Foot Core Training to Prevent Running-Related Injuries: A Survival Analysis of a Single-Blind, Randomized Control Trial

SLR - October 2021 - Kevan Patel

Level of Evidence: Level 1

Scientific Literature Review

Reviewed By: Kevan Patel, DPM
Residency Program: St. Joseph Medical Center – Houston, TX

Podiatric Relevance: Recreational running is becoming increasingly popular, but with that comes an increase in running-related injuries (RRI). Common preventative measures such as warming up, cooling down, and stretching lack scientific evidence of being effective. Studies on programs to reduce RRIs have also yielded uninspiring results. However, studies on strengthening the foot and ankle muscles, especially the intrinsic, have been reported to be effective in reducing RRIs and increasing performance. The purpose of this study was to investigate the effectiveness of a novel foot muscle strengthening program in reducing the incidence of an RRI. 

Methods: This was a survival analysis of a single blind, randomized controlled study where 118 runners were assessed at baseline and randomly allocated to either an intervention group (IG) or a control group (CG). Inclusion criteria were ages 18-55 years, one year of running between 20-100 km per week, no RRI in the two months before baseline assessment, no experience running barefoot or in minimalist shoes, no history of lower limb surgery, and no chronic diseases or impairments that could influence running performance, such as osteoarthritis. The IG underwent an eight-week training course of 12 exercises focused on the foot-ankle muscles and the CG instructed to do a five-minute stretching protocol, with both cohorts doing their respective protocols three times a week, followed by remotely supervised training thereafter by a physical therapist. Assessments consisted of three separate biomechanical evaluations of foot strength and foot posture at baseline, eight weeks and 16 weeks, and a weekly report on each participant’s running distance, pace and injury incidence over a 12-month period. 

Results: The authors found that the CG participants were 2.42 times more likely to sustain a RRI in 12 months than IG participants, with a RRI occurring in 20 participants from the CG and 8 participants from the IG. Foot position index, a value indicative of the strength of the runner’s foot, was significantly correlated with time to injury and suggested that the higher a runner’s FPI, the longer it would take to develop a RRI. No differences were seen in running volume or RRI risk among the two groups. The only predictive risk factor was age for this study, for which they found that for each year of age increase was associated with 1.07-fold increase in RRI risk, which correlated with previous studies. And found that four to eight months of the foot exercise protocol was effective in reducing RRI risk

Conclusions: The authors concluded that this novel foot muscle strengthening and training protocol showed a lower rate of RRIs compared with runners and an effective RRI risk reduction in recreational runners at four to eight months of training. They did acknowledge limitations in the study but this offers a great baseline and insight for future research. This study offers us good potential advice to our practicing professionals in Podiatry and our Physical Therapist colleagues that we can pass on to our patients that are runners that they could potentially prevent injury by strengthening their muscles in their foot.