January 2026

The Agony of De Feet: Forgotten but Unforgiving

For the past 30 years, the emphasis on muscle strengthening for health, longevity, and quality of life has become a regular part of wellness coaching. While resistance training (RT) has been elevated to near-equal status as cardiovascular training, most of the focus has been on larger, more-evident muscles, the ones you can see or support major joints or, when they fail, the ones that contribute to or prevent pain. And yet, for all their conspicuousness, the feet rarely get restorative or rehabilitative attention other than pedicures and whatnot. Some of that stems from a long-held but since reconsidered view that the many muscle of the feet can’t be trained. When there’s a problem, orthotics – static devices to realign the foot – were the go-to for foot problems. We may now know better.

An Australian review article looked at the impact of aging on the foot muscles and whether or not RT for them is “achievable, desirable, and feasible”. Many of the main foot muscles get weaker – toe flexion forces are 29% weaker during a reaching task; big toe and lesser toes are 32% and 27% weaker, respectively, in the >40 group compared to the <40’s; and strength is associated with “decreased muscle thickness and cross-sectional area”. Women had weaker feet, largely based on body size but also due to “sociocultural influences”.

Several studies have demonstrated the effectiveness of RT for the feet, especially the toe flexors. Participants in 12-wk programs of supervised and home-based routines gained 36% strength in their toes.

Still unknown is do stronger feet prevent falls? As of now, “it is unclear whether a lower rate of falls can be expected from strengthening foot muscles in isolation”. In other words, overall RT yields overall benefits when feet are included.              

ESSR Oct. 2025

AI Is Coming to Your Orthopod’s Office

You know that aching knee that seems to be getting worse but doesn’t yet require surgery? And your orthopedist won’t or can’t tell you when you’ll need it? Well, someday a computer program can. A Chinese study developed an artificial intelligence (AI)-assisted model that looks at clinical, radiological (MRI), and biomechanical information to predict whether knee osteoarthritis (KOA) will soon worsen. They had data on 594 patients and 1753 patients free of KOA to develop a “predictive model” using AI. By analyzing the biochemical test results, clinical data, and MRI results of the healthy knees, they hoped they could predict whose knees would “experience worsening pain alone, worsening pain alongside joint space narrowing in the knee (an indicator of structural worsening), joint space narrowing alone, or no worsening at all.”

In addition to objective estimates of knee OA, they had 7 physicians who used the model to assist their own predictions of future OA. They found that doing so improved the accuracy of their 2-year predictions from 46.9% to 65.4% – that’s 39% improvement in their predictive capabilities.

The value of this type of AI application is that doctors could, as the model is refined and validated in additional groups of patients, better guide their achey-kneed patients with more precise exercise prescriptions relative to their functional capabilities now and in the near future; and tailor the progression of exercises to patients’ goals and needs as they approach the day of liberation, the day they get a total knee replacement.             

PLOS Medicine, Aug. 2025 in LER Oct. 2025

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