Effects of a forefoot strengthening protocol on explosive tasks performance and propulsion kinetics in athletes: a single-blind randomised controlled trial | Find Your Stride | Edinburgh Podiatrist

Introduction - a closer look at forefoot strength

Forefoot strength is having a moment. From toe flexor dynamometry to “short foot” drills, clinicians and coaches want to know whether a stronger propulsive foot actually moves the performance needle for athletes, and in which directions. A new single‑blind randomised controlled trial in PLOS ONE (2025) offers one of the clearest tests to date: an 8‑week, periodised high‑load forefoot program in highly trained athletes, with detailed kinetics across sprinting, cutting, and jumping.

Train the Propulsive Foot: Tourillon et al. (2025) Test a High‑Load Toes Program for Athletes

Study in brief (what they did)

• Participants: 28 highly trained athletes, randomised to Training vs Control after a 4‑week baseline.

• Intervention: 8 weeks, 2 sessions/week, “periodised high‑load” forefoot protocol blending:

  • High‑tension forefoot isometrics (including 1st ray bias), rebound jump elements.

  • Home isometric work; some sessions paired with neuromuscular electrical stimulation (NMES).

• Outcomes at weeks 1, 5, 14, 18:

  • Primary: MTP joint (MTPj) maximal isometric flexion torque.

  • Secondary: Cross‑sectional area (CSA) of abductor hallucis and flexor digitorum longus (ultrasound), sprint acceleration (with force plates over defined track sections), 90° cutting time and kinetics, vertical and horizontal CMJ performance and kinetics, rebound jump SSC metrics.

Methodological plusses: randomised design, blinded assessor, high compliance (>90%), both group‑level mixed models and individual minimal detectable change (MDC) analyses, and force‑platform kinetics with standardised minimalist footwear.

Headline findings (clinically translated)

• Forefoot strength and muscle size improved substantially:

  • Large increases in MTPj torque (effect sizes ~1.4–2.0), with ~92% exceeding MDC.

  • CSA increases in abductor hallucis and flexor digitorum longus mirrored the strength gains.

  • Gains persisted at 4‑week detraining follow‑up.

• Cutting and horizontal jumping performance improved:

  • Moderate to large effects on cutting and horizontal CMJ performance (ES ~0.5–1.1), with 42–67% exceeding MDC.

  • Kinetics showed better medio‑lateral force transmission during cutting and increased propulsive horizontal forces during jumping.

• Sprint performance: mixed picture

  • No clear improvement in overall sprint acceleration time.

  • However, vertical propulsion kinetics at maximal speed improved (ES ~0.9–1.2), suggesting more effective force application without translating to faster splits over the tested distances.

• Vertical jump: not a standout

  • Improvements favored horizontally oriented tasks; vertically oriented performance changes were limited despite better vertical propulsion kinetics at top speed.

    
    

Why this matters for podiatry, running, and court/field sports

• Forefoot capacity links to direction‑specific performance:

  • The program meaningfully improved outputs in tasks dominated by horizontal or lateral force demands (cuts, horizontal jumps). That aligns with the forefoot’s role as a propulsive lever and lateral stabiliser during push‑off and change of direction.

• Sprinting is complex:

  • Better vertical kinetics at maximal speed without faster times underscores that sprint performance hinges on whole‑chain coordination (hip/knee/ankle stiffness timing, posture, step length/frequency), not foot strength alone.

• Intrinsic/extrinsic hypertrophy with function:

  • CSA increases alongside torque gains suggest the program wasn’t just “neural.” For injury contexts (e.g., plantar plate stress, metatarsalgia risk), hypertrophy is a double‑edged sword — capacity goes up, but so can local load if progressions are rushed.

Strengths

• Highly trained athlete sample increases sport relevance beyond novice cohorts.

• Comprehensive kinetic profiling with force plates across multiple tasks, not just simple performance times.

• Individual MDC analysis helps clinicians interpret who meaningfully benefited, not just group means.

• Detraining check suggests some durability of adaptation over a month.

  
  

Limitations and cautions

• Sample size is modest; sport mix varied. Effects may differ by sport demands (e.g., soccer vs track sprint).

• Protocol complexity and partial NMES use may limit generalisability. It’s not just “toe curls”; it’s a periodised, supervised plan with specific loading and cues.

• No direct running (distance) outcomes or field‑based re‑injury data. For endurance runners, horizontal CMJ and cutting gains are promising but indirect.

• Sprint findings remind us: forefoot strength is necessary but not sufficient for speed; proximal mechanics and technique remain decisive.

• Minimalist standardised footwear in testing controls variability but may not mirror an athlete’s habitual shoe, affecting transfer.

  
  

Practical programming for clinicians and coaches

• Who benefits most

  • Field/court athletes with heavy cutting demands.

  • Runners whose goals include acceleration changes (XC starts, cross‑country undulations) and better horizontal force orientation.

  • Athletes with demonstrably low MTP torque or intrinsic weakness on ultrasound/dynamometry.

• Dosing blueprint (evidence‑informed)

  • Frequency: 2 sessions/week for 8 weeks.

  • Session structure (35–45 minutes):

    1. High‑tension forefoot isometrics in dorsiflexed MTPj (~30°) positions, emphasising 1st ray leverage.

    2. Dynamic isometric holds through the 1st ray; progress range/time under tension.

    3. Forefoot rebound jumps (low amplitude, high stiffness) for SSC specificity.

    4. Optional: NMES overlays on key isometrics for athletes tolerating it and with access.

  • Progression: Blocked progression every 2 weeks (load, hold duration, density); monitor RPE 4–6/10 early, 6–7/10 late.

  • Pairing: Place before cutting/change‑of‑direction drills and horizontal plyometrics to exploit potentiation.

  • Retention: One session/week in‑season likely maintains torque/CSA; study suggests 4‑week durability, but sport loads vary.

• Integration with injury risk management

  • Screen for forefoot pain, plantar plate irritability, or sesamoid tenderness; add graded exposure and manage weekly sprint/COD spikes.

  • Don’t let forefoot work replace lateral chain strength: include peroneals, hip abductors, and trunk anti‑rotation for robust frontal‑plane control.

  • Footwear: Progress plyometrics cautiously in minimal shoes if the athlete races in more cushioned models.

    
    

For runners specifically

• Expect better horizontal force orientation and propulsive “pop,” helpful for cross‑country starts, hill surges, and trail undulations.

• Don’t expect automatic PRs in flat sprint splits. Combine with posture drills, step‑to‑step stiffness work, and hip/knee strength.

• Watch tissue tolerance: forefoot SSC elements add localised load; progress weekly contacts and monitor soreness under the 1st MTP.

  
  

Bottom line

• A targeted, high‑load forefoot program can substantially increase MTP torque and toe‑flexor muscle size and convert that capacity into meaningful improvements in cutting and horizontal jump performance, with kinetic evidence of better propulsive and medio‑lateral force transmission.

• Sprint acceleration times did not improve, despite better vertical propulsion at maximal speed — reinforcing that foot strength is a potent contributor, not a standalone solution, for speed.

• Clinically, this supports adding periodised forefoot strengthening as a complement to COD and horizontal plyometrics, while keeping holistic sprint mechanics and proximal strength front and center.

  
  

What we still need to know

• Sport‑specific transfer and injury outcomes (re‑sprain, metatarsalgia, plantar plate).

• Dose–response and minimal effective dose for in‑season maintenance.

• Comparative effectiveness vs simpler programs (e.g., short‑foot + bands) in trained cohorts.

• Footwear context: Does adaptation differ in plated vs cushioned vs minimalist shoes?

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Citation

Tourillon R, Fourchet F, Edouard P, Morin J‑B. Effects of a forefoot strengthening protocol on explosive tasks performance and propulsion kinetics in athletes: A single‑blind randomized controlled trial. PLoS ONE. 2025;20(6):e0313979. doi:10.1371/journal.pone.0313979