{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:20:45Z","timestamp":1792182045374,"version":"4.4.0"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAPMA"],"abstract":"<jats:p>Background: Flatfoot is an alteration of the normal structure of the foot, characterized by a partial or total reduction of the medial longitudinal plantar arch, valgus deformity of the heel, and abduction of the forefoot. While treatments often include strengthening of the intrinsic foot muscles, evidence of its efficacy in adults with flatfoot remains limited. Objectives: The main objective of this review was to evaluate the effects of strengthening the plantar intrinsic muscles in adults with flatfoot. Methods: Searches were conducted in PubMed, Embase, Cochrane, PEDro, and Web of Science databases up to October 2023. The review protocol was developed and followed according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies included were those published on intrinsic muscle strengthening in adult populations. A qualitative synthesis of all included articles was performed, along with a quantitative sub-analysis of randomized controlled trials and a critical methodological assessment. Results: Eleven studies involving a total of 374 participants were selected. Most studies identified the \u201cshort foot exercise\u201d as the optimal exercise for isolating and training the plantar intrinsic foot muscles. The most commonly analyzed variables were the Foot Posture Index and the Navicular Drop Test. Conclusions: Strengthening the plantar intrinsic muscles enhances the height of the medial longitudinal arch, improves hindfoot posture and balance, and increases hallux abductor muscle activity. This strengthening, whether achieved through short foot exercises alone or in combination with other techniques, is effective in treating adult flatfoot. Current literature suggests that a duration of 4\u20136 weeks may be sufficient to achieve beneficial outcomes.<\/jats:p>","DOI":"10.3390\/japma116010008","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T15:57:11Z","timestamp":1771603031000},"page":"8","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of Strengthening the Intrinsic Muscles of the Foot in Adults with Flatfoot: A Scoping Review"],"prefix":"10.3390","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1470-0429","authenticated-orcid":false,"given":"Marta Mar\u00eda","family":"Moreno-Fresco","sequence":"first","affiliation":[{"name":"Department of Podiatry, University of Seville, 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5708-4178","authenticated-orcid":false,"given":"Pedro V.","family":"Munuera-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Podiatry, University of Seville, 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Regife-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Podiatry, University of Seville, 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4876-5478","authenticated-orcid":false,"given":"Jose M.","family":"Cuevas-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Podiatry, University of Seville, 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8088-4955","authenticated-orcid":false,"given":"Priscila","family":"T\u00e1vara-Vidal\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Podiatry, University of Seville, 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"ref_1","first-page":"81","article-title":"Flatfeet: Biomechanical implications, assessment and management","volume":"38","author":"Chander","year":"2019","journal-title":"Foot Edinb. Scotl."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1007\/s11999-015-4581-6","article-title":"Classifications in Brief: Johnson and Strom Classification of Adult-acquired Flatfoot Deformity","volume":"47","author":"Abousayed","year":"2016","journal-title":"Clin. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.fcl.2012.03.002","article-title":"The RAM classification: A novel, systematic approach to the adult-acquired flatfoot","volume":"17","author":"Raikin","year":"2012","journal-title":"Foot Ankle Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1007\/s00132-020-03995-5","article-title":"Etiology, pathogenesis, clinical features, diagnostics and conservative treatment of adult flatfoot","volume":"49","author":"Gutteck","year":"2020","journal-title":"Orthopade"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1016\/j.otsr.2014.07.030","article-title":"Adult flatfoot","volume":"101","author":"Toullec","year":"2015","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.jphys.2022.11.011","article-title":"A comprehensive exercise program improves foot alignment in people with flexible flat foot: A randomised trial","volume":"69","author":"Brijwasi","year":"2023","journal-title":"J. Physiother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1080\/00913847.2018.1553466","article-title":"Effects of selective strengthening of tibialis posterior and stretching of iliopsoas on navicular drop, dynamic balance, and lower limb muscle activity in pronated feet: A randomized clinical trial","volume":"47","author":"Alam","year":"2019","journal-title":"Phys. Sportsmed."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Polichetti, C., Borruto, M.I., Lauriero, F., Caravelli, S., Mosca, M., Maccauro, G., Greco, T., and Perisano, C. (2023). Adult Acquired Flatfoot Deformity: A Narrative Review about Imaging Findings. Diagnosis, 13.","DOI":"10.3390\/diagnostics13020225"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1148\/rg.2019190046","article-title":"Adult Acquired Flatfoot Deformity: Anatomy, Biomechanics, Staging, and Imaging Findings","volume":"39","author":"Flores","year":"2019","journal-title":"Radiographics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s00590-017-1945-5","article-title":"Adult-acquired flatfoot deformity","volume":"2","author":"Smyth","year":"2017","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/1364557032000119616","article-title":"Scoping studies: Towards a methodological framework","volume":"8","author":"Arksey","year":"2005","journal-title":"Int. J. Soc. Res. Methodol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/1748-5908-5-69","article-title":"Scoping studies: Advancing the methodology","volume":"5","author":"Levac","year":"2010","journal-title":"Implement. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"O\u2019Brien, K.K., Colquhoun, H., Levac, D., Baxter, L., Tricco, A.C., Straus, S., Wickerson, L., Nayar, A., Moher, D., and O\u2019mAlley, L. (2016). Advancing scoping study methodology: A web-based survey and consultation of perceptions on terminology, definition and methodological steps. BMC Health Serv. Res., 16.","DOI":"10.1186\/s12913-016-1579-z"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/XEB.0000000000000050","article-title":"Guidance for conducting systematic scoping reviews","volume":"13","author":"Peters","year":"2015","journal-title":"Int. J. Evid. Based Healthc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/S0030-5898(20)30252-2","article-title":"Techniques in the evaluation and treatment of the injured runner","volume":"13","author":"Brody","year":"1982","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.clinbiomech.2005.08.002","article-title":"Development and validation of a novel rating system for scoring standing foot posture: The Foot Posture Index","volume":"21","author":"Redmond","year":"2006","journal-title":"Clin. Biomech."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater reliability: The kappa statistic","volume":"22","author":"McHugh","year":"2012","journal-title":"Biochem. Medica"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1123\/jsr.2021-0244","article-title":"Evidence for Rehabilitation Interventions After Acute Lateral Ankle Sprains in Athletes: A Scoping Review","volume":"31","author":"Tee","year":"2022","journal-title":"J. Sport Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1053\/j.jfas.2022.06.007","article-title":"Effect of Arch Height Flexibility in Individuals With Flatfoot on Abductor Hallucis Muscle Activity and Medial Longitudinal Arch Angle During Short Foot Exercises","volume":"62","author":"Ishiyama","year":"2023","journal-title":"J. Foot Ankle Surg."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Park, D.-J., Lee, K.-S., and Park, S.-Y. (2021). Effects of Two Foot-Ankle Interventions on Foot Structure, Function, and Balance Ability in Obese People with Pes Planus. Healthcare, 9.","DOI":"10.3390\/healthcare9060667"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.gaitpost.2019.09.030","article-title":"Effects of plantar intrinsic foot muscle strengthening exercise on static and dynamic foot kinematics: A pilot randomized controlled single-blind trial in individuals with pes planus","volume":"75","author":"Okamura","year":"2020","journal-title":"Gait Posture"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Pab\u00f3n-Carrasco, M., Castro-M\u00e9ndez, A., Vilar-Palomo, S., Jim\u00e9nez-Cebri\u00e1n, A.M., Garc\u00eda-Paya, I., and Palomo-Toucedo, I.C. (2020). Randomized Clinical Trial: The Effect of Exercise of the Intrinsic Muscle on Foot Pronation. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17134882"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.3233\/BMR-200255","article-title":"Short foot exercises have additional effects on knee pain, foot biomechanics, and lower extremity muscle strength in patients with patellofemoral pain","volume":"34","author":"Tunay","year":"2021","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"250","DOI":"10.3961\/jpmph.19.072","article-title":"Effects of the Short Foot Exercise With Neuromuscular Electrical Stimulation on Navicular Height in Flexible Flatfoot in Thailand: A Randomized Controlled Trial","volume":"52","author":"Namsawang","year":"2019","journal-title":"J. Prev. Med. Public Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1123\/jsr.2018-0363","article-title":"Effects of Short-Foot Exercises on Foot Posture, Pain, Disability, and Plantar Pressure in Pes Planus","volume":"29","author":"Unver","year":"2020","journal-title":"J. Sport Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3136","DOI":"10.1589\/jpts.28.3136","article-title":"The effects of short foot exercises and arch support insoles on improvement in the medial longitudinal arch and dynamic balance of flexible flatfoot patients","volume":"28","author":"Kim","year":"2016","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e19260","DOI":"10.1097\/MD.0000000000019260","article-title":"The effect of short foot exercise using visual feedback on the balance and accuracy of knee joint movement in subjects with flexible flatfoot","volume":"99","author":"Kim","year":"2020","journal-title":"Medicine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1589\/jpts.26.117","article-title":"Immediate Effect of Short-foot Exercise on Dynamic Balance of Subjects with Excessively Pronated Feet","volume":"26","author":"Moon","year":"2014","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"618","DOI":"10.12659\/MSM.912785","article-title":"Short-Foot Exercise Promotes Quantitative Somatosensory Function in Ankle Instability: A Randomized Controlled Trial","volume":"25","author":"Lee","year":"2019","journal-title":"Med. Sci. Monit."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"S\u00e1nchez-Rodr\u00edguez, R., Valle-Est\u00e9vez, S., Fraile-Garc\u00eda, P.A., Mart\u00ednez-Nova, A., G\u00f3mez-Mart\u00edn, B., and Escamilla-Mart\u00ednez, E. (2020). Modification of Pronated Foot Posture after a Program of Therapeutic Exercises. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17228406"}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1930-8264\/116\/1\/8\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T16:25:00Z","timestamp":1771604700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/116\/1\/8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,20]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["japma116010008"],"URL":"https:\/\/doi.org\/10.3390\/japma116010008","relation":{},"ISSN":["1930-8264"],"issn-type":[{"value":"1930-8264","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,20]]}}}