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'Hyperpronation' in Dancers

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  #1  
Old 18th September 2012, 06:25 PM
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Default 'Hyperpronation' in Dancers

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Hyperpronation in Dancers; Incidence and Relation to Calcaneal Angle
Nowacki, Rélana M.E.; Air, Mary E.; Rietveld, A.B.M.
Journal of Dance Medicine & Science, Volume 16, Number 3, September 2012 , pp. 126-132(7)
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Hyperpronation is a common finding when examining the dancer-patient and is thought to be implicated in several dance-related injuries. Little is known about the incidence of hyperpronation-related symptoms in dancers. Additionally, there is no current easy method for estimating the degree of hyperpronation. This study was designed to investigate the incidence of symptoms related to foot hyperpronation in dancer-patients and to evaluate the potential correlation between the patient's calcaneal angle and severity of hyperpronation. A retrospective study of 2,427 dancers' charts over the past 6 years was undertaken to identify dancers who presented with musculoskeletal complaints or problems related to hyperpronation. Physical exam data and diagnoses were collected. Among 24 new dancer-patients presenting to clinic with hyperpronation-related symptoms, the calcaneal angle was measured and correlated with a clinical grading scale based on the Hübscher maneuver. Per chart review, the incidence of symptomatic hyperpronation resulting in prescription for orthotics was 30% (739 dancers out of 2,427). The most common related diagnosis was retropatellar chondropathy (10%). Clinical severity of hyperpronation was linearly related to the calcaneal angle (95% CI [1.25, 4.14], p = 0.0006; Pearson's r2 = 0.97). The calcaneal angles among mild, moderate, and severe hyperpronators differed significantly (H = 13.45, p = 0.0012). It was concluded that measuring the calcaneal angle may be a useful adjunct to the Hübscher maneuver for grading the clinical severity of a dancer's hyperpronation. Healthcare providers working with dancers should be aware of the presence of hyperpronation, its relation to compensatory turnout techniques, and association with injuries in the foot, ankle, knee, hip, and low back. A standard, time-efficient method of measuring and grading hyperpronation is still needed.
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Old 18th September 2012, 06:37 PM
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Default Re: 'Hyperpronation' in Dancers

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Old 25th June 2013, 11:40 AM
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Default Re: 'Hyperpronation' in Dancers

I saw a patient - 9 years old, stj hyper pronation, mild ples planus, no navicular drift and drop - extreme ligament laxity. I manufactured rigid orthoses with Kirby backskive for the supination moment. I also gave a ballet inlay. Perhaps proprioception is the problem? I recommended regular cycling to strengthen the plantarflexors of the foot. Any advice????
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Old 25th June 2013, 11:43 AM
Pierre Oosthuizen Pierre Oosthuizen is offline
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Default Re: 'Hyperpronation' in Dancers

I forgot to add that she's a ballet dancer and her teacher said that she has to sort out the pronation - they said she has tallent but in the exams she doen't get good marks, though. I thought cycling will also strengthen the muscle around the knee for better control. Am i thinking in the right direction?
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Old 25th June 2013, 12:45 PM
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Default Re: 'Hyperpronation' in Dancers

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Originally Posted by Pierre Oosthuizen View Post
I forgot to add that she's a ballet dancer and her teacher said that she has to sort out the pronation - they said she has tallent but in the exams she doen't get good marks, though. I thought cycling will also strengthen the muscle around the knee for better control. Am i thinking in the right direction?
So, what exactly is her problem. Is it the bad marks in the examination? Is the concern from the parents? Is there actually pain in the foot?

If you watch dancers dance, they will jumping and landing from jumps quite a bit. That will tend strengthen the muscles around the knee. Did you find any weakness of the muscles on exam?

Eric
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Old 25th June 2013, 01:12 PM
Pierre Oosthuizen Pierre Oosthuizen is offline
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Default Re: 'Hyperpronation' in Dancers

No. Only extreme hypermobility. Even in her upper limbs. Her mother was concerned about the teacher's comment: "If she is serious about dancing she needs to sort out the pronation in her feet". A colleague at work - a biokineticist - suggested exercises to improve proprioception. I'm confused - are the orthoses a bluff, or necessary? The pt doesn't complain about pain, yet I would like to help her excel. That is the reason I prescribed orthoses - with the hope that it will improve her pronation so that she can continue enjoying ballet. Cycling would have a positive benefit - or is my thinking too creative, speculating and should I seek literature to support my orthoses + cycling ideas? I only invoiced for one pair of orthoses - I do my own Lab work, thus my intension is not making money.
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Old 25th June 2013, 01:22 PM
Pierre Oosthuizen Pierre Oosthuizen is offline
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Default Re: 'Hyperpronation' in Dancers

I just read on http://www.dancemagazine.com/issues/...our-Bad-Habits that it might be in technique - was I over enthusiastic? Is it possible to over stretch the medial ligament (deltoid)? Or is she hypermobile.... Perhaps I should check on her follow up upon fitting the orthoses.....
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Old 25th June 2013, 01:28 PM
Pierre Oosthuizen Pierre Oosthuizen is offline
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Default Re: 'Hyperpronation' in Dancers

The biokineticist also examined her - the muscles were not short, triceps surae were not short. Post tib tendon + muscle works well. Just the ... overpronation even when walking normally. First ballet dancer case that I see in my short carreer (started in Jan 2010). THe problem is during plie. Perhaps she is pronating the STJ instead of externally rotating the hips? And thus over stretched the medial ankle ligaments???
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Old 25th June 2013, 02:58 PM
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Default Re: 'Hyperpronation' in Dancers

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Originally Posted by Pierre Oosthuizen View Post
No. Only extreme hypermobility. Even in her upper limbs. Her mother was concerned about the teacher's comment: "If she is serious about dancing she needs to sort out the pronation in her feet". A colleague at work - a biokineticist - suggested exercises to improve proprioception. I'm confused - are the orthoses a bluff, or necessary? The pt doesn't complain about pain, yet I would like to help her excel. That is the reason I prescribed orthoses - with the hope that it will improve her pronation so that she can continue enjoying ballet. Cycling would have a positive benefit - or is my thinking too creative, speculating and should I seek literature to support my orthoses + cycling ideas? I only invoiced for one pair of orthoses - I do my own Lab work, thus my intension is not making money.
The thing about ballet is that dancers are supposed to look a certain way. If your body can't move into the positions that they want you to be in, then you are not going to be a ballerina. If you look at pictures of what a plie is supposed to look like, you need a lot of turn out (dancer speak for external rotation of leg relative to the hip.) If you don't have that motion, some will try to "cheat" by attempting to get that motion in other joints. You can get additional turn out with foot abduction, but ballerinas are not supposed to look pronated. This is probably what her teacher was referring to. People with excellent muscular control can hold their foot in pretty much any position, so she can make her foot not appear so pronated, but in doing so she will lose some turn out. And she may be overworking her posterior tibial muscle. (It will certainly have to harder than someone who has more ideal anatomy.)

In real life, as opposed to ideal ballet, people will tend to let their foot flaten to the point where little muscular effort is required. (unless that position hurts) When this girl lets that happen she will appear "pronated". That is she will have a lot of foot abduction relative to the leg and possibly calcaneal eversion and possibly a heel that sits lateral to the leg. It's very unlikely that any orthotic that will be comfortable is going to be able to make her foot appear not pronated. Things get worse if you are expecting this to go into the ballet shoe. There is a good probability that a device with a really high arch will cause blisters in the arch. An orthotic may help her in life, but It probably wont make her a ballerina. The orthotic is not going to change the shape of the foot.

Eric
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