Use Your Feet to Keep Your Feet

While struggling to run with peripheral artery disease (PAD), I discovered the value of strengthening my feet, especially for effective toe and foot flexion. Imagine gripping the ground with your toes – toe flexion. Imagine gripping the ground with your whole foot – foot flexion.

Flexing my “little” toes: second toe, or “long toe,” third toe, or “middle toe,” fourth toe, or “ring toe,” and the fifth toe, or “little toe”, “pinky toe”, or “baby toe,” the outermost toe, depends largely on contraction of the flexor digitorum brevis muscles (and longus, see below), as you can see in the image, above, though it’s clearly more complex than that.

Flexion of the big toe, or hallux, requires the action of the flexor hallicus longus muscle and tendon.

You can see the long tendon of the flexor hallicus longus muscle inserting under the big toe. By the way, a strain of the flexor hallicus longus muscle has caused me trouble with posterior shin splints, a royal pain I managed to fix by applying pressure to the muslce with my thumb, to encourage the muscle to chill out a bit.

As you can see, flexing either your toes, or your whole foot, involves complex biomechanics. In fact, here’s a more complete list of the muscles and tendons involved, from Healthline at this link.

Plantar flexion involves a coordinated effort between several muscles in your ankle, foot, and leg. These include:

  • Gastrocnemius: This muscle makes up half of your calf muscle. It runs down the back of your lower leg, from behind your knee to the Achilles tendon in your heel. It’s one of the main muscles involved in plantar flexion.
  • Soleus: The soleus muscle also plays a major role in plantar flexion. Like the gastrocnemius, it’s one of the calf muscles in the back of the leg. It connects to the Achilles tendon at the heel. You need this muscle to push your foot away from the ground.
  • Plantaris: This long, thin muscle runs along the back of the leg, from the end of the thighbone down to the Achilles tendon. The plantaris muscle works in conjunction with the Achilles tendon to flex your ankle and knee. You use this muscle every time you stand on your tiptoes.
  • Flexor hallucis longus: This muscle lies deep inside your leg. It runs down the lower leg all the way to the big toe. It helps you flex your big toe so that you can walk and hold yourself upright while on your tiptoes.
  • Flexor digitorum longus: This is another one of the deep muscles in the lower leg. It starts out thin, but gradually widens as it moves down the leg. It helps to flex all the toes except for the big toe.
  • Tibialis posterior: The tibialis posterior is a smaller muscle that lies deep in the lower leg. It’­s involved with both plantar flexion and inversion — when you turn the sole of the foot inward toward the other foot.
  • Peroneus longus: Also called fibularis longus, this muscle runs along the side of the lower leg to the big toe. It works with the tibialis posterior muscle to keep your ankle stable while you stand on tiptoe. It’s involved in both plantar flexion and eversion — when you turn the sole of the foot outward, away from the other foot.
  • Peroneus brevis: The peroneus brevis, also called the fibularis brevis muscle, is underneath the peroneus longus. “Brevis” means “short” in Latin. The peroneus brevis is shorter than the peroneus longus. It helps keep your foot stable while in plantar flexion.

As described in the short video, below, I found foot flexion to be highly effective for improving my run with PAD, especially when running uphill. This, combined with toe separation using Yoga Toes, is where I would start my work today, if I was just starting out on my “running with peripheral arterial disease journey.”

From this work, I concluded that we tend to underuse the muscles that operate our feet, especially the flexors, due to excessive use of shoes, and lack of foot awareness. You can increase your foot awareness by watching our “Yoga Toe” video:

Next time you are out for a walk, consider activating your foot flexors, just for fun, and you’ll find they can help you a lot, especially as you age, or if you have peripheral artery disease.

These muscles dramatically improve my run, thus increasing my chances of ever running a marathon again, or completing another full Ironman race – those are two of my personal goals.

What are your personal exercise-related goals, I wonder.


-kev aka FitOldDog

keep your feet
MRI scans through the thighs of three guys. Grey is muscle, white is fat, clear ring around the central white spot (bone marrow) is the femoral bone. Note the loss of both muscle and bone mass in the sedentary guy.

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Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.