
We hang on hang boards and do pull ups for upper body strength but what do we do for our feet? If our feet are weak, our toes could be in trouble. Toe joints are pushed to end range extension compressing the joint cartilage and stretching passive structures (ligaments and the joint capsule) often leading to joint hypermobility. Strong feet reduce end range loading by providing dynamic stability to the joint and improves foot work through better ability to purchase on small holds.
Eighty to ninety percent of climbers have foot pain while climbing (1). One of the more painful and functionally limiting foot issues associated with climbing are bunions (1,2). Bunions are associated with the custom of wearing very tight-fitting climbing shoes. Read this for more info on the impact of climbing shoes: Re-Thinking the culture of overly tight climbing shoes: How downsizing upsizes foot pain when climbing.
Beyond the shoes, poor stability is likely a big culprit in developing painful feet. A recent study reported 45% of the climbers have pain in the first toe. Structural deformities of the foot are present in 54% of climbers (3).
The literature refers to bunions as hallux valgus. Hallux valgus (HV) deformities are often accompanied by osteoarthritis in the big toe. The impact of hallux valgus not only results in pain climbing but long-term impacts on gait and often leads to pain walking, running, and make finding well-fitting shoes difficult. The underlying mechanism of HV remains unproven, but muscular weakness is correlated to foot deformities and pain (4).
Although correlation does not mean causation, we do see that people with HV deformities have weaker intrinsic foot muscles, smaller cross-sectional area of foot muscles, muscles imbalances, and alterations in muscle recruitment (5,6,7,8,9,).
The literate also reports efforts to treat HV pain and dysfunction with foot strengthening reduces pain, improves function, and in some cases improved position of the first toe (10,11,12,13, 14).
Strong feet reduces foot pain
During gait or when pushing off a foot hold, muscles and of the foot and lower leg transform the foot into a ridged lever increasing our efficiency and stabilizing the foot. If muscle coordinated and normal joint mobility are not optimal, our foot compensates, the work is inefficient, and overuse issues develop.
The windless mechanism is a biomechanical term often used in the literature to describe the proper position of the foot at push-off. The lack of a properly working windlass mechanism hampers the foot’s ability to move out of pronation, decreases the propulsive force of the foot (15) and has been associated with overuse injuries of the lower extremity.


You can skip to the exercises now or keep reading to understand why these exercises work for climbers.
Important muscles for stablizing the foot
There are three deep muscles that attach directly to the MTP (metatarsal phalangeal joint) of the big toe providing support for the toe and arch of the foot: abductor hallucis, adductor hallucis, and flexor hallucis brevis.


Further stability is provided by external muscles on the inside of the foot and ankle including the tibialis posterior, flexor hallucis longus, and flexor digitorum longus. These muscles support the arch and control pronation (flattening of the arch) (16,17).

Together these muscles provide the necessary stability to protect the big toe and create a a
stable arch to push off. EMG studies show the deep muscles are activated in both the short foot (SF) and toe spread out (TSO) exercises in people with bunions and hallux valugs deformity (18). An improvement in position of the first toe and an increase size of the abductor hallucis muscle in subjects who performed TSO exercises for 8 weeks/4 times a week for 20 minutes (18).



Toe spread out and short foot exercise are a good place to start if dealing with painful toes. However, there is one cavate. If the big toe has moved into a valgus deformity, the flexor hallucis longus’s insertion point on the big toe can pull the big toe further into a valgus position if overactivated, leading to increased deformity in hallux valgus. If your toe is already drifting toward the second toe, you will want to train with the toe passively corrected so the line of pull of the muscle flexes the toe joint rather than pulling it sideways toward the 2nd toe (19).



When muscles are weak and have not been trained it is tricker then you might think to get the correct muscles working. Take your shoes off and work on these under your desk at work or while scrolling on your phone. Many reps (50+), multiple times a day is good when doing non-resisted muscle training with the goal of building coordination.
Pain in the foot due to bunions, joint inflammation, or even plantar fasciitis, it is commonly causes us to push off the outside toes to reduce stress on painful tissues. Pushing off the outside toes limits extension at the big toe joint, reduces tension through the plantar fascia, and leaves the foot in a pronated and biomechanically inefficient position. The foot muscle don't turn on and we end up in a vicious cycle of continued weakness in the foot becuase we are not using the muscles appropriatly. In addition to the short foot and toe spread out add "toe push ups" to retrain the deep muscles for push-off.
For toe push ups, focus on pressing the big toe into the ground, keep the toe straight not letting them curl, drive the heel up without letting the toe joint bend (as woudl happen in walking), as the heel comes up squeeze the calf tight. Start with low loads by doing it seated with high reps (30+). The inital aim is to train coordination involving muscle sequencing and timing. Your brain will learn the movement pattern and as the muscles get stronger you will be able to do this full weight bearing and eventually single leg building strength. As you progress to standing heel raises, keep the big toe actively pressed down into the floor and weight directed through the big toe. In standing heel raises, the toe joint will bend but the muscle will be engeged stabalizing the joint. Find more training ideas in the videos below.
Stick with level 1 exercises for a few weeks and when progressing to intermediate or advanced training be sure it is pain free and you can hold the positions demonstrated without compensations.
People who are not experiencing pain but want to prevent issues down the road can start with intermediate and advanced training with impressions for how to use the toe when you push off foot holds. Check out both training levels below.
References
SM, Gil. Foot Injuries In Sport Climbers: Foot Wear And Other Associated Factors. International Journal of Medicine & Science of Physical Activity & Sport/Revista Internacional de Medicina y Ciencias de la Actividad Física y del Deporte 23.90 (2023).
Lejonagoitia-Garmendia, M., et al. "Foot injuries in sport climbers: footwear and other associated factors." Revista multidisciplinar de las Ciencias del Deporte 23.90 (2023)
Cobos-Moreno, Paula, Álvaro Astasio-Picado, and Beatriz Gómez-Martín. "Epidemiological study of foot injuries in the practice of sport climbing." International journal of environmental research and public health 19.7 (2022): 4302.
Moulodi N, Azadinia F, Ebrahimi-Takamjani I, Atlasi R, Jalali M, Kamali M. The functional capacity and morphological characteristics of the intrinsic foot muscles in subjects with Hallux Valgus deformity: A systematic review. Foot (Edinb). 2020 Dec;45:101706. doi: 10.1016/j.foot.2020.101706. Epub 2020 Jun 15.
Arinci İncel N, Genç H, Erdem HR, Yorgancioglu ZR. Muscle Imbalance in Hallux Valgus. Am J Phys Med Rehabil. 2003;82(5):345–349.
Comparison of muscle activities of abductor hallucis and adductor hallucis between the short foot and toe-spread-out exercises in subjects with mild hallux valgus. J Back Musculoskelet Rehabil. 2013;26(2):163–168.
Lobo CC, Marn AG, Sanz DR, et al. Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus A case-control study. Med (United States). 2016;95(45):1–5.
Kurtoğlu Olgunus, Z., Çiçek, F. & Koç, T. Positional and dimensional relation of tendons around the first metatarsal bone with hallux valgus. Surg Radiol Anat 45, 183–192 (2023).
Moulodi, Nasrin, et al. "The functional capacity and morphological characteristics of the intrinsic foot muscles in subjects with Hallux Valgus deformity: A systematic review." The Foot 45 (2020): 101706.
Glasoe WM. Treatment of progressive first metatarso- phalangeal hallux valgus deformity: A biomechanically based muscle-strengthening approach. J Orthop Sports Phys Ther. 2016;46(7):596–605.
Arge A, Lenzner A, Gapeyeva H, Pääsuke M. Range of motion and pain intensity of the first metatarsophalangeal joint in women with hallux valgus deformation after two-month home exercise programme. Acta Kinesiol Univ Tartu. 2012;18:111. doi:10.12697/akut.2012.18.12
Karabicak GO, Bek N, Tiftikci U. Short-term effects of kiesiotaping on pain and joint alignment in conservative treatment of hallux valgus. J Manipulative Physiol Ther. 2015;38(8):25–31
Khan AZ, Patil DS. The Effect of Therapeutic Approaches on Hallux Valgus Deformity. Cureus. 2024 Apr 22;16(4):e58750. doi: 10.7759/cureus.58750.
Oztarsu MB, Oksuz S. Comparison of the effects of progressive supervised and home program exercise therapy in mild-moderate hallux valgus. J Comp Eff Res. 2023 Mar;12(3):e220091.
Lucas, Rachel, and Mark Cornwall. "Influence of foot posture on the functioning of the windlass mechanism." The Foot 30 (2017): 38-42.
Glasoe, Ward M. "Treatment of progressive first metatarsophalangeal hallux valgus deformity: a biomechanically based muscle-strengthening approach." journal of orthopaedic & sports physical therapy 46.7 (2016): 596-605.
Dygut J, Piwowar M. Muscular Systems and Their Influence on Foot Arches and Toes Alignment-Towards the Proper Diagnosis and Treatment of Hallux Valgus. Diagnostics (Basel). 2022 Nov 25;12(12):2945.
Kim MH, Yi CH, Weon JH, Cynn HS, Jung DY, Kwon OY. Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with hallux valgus. J Phys Ther Sci. 2015;27(4):1019–1022. doi:10.1589/ jpts.27.1019
Eustace S, Williamson D, Wilson M, O'Byrne J, Bussolari L, Thomas M, Stephens M, Stack J, Weissman B. Tendon shift in hallux valgus: observations at MR imaging. Skeletal Radiol. 1996 Aug;25(6):519-24.
Comments