Clinical Pilates in Practice: Toe Flexor Strength & Mobility (March 2022)


This study sought elucidate the influence that foot posture has on the relationship between toe flexor strength and functional performance in older adults. The authors recognise the study's limitations: the study cohort was limited to women, and did not measure body kinematics or muscle activity.


Kusagawa, Y., Kurihara, T., Imai, A., Maeo, S., Sugiyama, T., Kanehisa, H., & Isaka, T. (2020). Toe flexor strength is associated with mobility in older adults with pronated and supinated feet but not with neutral feet. Journal of foot and ankle research13(1), 55.



  • Both pronated and supinated foot postures influence rearfoot frontal plane motion, plantar pressure distribution, and muscle activity in the lower limb during gait.
  • Individuals with pronated feet require increased intrinsic muscle activity to stabilize the transverse tarsal joint, which enhances the generation of propulsive force.
  • Individuals with supinated feet have a decreased peak rearfoot eversion angle and midfoot eversion angle during gait.
  • Previous studies show that reduced toe flexor strength appears to be a risk factor for falls in older adults; toe flexor strength therefore determines mobility in older adults.

 Reduced toe flexor strength appears to be a risk factor for falls in older adults; toe flexor strength therefore determines mobility in older adults.

  • In older adults with pronated or supinated feet, toe flexor strength is significantly correlated with comfortable walking speed.
    • This is likely a compensatory strategy for altered lower limb biomechanics that occur as a result of foot pronation or supination.
    • Older adults with neutral feet do not exhibit a correlation between toe flexor strength and walking speed. 


  • Increased toe flexor strength is a compensatory strategy in older adults, and thus toe flexor strengthening without consideration of the underlying biomechanics changes at the foot may not be an optimal treatment goal.
  • If not already part of your studio repertoire, consider the Toe Gizmo or the Foot Corrector.
    • Both pieces of equipment can be easily replicated with bands and half-balls.   
  • In standing, ensure weight distribution over the tripod of the foot.
    • Standing Arm Springs at the Tower.
    • Standing Leg Press at the Wunda Chair.  
  • Build intrinsic foot muscle strength with the foot in as-close-as-possible to a neutral position.
    • Joint mobilisations and soft tissue techniques may be indicated.
    •  Reformer, Cadillac, and Wunda Chair footwork with neutral rearfoot and midfoot positioning.
    • Parakeet.


Keep up to date with research relevant to your clinical Pilates practice.

The Calibrate Pilates team translates research into clinically relevant information so that you can build your core practice and improve client outcomes. 

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