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Foot Injuries in Dancers. Are they preventable?

Posted By Maggie Lorraine on behalf of the IADMS Education Committee, Wednesday, July 6, 2016

Perfecting the art of dance requires long hours of intensive training over many years with constant repetitions of exercises to refine and perfect the execution of sequences and movements. Dance places high demands on the body and for this reason professional dance training institutions often include physique testing, conducted by the resident physiotherapist as part of the audition process. Subsequently even the physiques that are deemed “ideal” for training at a pre professional level are at risk of injury as a result of faulty alignment and technique.  In recent years the quest for greater virtuosity in performance has added an extra layer of risk to the aspiring young dancer who is hoping to achieve a career in dance. Issues such as more intrusive stretching techniques to achieve higher extensions of the leg, bigger and higher jumps with added complexity, more virtuosic turns and particularly greater engagement of the spine in movement. These trends have all added to the necessity for dance teachers to have a comprehensive knowledge of human anatomy, physiology and kinesiology. This knowledge will give teachers the information to guide their students to reach their full potential and to avoid sustaining injuries.


No dancer is immune to the possibility of injury, however the young dancer who is experiencing a growth spurt is at the greatest risk. Whilst growing, a child’s bones are more susceptible to issues, since as the bones lengthen the growth places stress on the muscle tendon unit and consequently the young dancer at a higher risk for stress fractures and fractures.


Building from our previous posts on the foot’s skeletal and muscular structure, this article focuses on the foot and issues that arise from faulty biomechanics, technique and resulting from over pronation of the feet.

Incorrect turn out of the legs and feet often results in over pronation or “rolling “of the foot and ankle. To make up for inadequate mobility at the hip, dancers often rely on the rotation of the knee, and ankle to achieve the desired 180-degree turn out of the feet. This problematic mode of movement compromises the control of the rotation of the leg in the hip socket and the efficient recruitment of the deep rotator (turn out) muscles which assist in the stabilizing muscles of the legs and pelvis.  Maintaining alignment, stability, strength and control is difficult to achieve whilst dancing with torsion of the knee, and pronated foot. When the foot is pronated the weight of the body falls through the unaligned joints of the knee and ankle creating an increased torque of the medial (inner) arch and ankle and poor intrinsic foot muscle control  (see photograph above).

When there is poor intrinsic muscle strength in the arch of the foot, foot pain may occur. The intrinsic foot muscles are the tiny muscles, which contribute to control a ballet dancer's arch. If the muscles are not working effectively, larger muscles known as the extrinsic foot muscles, which originate on the leg and cross over the ankle joint, become overused.

Over-pronation of the feet can lead to a number of problematic conditions, which contribute to foot pain and may cause conditions such as bunions, hallux rigidus, plantar fasciitis, and sesamoiditis.


Unfortunately bunions can be common in dancers. They begin to develop in young dancers who do not have the muscle recruitment in place to support the growing bones. Both male and female dancers are at risk from the increased stress on the medial column of the foot as a dancer attempts to achieve greater turnout from the knee and ankle. Some bunions (or hallux valgus) are hereditary, however dancers may develop them as a result of forcing turn out with little to no intrinsic muscle control. Tight fitting shoes and pointe shoes may also contribute to bunions as the shoes narrow to the pointe and the foot is broadest across the metatarsals. Squeezing the toes into narrow pointe shoes put pressure onto the big toe joint which is exacerbated by carrying the weight of the body on the tiny surface of the shoe en pointe.


Repeated strain on the big toe joint may result in hallux rigidus or stiffness of the big toe. Dancers with bunions are more prone to hallux limitus. The shock and forces from dancing can lead to inflammation of the big toe joint, and over time cause stiffness and a lack of range of motion. Because of the pain and stiffness, dancers will shift their weight to the outside of the foot during demi-pointe. 


Metatarsalgia is an overuse injury and the term describes pain in the ball of the foot, which usually develops over months. High impact activities such as jumping without sound foot control and abnormal weight distribution on the foot can result in this injury. Although this injury is not solely a result of hyperpronation, the reduced foot control resulting from poor intrinsic strength will be a contributing factor.


Sesamoiditis is another condition where pain is often felt in the ball of the foot and is a result of excessive pressure on the forefoot. The sesamiod bones are two tiny bones within the flexor hallucis longus (FHL) that run to the big toe and when a person has sesamoiditis the tendon become inflamed. Dancers, who alternate between extreme plantar flexion and dorsiflexion rely on the flexor hallucis longus (FHL) for dynamic stability of the foot during these movements and they may be particularly susceptible to this condition. Other causes can be an increase in activity, having a foot with a high arch or a bony foot (with insufficient fat to protect the tiny bones) and also stress fractures. Most frequently dancers with sesamoiditis have an imbalance of FHL vs. gastrocnemius/soleus {calf muscles} and FHL vs. intrinsics.


The plantar fascia is a dense band of fibrous tissue that originates at the heel and connects to the base of the toes. It stretches each time the foot is used, and is prone to overloading especially if the arch is not supported by proper footwear. Dancers experience pain and swelling at the inside base of the heel and arch area and it is known as plantar fascilitis.

This article has focused on foot injuries, which may result from faulty biomechanics of the foot in dancers.

Forcing turn out from the foot and ankle instead of at the top of the leg at the hip joint results in faulty alignment and poor muscle recruitment. Dancers require strong intrinsic muscles of the feet, which are imperative for aligned foot control against the ground in repetitive movements of the foot, pointe work and jumping.  Without this control of the foot the dancer is at risk of injury.

The next article in this series will examine issues resulting from incorrect stretching of the foot and faulty

biomechanics of rising to demi pointe and pointe.


Maggie Lorraine


The following IADMS link provides an excellent training program for dancers:


         Turnout for Dancers: Supplemental Training

         Feet: Skeletal and Muscular Structure

         Resource Paper: The challenge of the Adolescent Dancer

Follow these links for more information:

YouTube - 1

YouTube - 2



Further reading:

Grossman G, Krasnow D and Welsh TM. Effective use of turnout: biomechanical, neuromuscular, and behavioral considerations. Journal of Dance Education 2005; 5(1): 15-27.


Jeffrey A. Russell, PhD, ATC. Breaking pointe: Foot and ankle injuries in dance.



Maggie Lorraine is the Leading Teacher in Ballet at the Victorian College of the Arts Secondary School and is a member of the IADMS Education Committee.

Tags:  dancers  feet  foot  injury  prevention  teachers 

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Feet: Skeletal and Muscular Structure

Posted By Elsa Urmston on behalf of the IADMS Education Committee, Tuesday, April 5, 2016

Over the next few months the Education Committee bloggers shine a light on the importance of the feet.  In June, Maggie Lorraine will write a two-part blog which focuses on potential foot injuries, structural issues, and working with them in dance.  We look forward to her insight.  By means of introduction to this topic, this short blog provides an introduction to the foot’s skeletal and muscular structure.

We all know that tired feeling in our feet at the end of a busy dancing day, don’t we?  They ache, they click, and let’s face it, dancers’ feet aren’t always the prettiest of things!  We look down at our bruised feet and hard skin, massage our insteps, and slather on moisturizer in an attempt to keep them as pliable as possible.  And no wonder, they work hard and we ask a lot of them!!


But what do you know about the structure of the foot?  It’s a hugely complex skeletal structure, comprising 26 bones, 34 joints and more than 100 muscles1, tendons and ligaments, all arranged to be weight-bearing in all sorts of different contexts from pointe to heeled shoes, from sliding across the floor in bare feet to taking off and landing on all surfaces of the foot.  And of course, the foot contributes to that sought-after, beautiful line from the toes and arch of the foot and into the rest of the lower leg in an arabesque.  Most importantly the foot is designed to create resilience and acts as a shock-absorber to the rest of the body. As Russell2 explains, “the foot’s structure, with its many bones intricately fitting together, provides a dynamic platform on which to support the body. The foot’s adaptability to the floor or ground, regardless of whether or not it is encased in a shoe, is what starts the process of pushing off the floor, absorbing shock when landing from a jump, changing direction in turns, and providing a surface on which to spin, to name a few of the foot’s functions important to dance.”


There are many super resources online which can help you learn the various bones and joints of the foot for example here and here, plus this interactive tutorial: Foot Anatomy Tutorial.


We provide a simple diagram here.

The foot can be divided into the posterior and anterior sections.  The ankle joint itself (a synovial hinge joint) is formed between the distal ends of the tibia and fibula and the talus where plantarflexion (pointing) and dorsiflexion (flexed foot) occurs.  The seven tarsal bones including the talus then make up the posterior portion of the foot, nearest to the heel, or calcaneus.  Each tarsal bone is roughly square in shape with flat articular surfaces and together the surfaces glide past each other to provide lateral stability just below the ankle joint itself; they contribute hugely to subtle changes in balance and it is here that inversion (sickling) and eversion (winging) can occur.  The five metatarsals and fourteen phalanges comprise the anterior section of the foot, extending away from the ankle joint itself down towards the toes.  These bones act as levers, alongside the muscular system of the lower legs and feet to allow the dancer to come up onto demi-pointe and ultimately to jump and locomote.


The skeletal structure of the foot also creates the longitudinal and transverse arches of the foot which are vital to spread the dancer’s weight across the whole foot.  The arches absorb shock from the ground in landing from a jump which is why it is so important for dancers to maintain strong, articulate feet.  The arches are reinforced by the ligament system and power is achieved by the muscles working on the joints to create motion through the foot’s resilient dome-like structure.


As you’d expect, the muscular system of the foot is also complex! They can be divided into two groups; extrinsic and intrinsic muscles.  The extrinsic muscles arise from the anterior, posterior and lateral areas of the lower leg and are mainly responsible for actions such as plantarflexion, dorsiflexion, inversion, and eversion.  The intrinsic muscles are responsible for more fine motor control actions such as the adaptation of the foot to the body’s weight and balance and the movement of individual toes.  These intrinsic muscles are layered through the foot to achieve the precision and intricate demands that dancers place on their feet – no wonder our feet and ankles fatigue!  These two great tutorials are a great interactive introduction to the musculature of the feet.


Intrinsic Muscles of the Foot: Dorsal Muscles


Intrinsic Muscles of Foot:  Plantar Muscles



So, the balance between strength and flexibility is of paramount importance in the dancer’s foot.  When it is achieved we are able to power through space, travelling with height, speed, and dexterity.  The simple directive of ‘using the floor’ is familiar to many of us.  Building strength and articulation can be achieved through emphasising the stroking of the sole of the foot on the floor in tendu and degagé, leaving the heel until last as the foot extends away from the body, and lowering it first as the foot closes back in.  This pressing of the foot into the ground strengthens the intrinsic muscles of the foot whilst also rehearsing the action of pushing into the ground to propel the body in a specific direction - fabulous conditioning exercise and a cornerstone of many dance techniques.  For more inspiration see The Royal Ballet’s class broadcast in 2014, a series of tendu exercises feature from about 6 minutes from the start of the video.


But what if strength and flexibility of the foot structure is compromised either through poor posture or dynamics in alignment of the body, or indeed due to an acute injury sustained whilst dancing? Our forthcoming posts will tackle these issues in June 2016.





1.  Clippinger, K.  The ankle and foot, Dance anatomy and kinesiology. Human Kinetics, 2007, 297-371.


2.  Russell, J.  Insights into the Position of the Ankle and Foot in Female Ballet Dancers En Pointe.  The IADMS Bulletin for Dancers and Teachers, 6(1), 2015, 10-12.  Available here.



Elsa Urmston, MSc, PGCAP, AFHEA, is the DanceEast Centre for Advanced Training Manager, Ipswich, UK and a member of the IADMS Education Committee.  She also sits on the One Dance UK Expert Panel for Children and Young People.


Tags:  anatomy  feet  foot 

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