title: The foot core system: a new paradigm for understanding intrinsic foot muscle function.
abstract: The foot is a complex structure with many articulations and multiple degrees of freedom that play an important role in static posture and dynamic activities. The evolutionary development of the arch of the foot was coincident with the greater demands placed on the foot as humans began to run. The movement and stability of the arch is controlled by intrinsic and extrinsic muscles. However, the intrinsic muscles are largely ignored by clinicians and researchers. As such, these muscles are seldom addressed in rehabilitation programmes. Interventions for foot-related problems are more often directed at externally supporting the foot rather than training these muscles to function as they are designed. In this paper, we propose a novel paradigm for understanding the function of the foot. We begin with an overview of the evolution of the human foot with a focus on the development of the arch. This is followed by a description of the foot intrinsic muscles and their relationship to the extrinsic muscles. We draw the parallels between the small muscles of the trunk region that make up the lumbopelvic core and the intrinsic foot muscles, introducing the concept of the foot core. We then integrate the concept of the foot core into the assessment and treatment of the foot. Finally, we call for an increased awareness of the importance of the foot core stability to normal foot and lower extremity function.
authors.affiliation: Department of Exercise and Sport Sciences, School of Health Sciences and Human Performance, Ithaca College, Ithaca New York, USA.
authors.forename: Patrick O
authors.initials: PO
authors.lastname: McKeon
authors.affiliation: Department of Kinesiology, Curry School of Education, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Hertel
authors.affiliation: Department of Biology, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Bramble
authors.affiliation: Department of Physical Medicine and Rehabilitation, Spaulding National Running Center, Harvard Medical School, Cambridge, Massachusetts, USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Davis
mesh_terms: D005075:Biological Evolution; D005081:Exercise Therapy / Q000379:methods; D005528:Foot / Q000033:anatomy & histology / Q000294:innervation / Q000502:physiology*; D005529:Foot Bones / Q000033:anatomy & histology / Q000294:innervation / Q000502:physiology; D005534:Foot Diseases / Q000628:therapy; D033023:Foot Joints / Q000033:anatomy & histology / Q000294:innervation / Q000502:physiology; D006801:Humans; D008023:Ligaments, Articular / Q000033:anatomy & histology / Q000294:innervation / Q000502:physiology; D009068:Movement / Q000502:physiology; D009119:Muscle Contraction / Q000502:physiology; D009126:Muscle Relaxation / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000033:anatomy & histology / Q000294:innervation / Q000502:physiology*; D011984:Sensory Receptor Cells / Q000502:physiology; D012775:Shoes; D013710:Tendons / Q000033:anatomy & histology / Q000294:innervation / Q000502:physiology
keywords: Biomechanics; Core stability/pelvis/hips, ribs; Foot Injuries; Podiatry