Foot pain is one of the most common musculoskeletal complaints affecting nearly 1 in 5 adults at some point in their lives. And yet, it is one of the most poorly managed musculoskeletal issues across our medical system.

Foot issues can have a significant impact on mobility, activity participation, and quality of life. We know that walking more and walking faster can increase your odds of longevity but who wants to walk more when your foot hurts? It can be a slippery slope becoming a huge barrier to your proactive health.

When your shoulder hurts, you work on your rotator cuff. When your back hurts, you strengthen your core muscles. But when your foot hurts we commonly seek orthotics, or chase a quick fix through a pill or passive treatment (like laser, shockwave and acupuncture).

When is the last time you specifically worked on the muscles of your foot??? We ask this question often in clinic; “Never” is by far the most common answer.

Yet, current scientific evidence strongly supports exercise-based rehabilitation for many foot related disorders.

 

Why exercise should be first line care for foot pain

Exercise-based rehab targets the root causes of foot pain rather than just putting a temporary bandage on the situation.
It improves tissue load tolerance, strengthens the intrinsic and extrinsic foot muscles, enhances balance and proprioception, and can address dysfunctional movement and biomechanical patterns that contribute to pain and injury.

A 2024 meta-analysis published in MDPI Sports compared exercise, orthotics, and combined approaches in adults with flexible flatfoot and associated foot pain. The findings were clear: exercise was more effective than orthotics in reducing pain and improving function. Importantly, neither approach significantly changed arch structure—highlighting that symptom relief does not require structural correction.

Quite simply: your arch shape does not need to be “fixed”.

Plantar fasciitis, one of the most common sources of heel pain, also responds well to targeted exercise. A 2021 Cochrane Review concluded that progressive loading exercises for the plantar fascia and calf complex reduce pain and improve outcomes better than stretching or rest alone.

Strengthening the foot’s intrinsic muscles and addressing proximal contributors (like glute weakness or poor ankle mobility) provides a more comprehensive and lasting solution.

Similar outcomes for exercise therapy have been found with achilles tendinopathy and metatarsalgia, with exercise being the gold standard of care.

 

Of course, not all causes of foot pain will equally respond to exercise. Stress fractures, tarsal tunnel syndrome, morton’s neuroma and a rigid, painful flatfoot for example may need some offloading and support. But these cases are generally the minority and not the majority.

 

The big orthotic myth

A common misconception is that structural foot issues like flat feet or overpronation automatically require orthotics. However, multiple studies, including a 2023 BMC Musculoskeletal Disorders meta-analysis, found that orthotics do not consistently improve outcomes in asymptomatic or mildly symptomatic individuals. In fact, many people with flat feet experience no pain at all.

Moreover, there is no strong evidence that orthotics can restore the arch in adults or significantly change long-term biomechanics. Instead, strengthening the muscles that support the arch can provide similar (if not better) functional support—without reliance on a passive device.

Why have orthotics become so popular? They can create a short-term change in biomechanics that reduce the stress concentration and alter pain perception. But now you have just pushed the problem down-stream and have become dependent on the expensive device.

Orthotics are a great business for practitioners. We once sold orthotics in our office, so we know. But our conscience weighed heavy on us, knowing it was just a short-term patch job and not really addressing the problem.

Around 2020 we decided we would no longer dispense orthotics and instead we would focus our efforts on being the best foot rehabilitation clinic we could possibly be and refer out in those rare cases an orthotic might be necessary.

 

What kind of foot exercises will likely help?

An exercise-based rehab plan should be individualized based on findings in a gait assessment, comprehensive assessment of joint and muscle function and movement capacity assessment. Common exercise considerations might include:

• Toe and foot strengthening (eg foot dexterity exercises, short foot exercises)

• Calf and Achilles loading (eg heavy slow resisted heel drops)

• Balance and proprioception work (eg single-leg isometric holds or step down)

• General lower extremity strength (eg compound lifts such as a squat and deadlift variations)

• Ankle, knee and hip mobility exercises (eg controlled articular rotations or knee over toe variations)

• Gait retraining (eg high gear push off)

• Sport or activity specific considerations (eg progressive return to running or change of direction capacity)

 

While foot pain most certainly requires a careful assessment and accurate diagnosis, exercise-based treatment should be considered a first-line approach unless proven otherwise. Orthotics and passive therapies (such as acupuncture, shockwave and laser) can have a place in care, but should be the exception, not the norm.

Exercise is the only intervention that strengthens the foot, addresses the kinetic chain, and empowers patients to take an active role in their recovery.

For foot pain, it’s not about supporting the arches—it’s about building resilience from the ground up.