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Stability of the foot and ankle: the impact of daily habits on dance training

Posted By Nancy Romita and Allegra Romita on behalf of the IADMS Dance Educators' Committee, Thursday, May 23, 2019

"The human foot is a masterpiece of engineering and a work of art"
- a
ttributed to Leonardo Da Vinci

 

As you read this, freeze. Hold the position in which you currently find yourself. Do not adjust anything. Without judgment or shifting, notice the position of both feet. Does one foot have more weight on it than the other? Are both feet on the floor? Is there an even weight distribution? Is one foot or ankle a little more turned or rolled in or out? Are you sitting on one foot? Is a leg crossed and how does that affect the shape of foot and ankle?

 

 

There are 26 articulating bones in each foot to provide dynamic resilience. The ankle joint has a secure mortis and tendon configuration to generate stability during flexion and extension. The foot and ankle are elegantly designed to be stable enough to bear the weight of the body and resilient enough to navigate uneven ground, such as climbing rocks or walking through sand.

 

Stabilization of the ankle and foot is crucial for injury prevention and enhances the potential for efficiency in action. The foot and ankle provide the structural base of support for standing, walking, and dancing. 65% of dance injuries are related to habitual mis-stacking of the skeletal structure (Liederbach, 2018).  It stands to reason that conscientious awareness to distribute the load of the foot develops the foundation for the stacking the skeletal structure. Unconscious habits in standing, sitting, or how you hold your feet while driving a car can either support the stability needed for the rigors in dance training or it can insidiously compromise it.

 

Injuries to the ankle and foot comprise 50% of all injuries sustained in dance (Conti & Wong, 2001, p. 43). Strengthening the surrounding neuromuscular structures of the foot and ankle is vitally important, but all the wonderful work in technique class, cross training in the gym, working on a Bosu ball, or using Therabands are compromised if unconscious foot habits undermine these actions by rolling in (eversion) or rolling out (inversion).

 

 

One tool to let go of habitual stance is to consider an anatomical visualization to enhance the integrity of foot stance. The tripod of balance is depicted in the image below. The first point of this visualization is between the distal head of the first and second metatarsal. The second point is between the distal heads of the fourth and fifth metatarsal. The third point of reference is at the center of the calcaneus. The anatomical visualization of these skeletal landmarks can aid in moving out of habitual stance toward a balanced distribution of weight through the foot and ankle. The image provides a stable foundation for stacking the skeletal structure in static and dynamic balance. The three points are landmarks around which the muscles of the foot and ankle can navigate movement.

 


 

 

Try these self-explorations:

 

In the next few days, notice how your foot rests when sitting at a computer or while driving.  Is there a habit that relates to how your feet work while dancing?

 

The next time you find yourself between exercises at the barre or in teaching you are watching students move, notice your habit for the foot and ankle in standing.

 

Notice if your foot is sickled underneath the chair or you literally sit on one foot while reading or working at a computer. The toll on the lateral ligaments and tendons can create an imbalance and instability of that foot.

 

When you notice an imbalance, allow for a breath, release unnecessary tension in the feet, and visualize the weight evenly distributed through the tripod of balance.

 

In this approach of anatomical visualization through somatic practice, we invite you to consider balance, not as a station one arrives at, but rather as a way of traveling. Balance is not one position. It is a manner of being and shifts from moment to moment in lively response to the environment. 

 

 

Habits in sitting, standing, and driving can either support or adversely affect the structural stability of the ankle and foot. Dr. Kenneth K Hansraj has linked daily habits of how we hang the head down to look at cell phone and the impact on postural balance with the health of the cervical spine (Hasraj, 2014). Further research on the correlation between habit and ankle injuries in dancers is warranted to prevent insidious weakness in the structure of the ankle from affecting the risk of injury in dancers. Bringing mindfulness to habit, and visualizing a balanced foot stance is one strategy to move toward balance and stability and support both dancing and the actions of daily life.

 

 

 

Authors:

Nancy Romita (MFA, AmSAT, RYT), Senior lecturer Towson University, Director of Alexander Technique Mid Atlantic Teacher Training, and co-author of Functional Awareness Anatomy in Action for Dancers.

 

Allegra Romita (MA, CMA, RYT) is Dance Education faculty at NYU Steinhardt and currently pursuing a second graduate degree in motor learning and control at Teachers College, Columbia University, NYC. She is co-author of Functional Awareness Anatomy in Action for Dancers.

 

 

References

 

Hasraj, K. (2014). The assessment of stresses in the cervical spine caused by posture and position of the head. Surgery Technology International. XXV, 25:277-9

 

 Conti, S. F., & Wong, Y. S. (2001). Foot and ankle injuries in the dancer. Journal of Dance Medicine and Science. 5.2: 43-50.

 

 Leiderbach M. (2018). Epidemiology of dance injuries: Biosocial considerations in the management of dancer health: Strategies for the prevention and care of injuries to dancers. American Physical Therapy Association Orthopedic Section Monograph, Independent Study Course 18.1-3, La Crosse, Wisconsin.

Tags:  ankle  dancers  foot  teachers 

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Does dancing in heels hurt your knees? This may be why.

Posted By Pamela Mikkelsen on behalf of the IADMS Promotion Committee, Thursday, February 14, 2019

Dancers know that the shoes we wear impact how our bodies feel after dancing. I know that dancing full production shows in heels left my knees sore in ways that wearing flat shoes didn’t. Some of this soreness can be explained by differences in choreography demands but how much of the soreness could come down to the shoes? There is little research on how performing the same task in different shoes changes how much the leg joints and muscles work. In a recent study published in Medical Problems for Performing Artists, we examined the impact of wearing heeled shoes on a basic dance jump: sautés.

 

We found that wearing heels causes the knee joint and muscles to work more while the ankle works less even when the choreography is the same. As dancers, we know the body has a great ability to adapt and perform under different conditions and this is a good demonstration but we can use this new knowledge to decrease injury rates in dancers. For instance, choosing flat shoes instead of heels during long rehearsals may be a safer choice with regard to minimizing knee pain for a show that requires heeled shoes for performance. Also, the footwear choice of a production may be influenced by understanding the demands of the choreography with the production team deciding on a flatter shoe to promote knee health of the performers. This research also demonstrates one potential benefit to wearing heeled shoes with the use of “teacher shoes” for instructors that have ankle injuries like Achilles tendon pain. The slight heel height may decrease the demand on the ankle and redistribute it to the knee for improved tolerance to being on one’s feet all day. This study provides further evidence to consider footwear, and especially heeled shoes, for performance and rehearsal with regard to potential overuse injuries.

 

The research was done by analyzing the mechanics of each joint of the leg during the sautés. The individual joints of the leg must each produce energy in order to do a movement like a jump. The amount of energy produced to create movement is called work and the different joints will do different amounts of work for different movements. Our study looked at how much work the hip, knee, and ankle each performed doing repeated sautés in bare feet and when wearing heeled character shoes. We had ten female dancers participate at the Musculoskeletal Biomechanics Research Laboratory at the University of Southern California. We found that, when wearing heels, the work was significantly shifted toward the knee and away from the ankle. The ankle produced less energy while the knee produced more to do the same sauté. 

 

 

The figure shows the phases of a sauté: Contact Phase, when the dancer is on the ground, and Flight, when the dancer is in the air. The Contact Phase can be broken into Energy Absorption (landing) where the leg joints do work to decelerate the body as it comes down and Energy Generation (take-off) where the leg joints do work to push the body upward. We found that the knee does more work than the ankle during both the landing and the take-off of a saute when wearing heels.

 

We hypothesized a few different reasons for the differences seen when wearing heels. When wearing heels, the foot is in more of a pointed position and the ankle can’t move as much as when barefoot. This may cause the dancer to use the knee more when wearing heels. Other reasons include the dancer’s perception of friction and feeling less stable in heels. The increase in knee demand indicates that footwear may contribute to knee injuries seen in dancers and should be considered when making choices during rehearsal and performance.

 

*****

The research was performed by me, Pamela Mikkelsen, PT, DPT, OCS; Danielle N Jarvis, PhD, ATC; and Kornelia Kulig, PT, PhD. I am a physical therapist that specializes in outpatient orthopedics in Los Angeles and an adjunct instructor of clinical physical therapy at the University of Southern California. In addition to working with the general orthopedic population, I work with dancers and have an interest in preventing injury this unique population. I worked as a professional dancer and teacher for over ten years and am excited to contribute to the scientific knowledge of this art form and help strive for safer practices.  

Tags:  ankle  dancers  heels  knee  research 

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