Intrinsic Muscle Strength Research Articles

Correlation Between Intrinsic Capacity and Muscle Strength and Quality in Older Patients with Cardiovascular Disease: A Cross-Sectional Study.

Cardiovascular disease (CVD) has become the leading cause of death worldwide. High muscle mass can reduce the incidence and mortality of CVD. In recent years, increasing attention has been given to the relationship between intrinsic capacity (IC) and CVD. This study aims to explore the relationship between the decline of IC, muscle strength, and muscle quality in older patients with CVD, providing a new method and basis for early recognition of IC decline in the older adults. This cross-sectional study included 475 older individuals from communities in Zhejiang. General data were collected, and a comprehensive geriatric assessment (CGA) was conducted. Participants with CVD were divided into three groups: IC retention, IC impairment, and IC significantly impaired. Bioelectrical impedance analysis (BIA) measurements were completed. Student's t-test or non-parametric tests (Mann-Whitney) were used to analyze the correlation between IC and muscle-related indicators. The best cutoff values were obtained using ROC curve analysis. Compared to non-CVD patients, CVD patients were older, more educated, and had higher rates of polypharmacy and comorbidity. IC decreased more significantly in CVD patients. Age (P=0.001), Fried (P=0.024), and GDS-5 (P=0.002) increased with the severity of IC decline. ADL (P=0.002), MMSE (P=0.000), MNA-SF (P=0.000), SARC-Calf (P=0.026), waist circumference (P=0.037), and muscle quality (P=0.010) decreased with the decline in IC. When IC decreased, the cutoff values for hand grip strength, waist circumference, and muscle quality were 25.45 kg, 72.55 cm, and 3.05, respectively. When IC decreased significantly, the cutoff values were 17.15 kg, 71.55 cm, and 2.28, respectively. The results of this study showed that in patients with CVD, the hand grip strength and muscle quality of patients with IC injury were lower than those of patients with IC retention.

Relationship between Dynamic Balance and Physical Characteristics and Functions in Elite Lifesaving Athletes.

Balance is important in lifesaving competitions. We aimed to investigate the relationship between dynamic balance and physical characteristics and functions in elite lifesavers by measuring the foot muscle cross-sectional area, ankle joint muscle strength, toe grasp strength, plantar superficial sensation, and dynamic balance (Y-balance test). In this observational study, we measured the foot muscle cross-sectional area, ankle dorsiflexion, plantar flexion, external flexion, isometric muscle strength, toe grasp strength, and superficial foot sensation of 15 adult lifesavers (12 males). The results show that toe grasp strength and ankle plantar flexion isometric muscle strength are particularly important for the dynamic balance of elite lifesavers working on sandy surfaces. Sand training improves intrinsic muscle strength and dynamic balance function. However, high training intensity may reduce plantar surface sensation; this needs to be verified through sand training interventions in the future.

A Microsurgical Skills Curriculum to Develop Unconscious Competence.

The attainment of microsurgical competency is an important milestone for plastic surgery trainees. Technical skill and a practiced disposition are required to successfully perform microsurgical procedures. Microsurgical skills curricula may foster both proficiency with technical movements and facilitate performance with minimal cognitive burden while using the operating microscope. The microsurgical skills curriculum presented in this article focuses on three fundamental principles: intrinsic muscle strength, accuracy and precision of movement, and supervised practice. Progressive operative entrustment of trainees is earned through successful completion of deliberate microsurgical exercises rather than timed anastomosis trials. The overarching goal of this curriculum is to develop unconscious competence in microsurgery.

Minimalist school shoes improve intrinsic foot muscle size, strength, and arch integrity among primary school students

ABSTRACT Minimalist walking shoes have been shown to improve foot muscle size and strength in active adults, but not in our previous study involving children, which could relate to the more structured footwear used in our study. Hence, this study examined the effects of true minimalists on intrinsic foot muscle size and strength, foot arch integrity, and physical function among primary school children. After a baseline assessment, 30 primary school students aged between 9 and 12 were given a pair of minimalist shoes (minimalist index = 92%) as their regular school shoes for two school terms, followed by a re-assessment. Seventeen of the 30 participants in the minimalist group completed the study. Compared to the control group, the minimalist group showed significantly increased cross-sectional area of abductor hallucis (p = 0.047, Cohen’s d = 0.57) and flexor digitorum brevis (p = 0.037, Cohen’s d = 0.80), increased strength of the hallux (p = 0.015, Cohen’s d = 0.76) and lesser toes (p = 0.014, Cohen’s d = 0.66), greater arch height (p = 0.020, Cohen’s d = 0.52) and standing long jump distance (p = 0.001, Cohen’s d = 9.79). The control group exhibited improved standing long jump performance only (p = 0.020, Cohen’s d = 10.70). Minimalist shoes worn daily to school promote intrinsic foot muscle size and strength, and improve foot arch integrity among primary school students.

Association between intrinsic capacity and weak muscle strength in naval medical center older adults

Purpose The purpose of this study was to determine the association between intrinsic capacity (IC) and dynapenia in older adults in outpatient clinics at the Naval Medical Center. Design/methodology/approach The study design was observational, analytical and retrospective. The study from which the collected data came was an observational analytical cohort, whose main objective was to describe the factors associated with frailty in older adults. The population comes from the Peruvian Naval Medical Center. This was a retrospective, observational, analytical study of the factors associated with frailty in older adults from the Naval Medical Center of Peru. Findings Data from 1667 participants was analyzed, 682 of them were female (40.9%) and 985 were male (50.1%); regarding age, most participants had 71–80 years (n = 761, 45.6%). Prevalence of the dynapenia was 34.5% (n = 576), and 80.08% (n = 1335) had an altered IC. In an adjusted model using Poisson regression, a prevalence ratio of 2.76 (95%, CI 2.06–3.70) was found. In conclusion, there is an association between IC and dynapenia in older adults. Originality/value In Latin America and Peru, there is limited information regarding this topic and tools for the evaluation of IC.

P301L‐Tau Expression Induces Skeletal Muscle Abnormalities in Mouse Model of Tauopathy

AbstractBackgroundPatients suffering from Alzheimer’s disease (AD) and related tauopathies often report signs of muscle weakness. The pathological accumulation of insoluble tau that forms neurofibrillary tangles (NFTs) is a hallmark of AD, yet it is unclear whether pathological tau impacts skeletal muscle. Proper muscle function is necessary for movement and consequently impacts quality of life in tauopathy patients, while concurrently contributing to the physiological maintenance of whole‐body endocrine and metabolic homeostasis. Skeletal muscle crosstalks with other organ systems; therefore, disruption of skeletal muscle health impacts whole‐body processes, such as the formation of pathological tau. The objective of this study was to determine the links between tauopathy and muscle function.MethodI performed intracerebroventricular injections with adeno‐associated viral (AAV) vector encoding P301L human tau (N = 4 females, 7 males) or a control plasmid (empty or a yellow fluorescent protein construct) (N = 5 females, 6 males). At 3 months, I measured grip strength. I harvested the brain, soleus, and tibialis anterior (TA) muscles at 15 months, and measured muscle mechanics concurrently in the soleus and extensor digitorum longus (EDL) muscles. I biochemically detected soluble tau and visualized TA structure immunohistochemically.ResultsGrip strength was reduced at 3 months in the P301L tau‐expressing mice of both sexes. The intrinsic force production of the soleus, but not the EDL, was reduced in P301L tau‐expressing males at 15 months. At this same time point, soluble tau accumulated in the cortex but not the soleus. Aggregation of nuclei were found histologically in the TA of P301L tau expressing mice but not in controls.ConclusionChanges in grip strength preceded insoluble tau accumulation and cognitive decline typical of this model. Reductions in the soleus force production indicate that P301L tau overexpression in the brain impacts intrinsic muscle strength, and occurs independently of innervation. The nuclear clumps detected in the TA of P301L tau‐expressing mice suggest that AAV‐P301L‐tau injections in the brain promote an inflammatory response in muscle. Together these data suggest that pathological tau species that are expressed in the brain reach peripheral tissues and exert deleterious consequences such as skeletal muscle abnormalities.

Reliability of Foot Intrinsic Muscle Strength Testing and Correlation with Corresponding Muscle Morphology in Elderly Adults

Reliability of Foot Intrinsic Muscle Strength Testing and Correlation with Corresponding Muscle Morphology in Elderly Adults

Association between the Strength of Flexor Hallucis Brevis and Abductor Hallucis and Foot Mobility in Recreational Runners

Different measurements of foot morphological characteristics can effectively predict foot muscle strength. However, it is still uncertain if structural and postural alterations leading to foot pronation could be compensated with more efficient function of the intrinsic foot muscles and how mobility and strength are associated. Additionally, the relationship between foot mobility and the strength of the intrinsic muscles that control the foot arch is still unclear. Therefore, this study aimed to investigate the morphological parameters between dominant and non-dominant feet and the relationship between the intrinsic foot muscle strength and foot mobility in recreational runners. We used a cross-sectional study design to evaluate twenty-four healthy recreational runners (minimum 15 km/week) with an average training history of 70 ± 60 months. Foot Posture Index (FPI-6), isometric intrinsic muscle strength, overall morphology, and normalized mobility of both feet were assessed. Parametric tests analyzed the unidimensional measures, and paired analysis determined differences between dominant and non-dominant sides. Pearson’s and Spearman’s correlation coefficients determined the relationships between normalized strength and the variables of interest (CI = 95%). There was no significant association between intrinsic foot muscle strength and mobility. The only difference observed was between the dominant and non-dominant foot regarding the normalized foot length and midfoot width during non-weight-bearing, with small and medium effect sizes, respectively. Neither foot morphology nor foot mobility was associated with strength from intrinsic foot muscles in healthy recreational runners. Further work should explore the relationship investigated in our study with professional athletes and runners with symptomatic lower limb injuries to potentialize training and rehabilitation protocols.

Surgical Efficacy and Prognostic Factors for Acute Traumatic Central Cord Syndrome Without Fracture and Dislocation.

This study was undertaken to evaluate the effectiveness of surgical treatment of acute traumatic central cord syndrome (ATCCS) without fracture and dislocation and explore surgical timing and factors influencing postoperative recovery of spinal cord function. We retrospectively collected the general and clinical data of 112 patients with ATCCS (American Spinal Injury Association impairment scale grade C or D) without fracture and dislocation who underwent surgical treatment in our hospital from January 2013 to August 2019. We used statistical methods to evaluate the safety of the operation and explore the timing of surgery and the factors influencing postoperative recovery of spinal cord function. The mean age of the 112 patients was 60.64±12.91 years. The Japanese Orthopaedic Association score and the American Spinal Injury Association motor score (AMS) of the 112 patients were significantly higher at final follow-up than at admission. No significant difference in recovery of spinal cord function was seen between the early operation group (≤4 days) and the late operation group (>4 days). Comparison of patients with a good prognosis vs a poor prognosis showed that age, intrahand muscle strength at admission, maximum spinal cord compression, maximum canal compromise, length of high-intensity signal in the spinal cord on sagittal T2-weighted magnetic resonance imaging, AMS, and American Spinal Injury Association injury grade D/C at admission had a significant effect on recovery of spinal cord function. Surgical treatment of ATCCS without fracture and dislocation is safe and effective. Age, admission AMS and American Spinal Injury Association impairment scale score, intrinsic hand muscle strength, maximum canal compromise, maximum spinal cord compression, and length of high-intensity signal in the spinal cord can be used to predict postoperative recovery of spinal cord function. [Orthopedics. 2022;45(6):325-332.].

Evaluation of functional recovery in the intrinsic and flexor muscles after nerve transfer for ulnar nerve lesion. A new measurement method: The Cha method

“Supercharge” end-to-side (SETS) nerve transfer for lesions of the proximal ulnar nerve is a recognized novel option, but improvement in motor function after surgery has not been properly evaluated. We therefore propose a modified method for quantitative evaluation of improvement in the intrinsic hand strength. We screened 216 patients with proximal ulnar nerve lesions who presented to our outpatient department from 2012 to 2020. Of these, 101 met our inclusion/exclusion criteria and were evaluated just before surgery. We used a novel method to measure finger abduction (“2nd-abd”), adduction (“5th-add”), and ring and little finger flexion strength (“4,5 grip”), and analyzed correlations with established pinch strength data. The male:female sex ratio was 86:15, and the ratio dominant to nondominant arm involvement was 68:33. All strength measurements were analyzed as percentage affected to contralateral normal side. On Pearson correlation analysis, the strength ratios for “4,5 grip”, “2nd-abd”, and “5th-add”, but not “5 fingers (total) grip”, showed significant positive correlation with key and oppositional pinch strength (all p < 0.001). Additionally, linear regression analysis showed identical results for each strength correlation with key/oppositional pinch, except for “5 fingers total) grip” (all, p < 0.001). SETS is a reasonable alternative for lesions of the proximal ulnar nerve. The measurement method we propose is feasible for specific assessment of intrinsic muscle strength, which improves after surgery. Level of evidenceDiagnostic, level IV.

Evidence for symmetrically reduced foot mechanics and energetics in patients after trimalleolar fracture repair: A cross-sectional study

BackgroundTrimalleolar fractures osteosynthesis is associated with a suboptimal outcome. It is hypothesized that patients with trimalleolar fractures face different ankle joint kinetics at mid- and long-term causing compensations at the distal foot joints. Research questionDo patients with a history of a trimalleolar fracture demonstrate different foot joint mechanics and energetics (1) between their affected side and their matched controls? (2) between their unaffected side and their matched controls? (3) between their affected side and their unaffected side? MethodsFifteen patients who sustained a trimalleolar fracture and underwent osteosynthesis for both the lateral, medial and posterior malleolus were compared to a asymptomatic control group which was matched for sex, age and walking speed. Three-dimensional gait analysis was used to quantify kinetic parameters in the Ankle, Chopart, Lisfranc and first metatarsophalangeal joint through a multi-segment kinetic foot model. Statistical analysis was performed using a Univariate Analysis of Covariance and/or a paired t-test. ResultsThe peak internal ankle moment was significantly lower in patients when compared to the control group (p < 0.001). Mean peak power generation and total positive work were significantly lower for the Chopart joint when comparing the patients to the control group (p < 0.001). These results were observed for both the affected and unaffected side of the patients compared to the control group, showing symmetrical changes in the patient group. SignificanceDespite adequate radiographic quality of reduction and the fact that all patients were treated according to a fixed postoperative protocol, this study indicates that patients with a history of a trimalleolar fracture demonstrate reduced foot joint kinetics. It is hypothesized that these findings originate from extrinsic and intrinsic foot muscle strength, stiffness and pain. Future research is needed to validate this hypothesis.

Prospective outcome analysis of ulnar tunnel syndrome: Comparing traumatic versus non-traumatic etiologies

Ulnar tunnel syndrome (UTS) is relatively uncommon compared to the carpal tunnel or cubital tunnel syndromes. Few reports dedicated to the functional outcomes after surgical intervention of the UTS exist. Herein we compare the outcomes of patients with UTS of different etiologies. Patients diagnosed with UTS between 2016 and 2020 were recruited. Ulnar tunnel release was performed in all patients, along with other necessary osteosynthesis or reconstructive procedures in the traumatic group. Patients were followed-up every six months post-operatively. Outcomes measured include: objective evaluations, subjective questionnaires, records of clinical signs, and grading of the British Medical Research Council scale for intrinsic muscle strength. 21 patients were recruited, and favorable results were noted in all of them after surgery. Traumatic UTS patients had a worse initial presentation than the non-traumatic cases, but had a greater improvement after surgery and yielded outcomes comparable with those of the patients without trauma. Patients with aberrant muscles in their wrists had better outcomes in some objective measurements than those without aberrant muscles. Ulnar tunnel release improves the outcome of patients regardless of the etiology, especially in patients with trauma-induced UTS. Thus, a proper diagnosis of the UTS should be alerted in all patients encountering paresthesia in the ulnar digits, ulnar-sided pain, weakness of grip strength, or intrinsic weakness to ensure good outcomes.

Validity of ultrasound imaging for intrinsic foot muscle cross-sectional area measurements demonstrated by strong agreement with MRI

PurposeIntrinsic foot muscles maintain foot structural integrity and contribute to functional movement, posture and balance. Thus, assessing intrinsic foot muscle size and strength are important. Magnetic resonance imaging (MRI) has been shown to accurately image the individual muscles but is costly and time consuming. Ultrasound (US) imaging may provide an alternative that is less costly and more readily available. The purpose of this study was to investigate the validity and intratester reliability of US imaging in measuring intrinsic foot muscle size in comparison to MRI.MethodsUS and MRI were employed to measure the intrinsic foot muscle size involving 35 participants (females = 13; males = 22). The scanned intrinsic foot muscles included the flexor hallucis brevis (FHB), abductor hallucis (ABDH), flexor digitorum brevis (FDB), quadratus plantae (QP) and abductor digiti minimi (ADM). Pearson product correlation (r), intraclass correlation coefficients (ICC), standard error of the measurement (SEm) and minimal detectable difference (MDD) were calculated.ResultsHigh correlations were detected between the US and MRI cross-sectional area (CSA) measurements (r = .971 to 0.995). Test reliability was excellent for both MRI and US (ICC = 0.994 to 0.999). Limits of agreement between MRI and US measurements from ranged from 5.7 to 12.2% of muscle size. SEm values for US ranged from 0.026 to 0.044 cm2, while the SEm for MRI ranged from 0.018 to 0.023 cm2. MDD values for US ranged from 0.073 to 0.122 cm2, while MRI ranged from 0.045 to 0.064 cm2.ConclusionsUS appears to be a valid and reliable alternative to MRI when measuring intrinsic foot muscle CSA. While US is less costly and more readily available, the MRI results were shown to be slightly more precise.

Physiotherapy in Musculoskeletal and Sports conditions: AB No: 175: Effect of Matrix Rhythm Therapy on Pain and Hand Intrinsic Muscle Strength in Students with Nomophobia

Physiotherapy in Musculoskeletal and Sports conditions: AB No: 175: Effect of Matrix Rhythm Therapy on Pain and Hand Intrinsic Muscle Strength in Students with Nomophobia

A Narrative Review of Metatarsal Bone Stress Injury in Athletic Populations: Etiology, Biomechanics, and Management.

Metatarsal bone stress injuries (BSIs) are common in athletic populations. BSIs are overuse injuries that result from an accumulation of microdamage that exceeds bone remodeling. Risk for metatarsal BSI is multifactorial and includes factors related to anatomy, biology, and biomechanics. In this article, anatomic factors including foot type, metatarsal length, bone density, bone geometry, and intrinsic muscle strength, which each influence how the foot responds to load, are discussed. Biologic factors such as low energy availability and impaired bone metabolism influence the quality of the bone. Finally, the influence of biomechanical loads to bone such as peak forces, load rates, and loading cycles are reviewed. General management of metatarsal BSI is discussed, including acute care, rehabilitation, treatment of refractory metatarsal BSI, and evaluation of healing/return to sport. Finally, we identify future research priorities and emerging treatments for metatarsal BSI.

Reliability of Peg Restrained Intrinsic Muscle Evaluator for Measurement of Intrinsic Hand Muscle Strength in Adults with Tetraplegia

Background: The manual muscle test (MMT) is the traditional method to assess the intrinsic hand muscle test. However, this test is qualitative and subjective. A device capable of rapidly measuring motor output along a linear scale may be of value in the evaluation of hand recovery from any neurological impairment. Objective: To demonstrate inter-rater reliability of the Peg Restrained Intrinsic Muscle Evaluator (PRIME) device for measuring intrinsic hand muscle strength in adults with impaired hand functions. Methods: 16 subjects (2 female, 14 male, mean age=47±15 years) with cervical spinal cord injury were enrolled. Intrinsic hand muscle strength of adults were performed by two-tester with use of PRIME device and manual muscle testing, within the same session. Inter-tester correlation was tested by Pearson's correlation and Intraclass correlation coefficient (ICC). Results: Intraclass correlation coefficients for hypothenar, first dorsal interosseous, abductor pollicis brevis and opponence pollicis muscles ranged from 0.7 to 0.8 with hypothenar muscle test being lowest ICC=0.7 and thumb opposition highest, ICC=0.81. Conclusion: Results from this study suggest that PRIME device demonstrates good reliability within testers for quantified measuring of intrinsic hand muscle strength. Further use of PRIME in clinic will aid in diagnostics, medical decision making and evaluation of rehabilitation progress in patients with cervical spinal cord injury.

RELIABILITY OF MAKE AND BREAK TESTS IN ASSESSING INTRINSIC FOOT MUSCLE STRENGTH USING A HANDHELD DYNAMOMETER IN HEALTHY YOUNG ADULTS

Purpose: The make and break tests are used in isometric muscle measurement via a handheld dynamometer. This study aimed to compare the reliability of intrinsic foot muscle strength assessment with break and make tests in healthy young adults. Methods: Seventy-five healthy adults completed the test-retest protocol with five days between tests. The maximal isometric strength measure of intrinsic foot muscles was measured during make/break tests using a handheld dynamometer. Test-retest reliability was calculated using intra-class correlation coefficients (ICC). Minimal detectable changes were calculated using standard error measurements. Results: According to the analysis, the strength results of the break test were higher in all muscles when compared to the make test (p&amp;lt;0.05). The strength measurements of the intrinsic foot muscles was found to have almost perfect test-retest reliability in the make and break test (ICC=0.938-0.986). Conclusion: Healthy adults showed stable test-retest results on all muscle strength measurements of the intrinsic foot muscles. The make and break test carried out usnig the handheld dynamometer is a reliable method for assessing intrinsic foot muscle strength in healthy adults. Both make and break tests are reliable measurements for the strength of intrinsic foot muscles.

Modification of Pronated Foot Posture after a Program of Therapeutic Exercises.

Working on the intrinsic musculature of the foot has been shown to be effective in controlling pronation. However, the potential coadjuvant effect that involving other muscle groups might have on foot posture remains unknown. The aim was, therefore, to assess whether a 9-week intrinsic and extrinsic foot and core muscle strength program influenced foot posture in pronated subjects. The participants were 36 healthy adults with pronated feet that were randomly assigned to two groups. The experimental group (n = 18) performed a strengthening exercise protocol for 9 weeks (two sessions of 40 min per week), while the control group (n = 18) did not do these exercises. After 9 weeks, the foot posture index (FPI) scores of the two groups were analyzed to detect possible changes. The FPI at the baseline was 8.0 ± 1.5. After the 9 weeks, the experimental group showed significantly reduced FPI from 8.1 ± 1.7 to 6.4 ± 2.1 (p = 0.001), while the control group had the same score as pre-intervention (FPI 8 ± 1.2, p = 1.0). The FPI scores showed no significant differences by sex. Strengthening of the intrinsic and extrinsic foot and core muscles contributed to improving foot posture in adults, reducing their FPI by 1.66 points.

Feasibility of the Archercise biofeedback device to strengthen foot musculature

BackgroundFoot muscle weakness can produce foot deformity, pain and disability. Toe flexor and foot arch exercises focused on intrinsic foot muscle strength and functional control may mitigate the progression of foot deformity and disability. Ensuring correct exercise technique is challenging due to the specificity of muscle activation required to complete some foot exercises. Biofeedback has been used to improve adherence, muscle activity and movement patterns. We investigated the feasibility of using a novel medical device, known as “Archercise”, to provide real-time biofeedback of correct arch movement via pressure change in an inflatable bladder, and foot location adherence via sensors embedded in a footplate during four-foot exercises.MethodsThirty adults (63% female, aged 23–68 years) performed four-foot exercises twice on the Archercise sensor footplate alone and then with biofeedback. One-way repeated measures ANOVA with pairwise comparisons were computed to assess the consistency of the exercise protocol between trial 1 and trial 2 (prior to biofeedback), and the effectiveness of the Archercise biofeedback device between trial 2 and trial 3 (with biofeedback). Outcome measures were: Arch movement exercises of arch elevation and lowering speed, controlled arch elevation, controlled arch lowering, endurance of arch elevation; Foot location adherence was determined by percentage of time the great toe, fifth toe and heel contacted footplate sensors during testing and were analysed with paired sample t-tests. Participant survey comments on the use of Archercise with biofeedback were reported thematically.ResultsSeventeen (89%) arch movement and foot location variables were collected consistently with Archercise during the foot exercises. Archercise with biofeedback improved foot location adherence for all exercises (p = 0.003–0.008), coefficient of determination for controlled arch elevation (p < 0.0001) and endurance area ratio (p = 0.001). Twenty-nine (97%) participants reported Archercise with biofeedback, helped correct exercise performance.ConclusionsArchercise is a feasible biofeedback device to assist healthy participants without foot pathologies perform foot doming exercises.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): 12616001559404. Registered 11 November 2016, http://www.ANZCTR.org.au/ACTRN12616001559404p.aspx

Daily activity in minimal footwear increases foot strength

Nearly one-third of older people experience at least one fall a year (Todd & Skelton, 2004) impacting their quality of life. Increasing intrinsic foot muscle strength can influence balance and stab...