These foot exercises help improve seniors' mobility

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You may not know Larry LaPrise, but you’re definitely familiar with his work. In the late 1940s, Mr. LaPrise wrote the "Hokey Pokey," that popular (albeit somewhat irritating) novelty dance that invites participants to put their right foot in, put their right foot out, put their right foot in and shake it all about.

Fortunately, we at McKnight’s have come across a much more beneficial (and ultimately less annoying) approach to foot movement, about which many of you have inquired.

On March 10, we wrote a news item entitled, “Study shows simple foot exercises significantly decrease seniors' risk of falls.” In this item (click here to see it) we told you about a group of Portuguese researchers who had discovered that simple foot and ankle exercises had enormous benefits when it comes to improving functional mobility in facility-dwelling seniors.

We did not, however, tell you what exercises were used in the study.

So I went back to our sources and have come up with some information that will hopefully help answer all your questions. Here goes:

Study details

The report we cited in our article was titled “Impact of low cost strength training of dorsi- and plantar flexors on balance and functional mobility in institutionalized elderly people,” and appears in the March 2009 issue (Volume 9, Issue 1) of Geriatrics and Gerontology International.

In researching the study, I learned that, to start with, researchers had all the participants go through a five-minute warm up—nothing too serious, mostly gentle stretching and marching in place.

Details on the specific exercises researchers used are pretty sparse in this study. (They clinically reported that seniors were “systematically positioned to perform exercises for ankle dorsiflexor and ankle plantar flexor muscles.”) The authors, however, point out that all the techniques they used were in line with recommendations made by the American College of Sports Medicine.

So I called the ACSM. I spoke with Dr. Angela Smith, an ACSM fellow and an expert on physical activity guidelines for older adults. Smith let me in on a number of easy to perform foot and ankle exercises.

Dorsiflexor muscle exercises

To start with, I asked about some dorsiflexor muscle exercises (those are the front muscles).

“For strengthening the ankle dorsiflexors, the lowest level is to do something against gravity,” Smith said.

While in a sitting position, and with heels planted firmly on the ground, lift the ball of the foot up in the air. There are two muscles that cross the back of the ankle, Smith explained. By performing this exercise in a sitting position, only one of the muscles is used, making this a good routine to start out with.

To make the routine a bit more difficult, try a standing position. Keep your heel on the ground and raise the ball of the foot in the air. Now, both those muscles are in play. But don’t just go straight up and down, Smith said. Moving your toes in more than one direction is helpful, too.

“If you can imagine almost making a U, so you’re lifting up to the inner side, bring it down by drawing a U in the air with your big toe, then pulling it up to the outer side,” she explained.

Plantar flexor muscle exercises

For exercising the plantar flexor muscles (the ones on the bottom of the foot), another simple gravity-based routine will do the trick.

“The simplest thing is to stand with your hands on a counter top or something firm and practice going up on tiptoes on both feet,” Smith said.

Once you get to the top, don’t just come straight back down. Slowly lowering your body is much more beneficial. Once you’ve built up some tolerance to this exercise, you can stay up longer, or switch to just one foot.

Another approach, which Smith cautions some seniors might not be able to perform, is to stand with the ball of the foot on the edge of a stair and steady yourself by holding on to the handrails. When lowering yourself back down, drop the heel below the edge of the stair.

Resistance can be added to any of these exercises by using elastic bands. In the Portuguese study, researchers made use of Thera-Bands to increase resistance and quickly improve the strength and functional mobility of the participants.

Other exercises

Smith clued me in on a few other simple exercises that aren’t mentioned in the study, but will also help improve balance and mobility. These exercises help reduce complications from bunions, and strengthen some of the many smaller muscles in the foot that people tend to forget about.

“If somebody has a bunion, the first thing they need to do is stretch out anything that is too tight,” Smith said. “Reach down with the thumb and index finger and work until they can improve the alignment as much as they can.”

“Have your heel on the ground, put your big toe on the ground and then try to fan the other toes out away from it,” she continued.

“When you get good at that, you can leave heel and other toes on the ground, and simply move your big toe toward the inner side by itself. Most people take a little while, maybe five or ten minutes to figure out how to do that.”

There haven’t been any studies conducted on these exercises that she knows of, but Smith said she’s got some anecdotal evidence that suggests they help bunions from progressing, and help keep people from needing surgery.

“My aunt and quote ‘all her friends in the bridge club’ who had all been told they needed surgery, not one of them had surgery at least in the next ten years before she died,” Smith offered. “So that’s about as anecdotal as they come.”

Another fun exercise that helps strengthen the many smaller muscles is a routine Smith calls “eat the towel.” Start with your heel down on the floor, and put a dish towel down under your toes, she explains. Then grip the towel with your toes and start to pull the towel under your foot. Keep stretching out and pulling in that towel until it’s all the way under your foot.

Smith mentioned to me that a bunch of similar foot and ankle exercises were illustrated in an issue of The Saturday Evening Post about 10 years ago. There was meant to be a follow-up article from people who used the exercises.

Hopefully, you, McKnight’s readers, will let us know if you start any of these foot and ankle exercise routines in your facility, and whether or not they work.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.