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The Foot

Today’s Wednesday Wisdom is dedicated to the foot. When considering our technique there’s no better place to start than from the bottom up, for any problems here are likely to affect everything above, in significant and potentially exacerbating ways. 


The comprehensive findings of Kadel (2006) reported injury incidence rates of the lower extremities, based on multiple previous studies, of 67% to 95% among professional ballet dancers, with the foot and ankle accounting for 34% to 62% of all injuries reported. It is therefore of prime importance for dancers to have as much knowledge of the foot from an anatomical and biomechanical perspective as possible in order to compliment and inform the physical development and application of technique.


Simmel, whose fantastic chapter about the foot in Dance Medicine in Practice has informed this post, advocates that, ‘A combination of stable statics, great flexibility and dynamic muscular strength…’ are essential for a dancer’s healthy feet (2014, p. 123). Each foot contains 26 separate bones, 33 joints, and over a hundred muscles, tendons and ligaments; of the muscles, 19 are intrinsic and 10 extrinsic. What do these terms mean? Usually one end of a muscle is fixed in its position whilst the other end will move when the muscle contracts. The origin is the attachment site which doesn’t move, whilst the insertion is the attachment site which does. The intrinsic muscles have both their origin and insertion in the foot; which essentially means these muscles have no action on movements within the ankle joint, instead they stabilize and support the three-dimensional structure of the foot, created through the joints and the arches. The extrinsic muscles originate outside of the foot, in the lower leg, but cross the ankle joint as tendons that then have their insertion on the bones of the foot.


The foot is a segmented structure, and as such is only able to bear weight if it is arched. There are three arches in the foot which give it a three-dimensional structure; the medial longitudinal arch, the lateral longitudinal arch (both of which run lengthways down the foot, the first on the inside, the second on the outside), and the transverse arch which runs from one side of the foot to the other, extending across between the metatarsals. The two longitudinal arches act like pillars for the transverse arch, and these arches account for the incredible strength of the foot. The interlocking shapes of the bones assist the maintenance of the arches as do the strong ligaments and the tendons that provide tension during muscular activity. The ligaments and tendons provide a springiness, for the arches tend to yield as they bear weight and spring back once the weight is removed. Exposure to this continued strain brings about strength.


Regular exercise and dance training build muscular strength and coordination; weight bearing activities promote circulation and work progressively and continuously to build and maintain strength.


The arches of the foot provide the stability, flexibility and elasticity required through a spiralling action, with the forefoot spiralling inwards (we want the big toe connecting with the floor, allowing a horizontal positioning) and the hindfoot spiralling outwards, which allows the calcaneus (heel bone) to be held vertically. It’s interesting to note how often we identify a spiralling action within the placing and alignment of the body in relation to the classical ballet technique. Only this week during a Body Conditioning class focused upon attending to this spiralling action of the foot and support of the transverse arch did one of my younger students reflect upon and draw parallels between this and the spiralling action we had spoken about previously in relation to ports de bras; the spiralling of the upper arm in an opposing direction to the lower, generating an effective dynamic to work with. Well done to Florence; perceptive and pertinent!


The talus bone in the hind foot is very important in that it transfers the body’s weight to the foot and conversely absorbs impact from the foot that is then transmitted upwards. The shape of the talus bone – broader at the front – leads to an increase in joint mobility when we as dancers stand on demi-point, hence the need to cultivate strength within our technique to maximise this safely. By contrast, during a deep plie the construction of the foot actually affords greater bony stability.


There are three lateral ligaments that stabilise the ankle joint, and interestingly these contain numerous receptors, responsible for balance and stability. Hinging of the ankle joint (movement up and down) takes place in the upper ankle joint, whist sideways movement takes place in the lower ankle joint. Together these joints form a functional unitpermitting mobility in all directions. Interestingly, Simmel (2014) points out that the axis of the ankle joint (located between the medial and lateral malleolus – the bony protuberances on either side of the ankle) - is turned slightly outwards in relation to the axis of the knee, which goes some way towards explaining any tendencies towards sickling as we extend the leg and point the foot; whereas during the plie the tibia turns inwards on the talus, which has the potential to contribute to and exacerbate tendencies towards the rolling in of the foot. As dancers we have to work hard through the development of our technique to counteract both of these tendencies arising from these biomechanical factors.


The Achilles tendon is the strongest tendon in the body. You will find no greater source of inspiration and respect for both the human body and the contributions made from dance and medical science, than the Royal Ballet’s principal dancer, Steven McRae, who underwent a full Achilles reconstruction, having to first learn to walk again before returning to the stage to dance after 2 years. His indomitable will was witnessed and celebrated by the ballet world, including the team at BBS who would not have missed his highly emotive return debut on 19th October 2021 for anything.

References


Kadel, N. J. (2006). Foot and ankle injuries in dance. Physical Medicine and Rehabilitation Clinics of North America, 17(1), 813-826. https://doi.org/10.1016/j.pmr.2006.06.006 


Simmel, L. (2014). Dance medicine in practice. Routledge.