The Foot Core System: Understanding the Function of Your Fabulous Feet


When you stop to think about all the work your feet do from day to day, you cannot help but wonder at their amazing strength. If you play sports or do high intensity fitness activities, you should have an even greater appreciation for your foot’s ability to withstand high force loads and produce its own forces.

With so much knowledge of human anatomy in the realm of sports medicine, it may seem surprising to learn that the foot is one of the least understood structures in the human body, and feet are only recently getting the attention they deserve from the human movement scientific community.

The Foot’s Complex Design

The foot is a complex structure whose functions are governed by numerous muscles, ligaments, tendons, nerves and joints that work together to provide balance and stability and produce movement. As such, the human foot has the potential to become weaker or stronger, and sustain and recover from chronic and acute injuries, depending on how it is used.

With that understanding in mind, you might think that rehabilitation of the foot would be approached in the same manner as any other area of the body, using therapeutic exercises, stretches and other treatment measures aimed at restoring or improving strength, range of motion and overall function. Yet interventions for foot-related problems tend to focus on providing external support for the foot through shoes and orthotics, rather than attempting to rehab the foot muscles to function with maximum efficiency.

Your Golden Arches

Central to overall foot function is the arch, or instep. Its ingenious design enables you to walk, run, jump and maintain balance through the recruitment of local stabilizer muscles and global movement muscles. In essence, the arch can be regarded as the “core” of the foot, just as the lumbropelvic region forms the core of the trunk.

Until recently, it was thought that the arch was held in place by passive structures such as bones, joints and ligaments. However, a growing body of research has brought to light the important role played by the intrinsic foot muscles that govern arch function.

The foot’s local stabilizers are the plantar intrinsic muscles that originate and insert on the foot, and the global movers are muscles that originate extrinsically in the lower leg, crossing the ankle joint and inserting on the foot. Both play a role in the foot’s ability to function as designed.

Intrinsic Foot Muscle Function

As we begin to understand more fully the important role played by the intrinsic foot muscles, it becomes increasingly clear that therapy geared toward stretching and strengthening those muscles should be an important part of any rehabilitation treatment protocol.

Functional qualities of the intrinsic foot muscles include:

  • Providing support for the foot arches: When weakened, intrinsic foot muscles lead to negative alterations in foot posture, while strengthening enhances foot posture.
  • Adapting to specific activities: Dynamic movements such as walking or running recruit the intrinsic foot muscles to a greater extent than standing.
  • Adapting to specific loads: Intrinsic foot muscles become more active when greater load demands are placed on them, such as single limb vs double limb stance.
  • Gait synergy: During the propulsion phase of the gait cycle, intrinsic foot muscles work together as a unit to provide dynamic arch support.
  • Modulation during standing and propulsion: Whether your feet are used as a platform for standing or a lever for dynamic propulsion, the intrinsic foot muscles provide support for the foot and arch.

When you consider the important roles played by the intrinsic foot muscles, it seems incomprehensible that they should be ignored during treatment for foot-related problems.



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Benefits of Training the Foot Core

A progression of short foot exercises that emphasize strengthening of the foot arch have been proven effective for realizing important improvements in foot function.

Some benefits of core foot training include:

  • Reduced arch collapse
  • Improved static balance
  • Improved dynamic balance
  • Improved postural control
  • Increased ankle stability

Your feet are designed to walk and run on their own strength, without the support of shoes or orthotic devices. Too much support can actually weaken your intrinsic foot muscles, meaning their function will be sub-par. Any rehab protocol for foot-related problems that ignores muscle strengthening will inevitably fall short of restoring optimal foot function.

Foot and Ankle Care in NYC

The foot and ankle specialists at NYDNRehab are dedicated to finding solutions for foot-related problems that enable patients to achieve optimal function. We understand that your body’s structures do not work independently of one another, and that problems in movement and performance have many moving parts. Do not settle for less than full function of your foot and ankle. Contact NYDNRehab today, and let us treat your foot-related condition and restore your foot function so you can enjoy your busy active life.


Motion capture video

Computerized pressure analysis

SEMG (surface electromyography)

Computerized gait analysis


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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