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Volume 7 Supplement 1

4th Congress of the International Foot and Ankle Biomechanics Community

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

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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


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.


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Correspondence to Penelope J Latey.

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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.

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About this article


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