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Just need some help with a 13 year old patient who is a keen ballet dancer.
The patient and her mother came to asking for a biomechanical assessment and help with (if possible), gaining more flexibility through her midtarsal joints whilst en pointe. Her left forefoot is flexing just pass 180 degrees and the right foot is limted to jsut less than 180degrees. The patient and mother expressed they do not want a 'banana foot', but do want to get about 10-15 degrees past 180degree.
She is hypermobile with the majority of hypermobility signs present, except her knees do not hyperextend. Flexible pronated foot type. Whilst trying to plantarflex the midfoot, soft tissue restriction stops her from plantarflexing further.
I was after some advice if it is possible at this age to continue to gain flexibility in this area, and with what exercises would need to be under taken?
Re: Increasing range of motion in forefoot for ballet dancer
Quote:
Originally Posted by Dean Hartley
Hello.
Just need some help with a 13 year old patient who is a keen ballet dancer.
The patient and her mother came to asking for a biomechanical assessment and help with (if possible), gaining more flexibility through her midtarsal joints whilst en pointe. Her left forefoot is flexing just pass 180 degrees and the right foot is limted to jsut less than 180degrees. The patient and mother expressed they do not want a 'banana foot', but do want to get about 10-15 degrees past 180degree.
She is hypermobile with the majority of hypermobility signs present, except her knees do not hyperextend. Flexible pronated foot type. Whilst trying to plantarflex the midfoot, soft tissue restriction stops her from plantarflexing further.
I was after some advice if it is possible at this age to continue to gain flexibility in this area, and with what exercises would need to be under taken?
Any help would be greatly appreciated.
Regards,
Dean
Dean:
Ligaments and tendons are what are restricting this young lady's range of motion in the midtarsal joint and all ligaments and tendons are viscoelastic in nature. Therefore, due to the known viscoelastic properties of stress-relaxation and creep-response in ligaments and tendons, all ligaments and tendons will elongate under tensile load over time and all ligaments and tendons will become more compliant at higher temperatures and will become more stiff at lower temperatures. Therefore, the most biomechanically logical way to stretch this athletes midtarsal ligaments and tendons is to have her soak her foot in a bathtub or whirlpool that is very warm/hot and then place a stretching force on that foot in the direction that the range of motion is desired. This should be done daily, if not twice daily and, over time, should gradually develop the desired midtarsal joint range of motion to give her the proper aesthetic appearance of her foot for ballet.
Hope this helps.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: Increasing range of motion in forefoot for ballet dancer
Quote:
Originally Posted by Kevin Kirby
Dean:
Ligaments and tendons are what are restricting this young lady's range of motion in the midtarsal joint and all ligaments and tendons are viscoelastic in nature. Therefore, due to the known viscoelastic properties of stress-relaxation and creep-response in ligaments and tendons, all ligaments and tendons will elongate under tensile load over time and all ligaments and tendons will become more compliant at higher temperatures and will become more stiff at lower temperatures. Therefore, the most biomechanically logical way to stretch this athletes midtarsal ligaments and tendons is to have her soak her foot in a bathtub or whirlpool that is very warm/hot and then place a stretching force on that foot in the direction that the range of motion is desired. This should be done daily, if not twice daily and, over time, should gradually develop the desired midtarsal joint range of motion to give her the proper aesthetic appearance of her foot for ballet.
Hope this helps.
Nice post, Prof. Kirby.
__________________ Science is the antidote to the poison of enthusiasm and superstition
Re: Increasing range of motion in forefoot for ballet dancer
As told by Shirley Maher, my old 'head of school' at podiatry, who worked for the Kirov Ballet a long time ago. Apparently, in contrast to western ballet companies, who looked for dancers who possessed initially increased ranges of joint motion, the Kirov liked to start with 'tight jointed' individuals, those with less than average ranges of joint motion, and stretch them to where they wanted rather than the former would end up too "floppy".
(Here's to Shirley, she was a 'good ol' stick' who put me in my place more than once!)
Re: Increasing range of motion in forefoot for ballet dancer
I am amazed that a 13 year old is " on points".
most ballet teachers leave points work till the child is " fully grown" ie at least 15/16 years old.
my daughter was 16 when she was allowed to do pionts work and i was horrified how rapidly her feet deteriated, not only the huge corns on the dorsal toes but the pain in the mid foot.
lucky for her, whilst good, she would never have made a living from it and gave it up at 18 years old.
Re: Increasing range of motion in forefoot for ballet dancer
Quote:
Originally Posted by Pauline burrell-saward
I am amazed that a 13 year old is " on points".
most ballet teachers leave points work till the child is " fully grown" ie at least 15/16 years old.
my daughter was 16 when she was allowed to do pionts work and i was horrified how rapidly her feet deteriated, not only the huge corns on the dorsal toes but the pain in the mid foot.
lucky for her, whilst good, she would never have made a living from it and gave it up at 18 years old.
Pauline:
Most ballet teachers start allowing their ballet students to start going en pointe at age 12 in the States.
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Ballet is one of the most popular youth activities in the United States. Many ballet students eventually train to dance "en pointe," the French words for "on pointe," or "on the tips of their toes." No research exists to define criteria for determining when a young dancer can transition from dancing in ballet slippers to dancing in pointe shoes. However, dancers can be evaluated for this progression based on a number of factors, including adequate foot and ankle plantarflexion, technique, training, proprioception, alignment, and strength.
Increasing range of motion in forefoot for ballet dancer
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