Though we are mostly focusing on the skeletal structure (26 bones and 33 joints) in the Foot Shape I and II sections, we will briefly be touching on the soft tissues of the foot (muscles, tendons and ligaments) in this lesson as well.
Midfoot
The midfoot consists of the navicular bone, the cuboid bone, and 3 cuneiform bones. It is part of the tarsal bones (all bones of the foot excluding the metatarsals and phalanges) that connect the forefoot to the hindfoot with muscles and ligaments. The midfoot and metatarsals meet at the tarsometatarsal joints (Lisfranc joints) which makes up a large part of the arch. Though midfoot fractures and sprains are uncommon in dancers (and often misdiagnosed as a metatarsal stress fracture), these injuries can be career ending if not treated properly.
Navicular
Cuboid
Cuneiform
Arch
The height of the arch is measured by the distance from the floor to the curve at the bottom of your feet. It is made up of the metatarsal and tarsal bones (all the bones in the foot except the phalanges and metatarsals) connected by ligaments and supported by the intrinsic muscles of the foot.
This curve acts as a spring and is largely responsible for bearing body weight and absorbing shock. People with unusually high arches (pes cavus) and flat arches (pes planus) may be more prone to certain injuries due to lack of ability to absorb pressure.
Because proper gradual overload of pointe work will strengthen the intrinsic muscles of the feet, it may help to improve function and alignment of your feet in everyday activities.
The shape of the bone structure, strength of the muscles and flexibility of the joints in the feet and ankles generally determines the shape and strength of the shank.
Contrary to popular belief, the bone structure of the arch has less to do with the dancers’ success en pointe than the strength of the muscles and the range of motion in the foot and ankle joints. What most people would favorably describe has a “high arch” or “strong arch” usually means flexibility and doesn't always determine strength (we will discuss the ankle in depth later on in this section).
There are 3 parts to the arch: Traverse arch, medial longitudinal arch and lateral longitudinal arch.
Medial Longitudinal Arch: Runs from the heel along the inside of the foot and is responsible for absorbing the majority of the shock. Higher and more prominent of the two longitudinal arches.
Lateral Longitudinal Arch: Runs from the heel along the outer edge of the foot. Can be viewed on dancers with a high arch (or hollow arch).
Transverse Arch: Runs across the midfoot from outside to inside along the metatarsal heads. Dancers with more flexibility in this region will need to consider a shoe with more support at the ball of the foot.
High and flat arches are more likely to cause pain from overuse and must have proper support and strengthening.
Pes Cavus (high arch)
Though this foot shape is considered favorable for dancers, this type of arch is more prone to overuse injuries due to its lack of shock absorption, stability and support en flat. There are 2 types of high arches: flexible high arch and rigid high arch
Flexible high arch
Disappearing heels: Dancers with a flexible high arch may fold longitudinally en pointe and shoes may be too small on flat and too big on pointe. These are called “disappearing heels.” Many dancers with this type of foot prefer to wear shoes tighter as there is too much excess fabric en pointe. However, if the shoes are too tight, it could put more strain on a foot that is already overworking and may lead to injuries.
Supination: dancers with this type of foot are more likely to supinate or roll to the outside of the foot. The fitter should consider a shoe that is stable en flat as well as stable en pointe
Soft shank: If the dancer’s intrinsic muscles are strong enough to support itself en pointe, they will be able to wear softer shoes that bend to the arch. Contrary to popular belief, a softer shoe may last longer than a harder shoe in some of these cases because a harder shoe will snap at the arch as opposed to a softer shank that will bend to the shape of the foot. If the dancer is not strong enough, the soft shank may not be supportive enough and will break quickly.
Hard shank: if the dancer does not have adequate strength, a harder shank will be safer as it provides more support. In this case, the foot may bend inside the shoe while the shank is still stiff and may not be flattering until the dancer gains more strength.
¾ Shank: for dancers who are stronger, a ¾ shank will support the dancer better as it gives the foot a “shelf” to sit on. This will distribute the weight to the heel and give better internal contact with the foot. For dancers who are weaker, the ¾ shank may not give enough support and could be dangerous.
Pre arched shank: a pre arched shank works well for dancers with a flexible high arch whether the dancer is stronger or weaker. Much like the ¾ shank, the shank will conform to the arch and have more internal contact points than with a flat shank.
Flat Shank: this type of shank works best if the dancer customizes the shank. Since everyone’s arch is in a different place, cutting the shank precisely where the arch breaks is the most accurate.
Rigid high arch:
Twisting Shank: Dancers with a rigid high arch are more prone to twisting shanks. The backbone of the shoe doesn’t lie straight in line with the heel and shifts to the outside or inside of the heel. Though dancers with severe twisting may twist in most shoes, some brands and models will twist less.
Supination: Much like the flexible high arch, rigid high arch is also prone to supinating and should consider a shoe they are less likely to rock laterally.
Soft Shank: this will give the dancer a better chance of getting on top of the box while they are working towards gaining more range of motion. This will allow better articulation of the foot to build strength and flexibility simultaneously.
Hard Shank: dancers with rigid high arch may not be able to get over on the box in a hard shank due to the lack of range of motion. If the dancer is not strong or flexible enough to get on top of the box and articulate the foot, they may overuse and damage the soft tissues in the back of the ankle.
¾ Shank: if the dancer is stable en pointe, a ¾ shank may last longer and give better support while distributing some of the weight to the heel. However, if the dancer sickles or bevels en pointe due to a weaker core or ankles, this may not give adequate support.
Pre Arched Shank: a pre arched shank would work well for this type of foot as the shape will help them get to the center of the platform and give more internal contact to the arch.
Flat Shank: this is often not well suited for this type of foot as the shank will stay flat as the dancer rises to pointe.
Normal (neutral): A foot with a normal arch and proper weight bearing cycle is considered the most stable. No particular shank needs to be considered other than what is normally considered for fittings (flexibility, strength, stability, skill etc).
Pes Planus (flattened arch):
Pes Planus is a collapsed or flattened medial longitudinal arch. Though it is widely viewed as problematic for pointe work, success on pointe is determined by the strength and flexibility of this type of foot rather than its shape.
There are two types of flat feet: flexible flat feet and rigid flat feet.
A rigid flatfoot is always flat but a flexible flatfoot is flat only when standing and appears normal when not bearing any weight. Though the rigid flat foot may be problematic, a flexible flat foot is considered a normal variant. Flexible flat feet often have a shorter Achilles tendon, which prevents dorsiflexion (raising of the foot) at the ankle joint but have enough range of motion in plantarflexion (pointing of the foot) to be able to get over en pointe. Both types are more likely to pronate (or roll in) putting more pressure on the big toe joint leading to a possible formation of bunions (hallux valgus).
Flexible (hypermobile) flat foot
Shank Strength: The shank strength for a flexible flat foot depends on the strength of the dancer’s feet. A stronger foot will be able to handle a harder shank while a weaker foot will only be able to handle a soft shank. If the dancer has enough range of motion in their ankle joints to get over en pointe but if the foot stays relatively straight, the shoes may last longer. In this case, the intrinsic muscles of the foot will work less and may lead to overusing the extrinsic muscles.
Tapered Box: In many cases, a flat foot may slide down into the box more than a normal or high arch because the heel doesn’t have much to cling onto. If the dancer happens to sink in most pointe shoes, a tapered box should be considered.
Wide Box: Since a flat foot may be more prone to bunions (Hallux Valgus), the fitter must be sensitive to give the dancer enough space in the width.
¾ Shank: A ¾ shank may be a good option for dancers with flexible flat feet because it will give better internal contact with the foot and give the dancer more support in the heel.
Pre Arched Shank: Much like the ¾ shank, a pre arched shank is a good option for dancers with flexible flat feet because it will give the dancer better support for the heel
Flat Shank: This type of shank may not be suitable for dancers with flat feet as it will give less support and more chances of sinking into the box.
Rigid flat foot
*Dancers with rigid flat feet may have the most difficult time en pointe but if the dancer has enough range of motion in their ankle joint, it is not impossible to go en pointe. If properly trained and fitted, pointe work may help strengthen the dancers feet for a healthier gait in their everyday life.
Soft Shank: A softer shank would be the most beneficial for this type of dancer to help them build strength and articulate as much as they can.
Wide Box: Since a flat foot may be more prone to bunions (Hallux Valgus), the fitter must be sensitive to give the dancer enough space in the width.
¾ Shank: A ¾ shank may be a good option for dancers with flexible flat feet because it will give better internal contact with the foot and give the dancer more support in the heel.
Pre Arched Shank: Much like the ¾ shank, a pre arched shank is a good option for dancers with flexible flat feet because it will give the dancer better support for the heel
Flat Shank: This type of shank may not be suitable for dancers with flat feet as it will give less support and more chances of sinking into the box.
Hindfoot
The hind foot is the back of foot that includes the talus bone (ankle bone) and the calcaneus bone (heel bone). The talus bone is the highest bone in the foot connecting the lower leg (tibia and fibula) and the calcaneus bone. The calcaneus bone is the largest bone in the foot.
Ballet dancers are especially susceptible to ankle sprains (most common traumatic injury), posterior impingement and other ankle injuries due the highly unstable and unusual positioning of pointe work.
Talus
Calcaneus
Talus
The talus (ankle bone) transmits the weight of the entire body to the foot. The talus and the joints that form the ankle largely determine how the dancer can rise onto pointe. There are three joints attached to the talus:
Talocrural Joint (ankle joint): joint between the talus and the bones of the leg (the tibia and fibula) that allows for the foot to flex and pointe. This joint is more stable in dorsiflexion (flex) than in plantarflexion (point).
Subtalar joint: between the talus and calcaneus
Talonavicular joint: between the talus and the navicular.
A dancer’s ability to rise onto pointe largely depends on the range of motion of the ankle joint. The anterior (front) part of the talus is wider and more stable than the posterior (back) of the talus which gives the ankle more stability when it is in the flexed position than in the pointed direction.
As the dancer balances in the unnatural position of being en pointe (fully pointed = least amount of stability), the talocrural joint (ankle) is strained and overworked due to its instability. The dancer bears significantly more weight en pointe (12 times the bodyweight) than on flat or even demi.
While there are many ligaments attached to the talus, there are no muscles originating from it, putting dancers at even more risk as connective tissues such as tendons and ligaments heal and build much slower than muscles.
However, ligaments can get stronger as the dancer exercise and stress the joint. But the overloading process must be gradual in conjunction with stretching so the ligaments have enough time to lay down more collagen and cells to get stronger. If the foot and ankle is overloaded or stretched too quickly, it will lead to injuries.
The fitter must take into account how flexible the joints are as well as how stable the dancer is both en flat and en pointe to determine the type of shank strength (stronger for flexible or weak ankles and feet and softer for rigid or strong ankles and feet) to gradually build up the range and strength.
Calcaneus
The calcaneus (heel bone) is the largest bone in the foot and lies underneath the talus. It has two joints:
Subtalar (talocalcaneal) joint: between the calcaneus and the talus.
Calcaneocuboid joint: between the calcaneus and the cuboid.
Ballerinas typically keep their weight on the ball of their foot even on flat so there are less traumatic injuries directly on the heel bone. However, heel spur can form at the bottom of the heel bone and may cause some pain. Dancers who experience pain in the hindfoot and ankle typically suffer from overuse soft tissue injuries such as a posterior impingement or plantar fasciitis. These injuries can be caused by a variety of issues such as overuse and underuse of certain muscles, improper shank, size or shape of the pointe shoe, floors that are too hard, low BMI, or nutrition. We will discuss these more in depth in a later section.
There are two main sets of ligaments on each side of the foot:
Medial Ligament: ligament in the inside of the foot
Lateral Ligament: ligaments on the outside of the foot - these ligaments are the most commonly sprained for ballet dancers. If the dancer is in a shoe that doesn't give enough lateral or medial support, they are in more danger of falling out of pointe towards the outside of the leg and damaging these ligaments. If the dancer is unstable en pointe, a longer wing or harder shank should be considered.
Instep
People often use the word "instep" interchangeably with the arch. But while the arch is the measure of the opening from the floor to the curve of the foot, the instep is the height or girth of the foot itself or the distance from the bottom of the foot to the top of the foot.
The height of the instep determines the profile (or crown) of the shoe. The shoe should lie flat on the top of the foot without any gapping between the foot and the shoe or the foot bulging over the throat of the shoe.
Shallow instep: needs a low crown. If the profile is too high, there will be a visible space between the foot and the shoe and the dancer will sink to the bottom of the box.
Medium instep: needs a moderate crown.
High instep: needs a high crown. If the profile is too low, the foot will bulge over the top of the shoe and may cause pain on the top of the foot and/or pull the dancer back from pushing over the top of the platform.
*Z-foot (Skew Foot):
A Z-foot is a hereditary and congenital foot deformity where the wrong joints will shift resulting in a Z-shape. This type of foot can be corrected in early detection but can lead to a variety of foot problems late in life if not treated.
Depending on the severity of the deformity, the dancer may or may not be able to attempt pointe work. If the dancer is able to go en pointe, twisting shanks are very common in this type of foot and nearly impossible to correct. The fitter must give the dancer ample room in the box to accommodate the joints as well as proper padding to fill in the negative space in the shoe.
Week 3 Assignment
1. Wet the bottom of your foot by stepping into a shallow pan of water
2. Step onto a cardboard or paper bag to show your footprint
3. Remove your foot from the bag/cardboard and take a photo of the footprint and post on the Week 3 Assignment page
4. Examine your footprint and describe the arch
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