Strengthening exercises

What are strengthening exercises, and how do they work?

Strengthening exercises build muscle strength in your foot and ankle. Examples are towel scrunches (scrunching a towel towards you with your toes) and calf raises¹. They work by asking your muscles to do a little more over time. You make the exercise harder, more like everyday tasks, or add load².

The small muscles inside the foot (the intrinsic foot muscles) are thought to matter for how your toes and foot line up and how well you sense the ground. Weakness in them may lead to instability and falls in older adults³. Foot problems are more often treated by supporting the foot from outside than by training these muscles⁴. Toe curls and up-and-down ankle movements also use the bigger lower-leg muscles heavily, so they're less recommended until you can control the small foot muscles⁵.

What are strengthening exercises used for, and how well do they work?

The best-supported use is chronic ankle instability (an ankle that keeps giving way) in adults. Strength training improves function, balance and strength, and balance training improves a wider range of things⁶. Most of these studies involved young, active people⁶.

For flat feet, the short foot exercise (gently drawing the ball of your foot towards your heel to shorten the foot) is recommended for foot alignment⁵. Doing it for 5 weeks or more may improve the arch⁷. Results vary between trials, so the benefit isn't certain⁵.

In older people, ankle and foot exercises improve some strength and balance measures but didn't reduce falls⁸. Strengthening the small foot muscles in adults aged 65 and over may possibly lower fall risk³. For people with diabetes and nerve damage, the benefits are unclear⁹. For plantar heel pain, an expert-agreed programme exists², but it isn't clear yet whether it works.

Expect gradual change. Some flat-foot trials saw benefit at 4–6 weeks, while at least 8 weeks is considered important for learning the movement⁵. These results don't cover acute ankle sprains, tendon problems or children. If you have new pain, see a podiatrist or physiotherapist rather than guessing the cause.

Are strengthening exercises right for me?

General foot and ankle exercises suit most people in good health with a reasonable level of fitness¹⁰. Older adults who want better balance can ask a physiotherapist about adding ankle and foot exercises to a falls-prevention programme⁸. General strength training in older adults has mainly helped those who are physically well¹¹. Less is known for children, adults over 50 with flat feet, and people with neurological conditions or recent surgery⁵³. After ankle surgery, follow your surgical team's advice.

Self-help exercise sheets may not suit everyone and don't replace an assessment. If you have a health condition, a recent injury or operation, or are pregnant or recently had a baby, check with a doctor, podiatrist or physiotherapist first¹³.

What happens when I do strengthening exercises?

A podiatrist or physiotherapist can show you the exercises and say which suit your foot or ankle. Many programmes start with learning control of the small foot muscles, then build strength⁴.

For the short foot exercise, sit first. Keep your toes relaxed and gently draw the ball of your foot towards your heel. Move on to standing on two feet, then one foot, then squats and single-leg hops, only when you can do each step well⁴. Towel scrunches and heel raises are other gentle starting points. Hold a chair or work surface for support during heel raises and single-leg standing.

No standard number of sets, holds or repetitions has been agreed, and handouts often leave them blank. Ask your clinician to fill in what suits you, and leave rest days between sessions. Programmes get harder by adding load or making the movement more like everyday tasks². It can help to keep a simple record of your pain, balance and what you can do, and share it at review appointments.

What are the risks of strengthening exercises?

In people at risk of foot ulcers, a foot and ankle exercise programme of 8–12 weeks didn't clearly raise or lower the chance of problems⁹. The main risk is doing too much on a sore or injured area. Stop an exercise as soon as it causes pain or you feel unwell, and don't try to work through pain¹¹⁴. Get advice before you restart.

How do strengthening exercises compare with other options?

Strengthening hasn't been shown to be clearly better or worse than orthoses, stretching, manual therapy or taping. Don't drop another treatment because of this; talk through your options with your clinician.

For an ankle that keeps giving way, both strength training and balance training help, and balance training improves a wider range of things⁶. Ask a physiotherapist whether strength, balance training or both suit you. Among exercises for the small foot muscles, the short foot exercise appeared the most effective¹⁵.