction in vertical ground reaction force impulse during running. Further, very low evidence indicated that strengthening of plantar intrinsic foot muscles improved balance. However, there was risk of bias and uncertainty about measurement equipment in the studies that produced these data.  

This review found that there was, at best, low certainty evidence that strengthening of plantar intrinsic foot muscles improves dynamic foot function and balance control. There is a need for high quality studies that aim to investigate the effect of functional strengthening exercises for the plantar intrinsic foot muscles in large samples of older people.  

Read the full study here.