Does Myofascial Release 'Improve' Flat Feet? | A Critical Review for Runners & Clinicians | Find Your Stride | Edinburgh Podiatrist

Introduction

Kaczor et al.(2025) state that flat feet (pes planus) aren’t just a structural variation they’re often linked to reduced ankle mobility, altered running biomechanics, and increased injury risk. For runners, this can mean anything from plantar heel pain to Achilles tendinopathy. In their 2025 randomized controlled trial Kaczor et al. set out to test whether myofascial release (MFR), a popular hands-on therapy can improve ankle range of motion (ROM) and foot function in adults with symptomatic flat feet. But does the evidence actually support what many clinicians are already doing in practice?

Flat feet (pes planus) are often linked to reduced ankle mobility, altered running biomechanics, and increased injury risk

Study Overview

• Design: Randomized controlled trial

• Participants: 60 adults with symptomatic flat feet

• Duration: 4 weeks

• Groups:

  • MFR + exercise (MRE)

  • MFR only (MR)

  • Exercise only (E)

  • Control (no treatment)

• Outcomes measured:

  • Ankle ROM (dorsiflexion, plantarflexion, inversion, eversion)

  • Foot function via FAOQ questionnaire

Key Findings

1. Range of Motion Improved—But Context Matters

Both MFR alone and combined with exercise significantly improved ankle ROM, especially dorsiflexion and plantarflexion. The combined approach (MRE) was the most effective.

👉 For runners:

Improved dorsiflexion is strongly associated with:

• Better shock absorption

• Reduced compensatory pronation

• Lower injury risk (e.g., Achilles tendinopathy)

  
  

2. Foot Function Improved Across the Board

Interestingly, all intervention groups (including exercise alone) improved foot function scores.

👉 Simplified:

• MFR is not clearly superior to exercise for functional outcomes

• Exercise remains a cornerstone intervention

  
  

3. No Clear Winner for Functional Outcomes

Despite ROM gains, no group outperformed others in FAOQ improvements.

👉 Clinician takeaway:

• ROM ≠ function (a critical distinction often overlooked)

Critical Appraisal: Where This Study Falls Short

❌ 1. Population Mismatch for Sports Medicine

Participants were non-athletic adults, not runners or high-load athletes.

👉 Problem:

• Results may not translate to:

  • Distance runners

  • Court sport athletes

  • Load-dependent injuries

❌ 2. Short-Term Intervention (4 Weeks)

Four weeks is too short to assess meaningful structural or performance adaptations.

👉 Missing:

• Long-term retention of mobility

• Injury rates

• Running economy or performance metrics

❌ 3. No Biomechanical or Performance Outcomes

The study measured ROM and questionnaire scores—but not running mechanics.

👉 What we actually care about:

• Ground reaction forces

• Foot strike patterns

• Energy return

• Injury incidence

Without these, the link to running performance remains speculative.

❌ 4. Over-Reliance on Goniometry

ROM was measured with a goniometer, which:

• Has limited reliability in subtle changes

• Doesn’t reflect dynamic movement

👉 Static ROM ≠ functional mobility during gait

❌ 5. Lack of Blinding & Small Sample Size

• Only 15 participants per group

• Potential bias despite attempts at blinding

👉 Limits statistical power and generalisability

What This Means for Runners

✔️ When MFR Might Help

• Short-term ankle stiffness

• Adjunct to rehab for:

  • Plantar fasciitis

  • Achilles issues

  • Restricted dorsiflexion

⚠️ What It Won’t Do Alone

• Fix flat foot structure

• Improve running efficiency directly

• Replace strength training

Clinical Takeaways for Podiatrists & Physios

1. Use MFR as an adjunct, not a primary intervention

2. Prioritise:

   • Strength (intrinsic foot + calf complex)

   • Load management

   • Running retraining

3. Combine MFR with exercise for best ROM gains

4. Don’t equate ROM improvements with functional outcomes

Bottom Line

This study supports what many clinicians suspect:

👉 Myofascial release can improve ankle mobility—but it’s not a 'silver bullet'.

For athletes, especially runners, the real gains will come from:

• Strength

• Progressive loading

• Biomechanical efficiency

MFR may help “unlock” movement—but performance is built elsewhere.

Citation

Kaczor S, Zmudzińska U, Kulis A. The Influence of Myofascial Techniques on the Range of Motion and Flat Foot Efficiency in Adults with Symptomatic Flat Foot: A Controlled Randomised Trial. Healthcare. 2025;13:2046.

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