Skip to content


  • Meeting abstract
  • Open Access

Relationship between intrinsic foot muscle weakness and pain: a systematic review

  • 1Email author,
  • 1, 2,
  • 1 and
  • 1
Journal of Foot and Ankle Research20147 (Suppl 1) :A51

  • Published:


  • Systematic Review
  • Significant Relationship
  • Muscle Strength
  • Quality Index
  • Muscle Weakness


Foot muscle weakness has been linked with painful foot pathologies. This systematic review evaluated the relationship between foot muscle weakness and foot pain in adults.


Electronic databases (AgeLine, MEDLINE, CINHAL, AMED, Scopus, SPORT Discus, Web of Science) and reference lists were searched for all years up to March 2013. Two independent reviewers rated all included papers for methodological quality using a modified checklist from the Quality Index Tool. Due to the heterogeneity of studies, no data were pooled for meta-analysis.


Seven studies evaluated the relationship between foot muscle weakness and foot pain. Methodological quality varied from poor (40%) to very good (89%). Four studies reported a significant relationship between foot muscle weakness and foot pain. Participants with plantar fasciitis were reported to have significant foot pain associated with a decrease in the cross-sectional area of the forefoot musculature and reduced toe flexor force. A study considering non-specific foot pain found a significant difference in dynamic toe flexor force between participants with disabling foot pain versus no pain on some day(s) and on most/every day. Finally, a clinical trial evaluating hallux limitus reported a significant improvement in pain and hallux plantar muscle strength after treatment. Of the three studies reporting no association, two reported only on hind foot muscles and one had a restricted sample. Summary of data extracted and quality index scores is shown in Table 1.
Table 1

Summary of Participant Characteristics, Outcome Measures and Quality Index Scores of Included Studies


Munteanu et al. 2012[1]

Duranti et al. 1985[2]

Schmid et al. 2009[3]

Chang et al. 2012[4]

Allen et al. 2003[5]

Mickle et al. 2011[6]

Shamus et al. 2004[7]

Sample size


A: n=15

A: n=80

A: n=8

A: n=20


A: n=10


B: n=5

B: n=80

B: n=8 Bilat

B: n=20


B: n=10

Mean age (SD), yrs

54.5 (11.2)

A: 55.4

A: 48

44.9 (8.4)

A: 44.9 (9.2)

71 (6.5)

A: 32 (6.3)


B: 51.7

B: 48


B: 43.1 (8.0)


B: 33.6 (5.4)


95 M 56W

A: 5M 10W

A: 38M 42W

1M 7 W

A: 4M 16W

158M 154W

A: 2M 8W


B: 2M 3W

B: 38M 42W


B: 4M 16W


B: 3M 7W

Pathology a

OA of 1st MPJ

HV/Chronic pain

Foot pain

Plantar fasciitis

Plantar fasciitis

Foot pain

Hallux limitus

Muscle tests b





Direct/St. G



Pain scales c





P+≥ 2 mths/A


Verbal p scale









Quality Index Score








Legend: A: Symptomatic Group B: Control Group Bilat - bilateral feet as control.

Pathologya: OA of 1st MPJ- osteoarthritis of 1st metatarsophalangeal joint; HV- hallux valgus.

Muscle testsb: Indirect: MRI- magnetic resonances imaging, EMG- electromyography. Direct: PP- pressure plate, St. G-strain gauge, Dyno- dynamometry.

Pain scalesc: FHSQ- Foot health survey questionnaire; P/A- present or absent; P + ≥ 2mths- present plus greater than or equal to 2 months duration;

FFI- Foot function index; MFPDI-Manchester foot pain and disability index; Verbal pain scale


Despite some conflicting data encountered in this systematic review, there is evidence of a significant association between foot pain and muscle weakness, primarily related to toe flexion and foot pain, when the pain is of frequent disabling intensity.

Authors’ Affiliations

Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, NSW, Australia
Institute for Neuroscience and Muscular Research, The Children's Hospital at Westmead, Sydney, NSW, Australia


  1. Munteanu SE, et al: Rheumatology. 2012, 51 (1): 176-83.2. 10.1093/rheumatology/ker344.View ArticlePubMedGoogle Scholar
  2. Duranti R, et al: American Journal of Physical Medicine. 1985, 64 (6): 295-304.3.PubMedGoogle Scholar
  3. Schmid DT, et al: Radiology. 2009, 253 (1): 160-6.4. 10.1148/radiol.2531090035.View ArticlePubMedGoogle Scholar
  4. Chang R, et al: Clinical Biomechanics. 2012, 27 (5): 500-5.5. 10.1016/j.clinbiomech.2011.11.007.View ArticlePubMedGoogle Scholar
  5. Allen RH, et al: Journal of Orthopaedic & Sports Physical Therapy. 2003, 33 (8): 468-478.6. 10.2519/jospt.2003.33.8.468.View ArticleGoogle Scholar
  6. Mickle KJ, et al: Arthritis Care & Research. 2011, 63 (11): 1592-8.7. 10.1002/acr.20578.View ArticleGoogle Scholar
  7. Shamus J, et al: Journal of Orthopaedic & Sports Physical Therapy. 2004, 34 (7): 368-76. 10.2519/jospt.2004.34.7.368.View ArticleGoogle Scholar


© Latey et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.