Calf raise alternatives for painful toes

If your toes hurt during your prescribed calf raises for Achilles rehab, it’s worth trying a few alternatives. Sports physio Maryke Louw demonstrates three options that can help you strengthen your calves and Achilles tendon without aggravating your toes. Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.

In this article:

1. Calf raises – what’s the problem we need to solve?

2. First, get the shoes right

3. Calf raise alternative 1: Resistance band exercise

4. Calf raise alternative 2: Isometric exercise

5. Calf raise alternative 3: See-saw exercise

6. Putting it all together

7. How we can help

We've also made a video about this:

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Calf raises – what’s the problem we need to solve?

The typical calf raise exercise is done on a flat surface – either on the floor or with the front of the foot supported on a step. In both cases, as you raise your heels, your toes remain on the floor; they are forced to bend up and now also support more of your body weight.

Obviously, this can be painful if your toe joints have issues of their own, for example arthritis, or perhaps your big toe has been fused. To solve this, we must find alternative exercises that work the calf muscles without requiring the toe joints to bend as much.

So, let's look at a few ways of keeping those toes a bit straighter while you exercise your calf muscles and Achilles tendon.

To help reduce toe pain, the calf raise alternatives you choose must allow your toes to remain relatively straight throughout the exercise.

First, get the shoes right

Usually, when people tell you to wear supportive shoes, they’re referring to foot arch support. But this is not the case here. What we're looking for in this case is a sturdy sole.

Our feet are quite flexible and can move in so many different ways that it can be difficult to target the correct areas accurately or predictably when you’re barefoot. When they are supported by a firm sole, the movement is a bit more predictable and the load on the foot and toes is spread more evenly.

So, I would strongly suggest that you wear supportive shoes (like running shoes) when you do these exercises. Running shoes where the heel is higher than the toes (heel-to-toe drop) have the added benefit of taking some strain off your Achilles tendon, helping the pain settle more quickly. Here are some examples:

Calf raise alternative 1: Resistance band exercises

It’s best to do these sitting on a chair (which works your soleus calf muscle more) as well as sitting flat on the floor (which works your gastrocnemius calf muscle more).

On a chair (targeting the soleus)

Demo

Instructions

1. Sit on a chair, with the leg you want to exercise slightly out in front of you, so that your heel is on the floor and the rest of your foot raised at about a 90-degree angle to your shin.

2. Loop a resistance band around the ball of your foot and hold the loose ends in your hands so that there’s some tension in the band.

3. Push your foot downwards against the resistance of the band, hold for a second or two, and then slowly bring it back to its original position.

On the floor (targeting the gastrocnemius)

Demo

Instructions

1. Sit on the floor, with the leg you want to exercise straight out in front of you, with your foot (again) at an angle of about 90 degrees to your shin.

2. Place a rolled-up towel or cushion under your calf, so your heel is off the floor and your ankle is free to move.

3. Loop the resistance band around the ball of your foot, and push your foot downwards against the resistance of the band, hold for a second or two, and then slowly bring it back to its original position.

Top tips (chair and floor)

• It’s really important to bring your foot back to its original position slowly (as opposed to allowing the resistance band to “snap” it back) because this is a crucial part of the strength training for your calf muscle – it’s referred to as an “eccentric” exercise.

• If you have insertional Achilles tendonitis, don’t bring your foot back further than 90 degrees to your shin, as this will compress your injured tendon against your heel bone, which might irritate it.

• If you have midportion or high Achilles tendonitis, you can bring it back past 90 degrees.

How many repetitions?

Traditional standing calf raises are done with your body weight or more, and it can be difficult to match that kind of resistance when you're using the bands. (This is also why it’s so important to get the eccentric part of the movement right.)

Depending on their activity goal, we might get our patients to gradually increase the difficulty of their standing calf raises to up to 3 sets of 15 calf raises with their body weight plus added weights.

With resistance bands, I would gradually build up to 3 to 4 sets of 25 to 30 repetitions.

Of course, you get different strength resistance bands, and you could also increase the resistance by doubling up the band or using two bands. It all depends on your activity goal – someone who would just like to be able to walk their dog won’t need to up their resistance, sets, and reps to the same level as someone who would like to run a marathon.

Like with all rehab plans for Achilles injuries, it’s useful to keep the story of the tortoise and the hare in mind. Don’t push yourself to see how many sets and reps you can do in a single session – you might just make your injury worse. It’s about gradually increasing the difficulty of your exercises over the course of several weeks. Here’s our article that explains the basic principles behind progressing Achilles rehab exercises responsibly.

Calf raise alternative 2: Isometric exercise

An isometric exercise doesn’t involve movement – you just hold a certain position for a certain time against resistance or gravity. I like the isometric option in this instance because you can add quite a bit of weight to your own body weight, if necessary, without bothering any pain-prone toes.

Demo

Instructions

These are for single-leg isometric holds. For double-leg ones, do the same with both feet.

1. Stand on a step so that your heel is over the side of the step and only the ball of your foot and your toes are on the step.

2. Keep your foot horizontal (so your toes don’t bend) and hold this position for 30 seconds.

Top tips

• Don’t drop your heel lower than the step, for two reasons: First, if you just “hang” in that low position, your calf muscle isn’t really working, so you won’t get any strength benefit. Second, if you have insertional Achilles tendinopathy, you will compress the tendon against the heel bone, which might irritate it.

• This is not a balance exercise, so feel free to hold onto something for balance.

• It’s usually better to start with double-leg isometric holds – if you start off with single-leg ones and your strength and control aren’t up to it yet, your foot might wobble and hurt your problem toe(s) that way. With double legs, you can add quite a lot of extra weight, so the injured leg will still get good strength training.

Repetitions and progression

• Starting with double legs and your own bodyweight, work up to 4 or 5 repetitions of a minute each with one or two minutes’ rest in between.

• Once you can do this easily, either add some weight, or if your toes are happy with it, go to single-leg isometric holds with fewer reps and shorter holds and work your way back up again, same as with the double-leg holds.

• Some people find that single-leg holds always irritate their toes – it’s likely because of how your weight has to shift when you assume that position. If that’s the case, continue with double-leg holds – I’ve had patients recover by doing double-leg exercises only, with added weight.

Calf raise alternative 3: See-saw exercise

For this one, you’re going to need a rolled-up exercise mat or something similar that you can use as the pivot point for the see-saw (i.e. your foot). A yoga block might also work – just make sure that it’s stable enough not to tip over while you do the exercise because that might really hurt your toes.

The idea here is to actually do a standing calf raise while giving your toes (the one end of the see-saw) some room so that they can stay straight and don’t have to bend upwards as you lift.

You might not be able to raise yourself up as high as with a normal standing calf raise, because you might slide off the front of your pivot point, but at least you will develop some concentric (raising yourself up) as well as eccentric (when you lower yourself back down again, slowly) strength.

Demo

Instructions

These are for double-leg see-saw calf raises.

1. Stand with the balls of your feet on the pivot point so your toes are sticking over the front and have space to move.

2. Raise yourself up and hold for a second or two.

3. Come back down slowly.

Top tips

• Same as with the isometric holds, don’t drop your heel below the horizontal if you have insertional Achilles tendinopathy.

• Also, same as above, start with double legs – only move on to single-leg exercises if the object you’re using as the pivot point is stable enough to do it safely.

Repetitions and progression

• Gradually work towards 3 sets of 15 each with just your body weight on double legs.

• Once this is easy, you can progress the exercise in the same way as above – either adding weight to double legs or going single-leg but with much fewer reps to start with and then gradually increasing them.

Putting it all together

You don’t have to do all of these exercises, and neither do you have to stick to only one.

For instance, if you find the see-saw exercise painful or tricky, focus on the other two: Work towards eventually adding some good weight to the isometric holds and get some eccentric exercise with the resistance bands.

And remember, you might be able to get away with not having to do any of these exercises. Some of my patients have found that their problem toes don’t complain if they stick to, say, 8 standard calf raise repetitions at a time with more added weight, while the toes do start to get painful if they go beyond 8 reps with less weight.

So play with various combinations, mix and match, and see what works for you.

How we can help

Need help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.