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Performance enhancement is a multibillion dollar industry, with little known about the efficacy or safety of many practices. Many sport governing bodies have banned certain equipment, supplements, and drugs, yet, some athletes use anyway. This use may pose a danger to the individual user, as well as to other participants, and can challenge the integrity of the sport. We must consider how we, as health care professionals, balance personal autonomy, individual safety, and the integrity of sport in fulfilling our social contract.

Context: Exercising intrinsic foot muscles (IFMs) can improve dynamic balance and foot posture. The exercises are not intuitive and electrotherapy (neuromuscular electrical stimulation [NMES]) has been suggested to help individuals execute the exercises. The aim of this study was to evaluate the effects of training IFM program on dynamic balance and foot posture and compare traditional training methods (TRAIN) with traditional training plus NMES on the perceived workload of the exercises, balance, and foot posture. Design: Randomized controlled trial. Methods: Thirty-nine participants were randomized to control, TRAIN, or NMES. TRAIN and NMES performed IFM exercises daily for 4 weeks; NMES received electrotherapy during the first 2 weeks of training. The Y-Balance test and arch height index were measured in all participants at baseline. The training groups were measured again at 2 weeks; all participants were measured at 4 weeks and 8 weeks, after 4 weeks of no training. Perceived workload (National Aeronautics and Space Administration Task Load Index) of exercises was assessed throughout the first 2 weeks and at 4 weeks. Results: A 4-week IFM training program demonstrated increases in Y-Balance (P = .01) for TRAIN and in arch height index (seated P = .03; standing P = .02) for NMES, relative to baseline. NMES demonstrated improvement in Y-Balance (P = .02) and arch height index standing (P = .01) at 2 weeks. There were no significant differences between the training groups. Groups were similar in the number responding to exercises in excess of minimal detectable change on all clinical measures. Perceived workload of the exercises decreased during the first 2 weeks of training (P = .02), and more notably at 4 weeks (P < .001). The groups did not differ in how they perceived the workload. Conclusions: A 4-week IFM training program improved dynamic balance and foot posture. Adding NMES in early phases of training provided early improvement in dynamic balance and foot posture, but did not affect perceived workload.