Myofascial Release for Adult Flat Foot: Useful Tool or Overstated Placebo? | Find Your Stride | Edinburgh Podiatrist

Flat foot (pes planus) is frequently discussed in podiatry and sports medicine because of its associations with overuse injuries, altered running biomechanics, and reduced ankle mobility. A 2025 randomized controlled trial by Kaczor et al. examined whether myofascial release (MFR) alone or combined with exercise improved ankle range of motion and foot function in adults with symptomatic flat feet. At first glance, the results appear encouraging. However, when viewed through the lens of running performance, injury prevention, and clinical decision-making, the findings deserve a more nuanced interpretation.

A 2025 randomized controlled trial by Kaczor et al. examined whether myofascial release (MFR) alone or combined with exercise improved ankle range of motion and foot function in adults with symptomatic flat feet.

Study Overview (What Was Done)

The authors recruited 60 adults (aged 20–49) with painful, flexible flat feet and randomized them into four groups for four weeks:

• MRE – Myofascial release + daily exercises

• MR – Myofascial release only

• E – Exercise program only

• C – Control (no intervention)

Outcome measures included:

• Ankle range of motion (dorsiflexion, plantarflexion, inversion, eversion)

• Foot and Ankle Outcomes Questionnaire (FAOQ) for self-reported function

The design was methodologically sound for a short-term intervention study, with assessor blinding and a control group strengthening internal validity.

Key Findings (What Improved)

1. Ankle Range of Motion Improved—Especially With MFR

Both MFR alone (MR) and MFR combined with exercise (MRE) significantly improved ankle range of motion across most planes. The largest effects were seen in dorsiflexion and plantarflexion movements highly relevant for running gait and load absorption.

From a podiatry and sports injury perspective, this matters because restricted ankle dorsiflexion has been linked to:

• Increased pronation velocity

• Higher Achilles and plantar fascia loading

• Compensatory knee and hip mechanics

The combined MFR + exercise group (MRE) consistently outperformed exercise alone, suggesting that soft tissue interventions may accelerate mobility gains.

2. Foot Function Improved—but Not More Than Control

Although FAOQ scores improved in all intervention groups, intergroup differences were not statistically significant. Surprisingly, even the control group showed some improvement.

This raises important clinical questions:

• Are functional improvements driven by natural symptom fluctuation?

• Is FAOQ sensitive enough to detect meaningful changes in active populations?

• Does increased range of motion automatically translate to better function?

For runners and athletes, self-reported function without performance or load-tolerance measures is a limitation.

Strengths of the Study

✔ Randomized controlled design

✔ Clearly described manual therapy protocols

✔ Clinically relevant outcomes (ankle ROM, patient-reported function)

✔ Addresses a gap in adult flat foot research, which often focuses on children

Limitations That Matter for Athletes and Clinicians

1. No Running or Performance Measures

Despite implications for sport, the study did not assess running mechanics, strength, or injury risk markers. Improved ROM does not necessarily equal:

• Better running economy

• Reduced injury risk

• Improved load management

2. Short-Term Results Only

The intervention lasted just four weeks, with no follow-up. For chronic flat foot–related issues, clinicians need to know:

• Do gains persist after treatment stops?

• Does repeated MFR reduce recurrence of symptoms?

3. Non-Athletic Sample

Participants were not recreational or competitive athletes, limiting transferability to runners who experience much higher repetitive loads.

4. Manual Therapy Bias

Hands-on therapies can introduce expectation and placebo effects, especially when outcomes include self-reported questionnaires.

Clinical Takeaways for Podiatrists and Sports Clinicians

• Myofascial release appears useful as an adjunct, particularly for improving ankle mobility in symptomatic flat foot.

• Exercise alone still works, reinforcing the importance of intrinsic foot strengthening and calf capacity.

• For runners, MFR should be viewed as a mobility-enabling tool, not a standalone treatment.

• The study supports a combined approach: soft tissue work → mobility → progressive loading.

In practice, MFR may help athletes access increased ranges of dorsiflexion and plantarflexion sooner, allowing better tolerance of strengthening, gait retraining, or return-to-run programs.

Bottom Line

This trial adds meaningful evidence that myofascial release can improve ankle mobility in adults with flat feet, particularly when combined with exercise. However, claims about functional superiority or sports injury prevention remain unsupported.

For runners and clinicians, the message is clear: manual therapy may open the door, but strength, load management, and movement retraining still do the heavy lifting.

Citation

Kaczor, S., Zmudzińska, U., & Kulis, A. (2025). 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, 13, 2046. https://doi.org/10.3390/healthcare13162046

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