Hallux Valgus in Dancers

NewsBot · May 22, 2014

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Hallux Valgus in Dancers: A Closer Look at Dance Technique and Its Impact on Dancers' Feet
Davenport, Kathleen L.; Simmel, Liane; Kadel, Nancy
Journal of Dance Medicine & Science, Volume 18, Number 2, June 2014, pp. 86-92(7)

Hallux valgus is a common deformity of the forefoot. There is no doubt that some dancers develop hallux valgus, but the question remains as to whether dancers are at greater risk than the general population for developing this deformity. Review of the literature reveals on-going debate regarding risk factors for hallux valgus, which may include increasing age, female gender, genetic predisposition, constrictive shoe wear, first ray hypermobility, foot architecture, tight Achilles tendon, and first metatarsal length. There is insufficient evidence to demonstrate conclusively that dancing, specifically pointe work, increases the prevalence or severity of hallux valgus; more research is needed. Treatment of hallux valgus in dancers should be conservative, with delay of surgical correction until retirement if possible.
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Admin2 · May 22, 2014

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NewsBot · Sep 3, 2015

The association between hallux valgus and proximal joint alignment in young female dancers.
Steinberg N, Siev-Ner I, Zeev A, Dar G
Int J Sports Med. 2015 Jan;36(1):67-74

Very little is known about the relationship between proximal joint alignment and hallux valgus among young dancers. This study sought to determine the extent to which spinal and lower extremity alignments are involved in hallux valgus, and to identify predicting variables for its development in young dancers. A group of 1336 young female dancers aged 8-16 years, and 226 control participants of the same age cohort were screened for the presence of hallux valgus, body physique characteristics, joint range of motion, and anatomical anomalies. Hallux valgus was common in the 2 young female populations studied. Among the dancers, 40.0% had bilateral hallux valgus and 7.3% unilateral. Among the controls, 32.3% had bilateral and 1.8% unilateral hallux valgus (χ2=8.27, df=1, p=0.004). Following logistic regression analysis, age (OR=1.028, 95% CI=0.968-1.091), genu varum (OR=1.514; CI=1.139-2.013) and scoliosis (OR=2.089; CI=1.113-3.921) were found to be significant predicting factors for hallux valgus in the dancer group, whereas in the control group, the predicting factors were age (OR=0.911, 95% CI=0.801-1.036) and ankle plantar flexion range of motion (OR=0.972; CI=0.951-0.992). In conclusion, it was found that spinal deformity, lower extremity alignment, and joint range of motion are strongly related to hallux valgus.
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NewsBot · Apr 17, 2019

Acute Effect of Toe Cap Choice on Toe Deviation Angle and Perceived Pain in Female Professional Ballet Dancers
Annamaria Salzano et ak
BioMed Research International 10 April 2019

Several classical dance complex movements, such as pointe, require body weight to be supported properly to avoid risk of foot injury. Regarding the choice of toe cap for pointe shoes, it is unclear which type can better alleviate pain symptoms and toe deviation angle in dancers. The aim of the current crossover study was to investigate the acute effect of using different types of toe caps among well-trained professional dancers on pain perception and toe deviation angle. Ten young female professional dancers volunteered to participate in the study. Each participant was tested during two separate sessions with an interval of 72 h in between. Participants were tested in the two sessions with a standard commercial or a customized prototype toe cap, always with pointe shoes, and in randomized order. An anteroposterior X-ray examination was performed separately for each participant and a visual analogue scale for pain perception was administered following each situation (with a standard commercial or a customized prototype toe cap). Significant amelioration was obtained when a customized toe cap prototype was used both for toe deviation angle and for visual analogue scale. Use of a customized toe cap prototype compared to a standard one may acutely reduce both toe deviation angle and pain in elite female professional dancers.
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NewsBot · Apr 17, 2019

Design and validation of a smart wearable device to prevent recurrent ankle sprain.
Attia M et al
J Med Eng Technol. 2018 Aug;42(6):461-467

Lateral ankle sprain is one of the most common ankle injuries, especially in sports. When not treated properly, chronic ankle instability (CAI) may develop causing recurrent sprains and permanent damage to ankle ligaments. In this study, the design, implementation and validation of a smart wearable device connected to a smartphone application is described. This device can predict and prevent the occurrence of ankle sprain. Prediction of potentially harmful motion is achieved by continuous monitoring of ankle kinematics using inertial motion sensors. Detection of such a motion immediately triggers electrical stimulation of the peroneal muscles causing foot dorsiflexion, and hence prevents potential injury. The proposed device has the advantage of having a very short response time of eight milliseconds which is sufficient to halt the sprain motion. Laboratory validation testing using a custom designed trapdoor showed an accuracy of 96% in detecting and correcting hazardous motion. Furthermore, this device complies well with the design constrains of a wearable device such as small size and low power consumption. It is also low cost and unobtrusive due to the wireless connection between all components. Future work is recommended to test the clinical effectiveness of the proposed device in patients with CAI.
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NewsBot · Apr 20, 2020

Correlation between degree of hallux valgus and kinematics in classical ballet: A pilot study
Haruka Seki, Akito Miura , Nahoko Sato, Jun Yuda, Toshiko Shimauchi
PlosOne April 6, 2020https://doi.org/10.1371/journal.pone.0231015

Hallux valgus is a serious medical concern for classical ballet dancers. Although it is well-known that progression of hallux valgus is related to inappropriate movement techniques in classical ballet, the kinematic relationship between the degree of hallux valgus and ballet techniques has not been substantiated. To develop proper training methods that prevent progression of hallux valgus, this study aimed to investigate the relationship between the degree of hallux valgus and movement techniques in classical ballet. Seventeen female classical ballet dancers at the advanced college-level participated in this study. Kinematic analysis of standing and plié in the first position was conducted via video capture technique. The Pearson product-moment correlation analysis was performed to examine the degree of hallux valgus and the following three kinematic variables: (1) the extent to which turnout is forced by other joints in the lower extremity than the hip joint, (2) the direction difference between the knee and toe in the transverse plane, and (3) the pelvis obliquity angle. Among these kinematic variables, we found a significant correlation between the hallux valgus angle and the pelvis obliquity angle during plié (P = .045). The greater the hallux valgus angle, the greater the retroversion of the pelvis, a result which was contrary to our prediction. We present the first evidence that the degree of hallux valgus correlates with kinematics in a very basic technique of classical ballet.
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NewsBot · Mar 21, 2022

The Impact of Hallux Valgus on Adolescent Ballet Dancer Balance and Health Related Quality of Life Scores
Ozcan Kaya et al
J Am Podiatr Med Assoc. 2022 Mar 11

Background: It's well known fact that Hallux valgus (HV) alternates foot biomechanics. In different populations HV and postural stability has been studied but HV and adolescent ballet dancer has not been studied. Aim of the our study is to explore affect of HV on adolescent ballet dancers' balance. Also we wanted to explore health related quality of life of adolescent ballet dancers with HV.

Methods: Ballets aged between 8-16 years old has been screened prospectively. The dancers divided into two groups group 1;Ballets with HV and group 2; Ballets without HV. HV diagnosis was made clinically. Two groups were compared according to balance parameters and health related quality of life (HRQOL) questionaires.

Results: Group 1 was formed with 31 participants and group 2 was formed with 24 participants. All participants in both groups were female. Mean age in group 1 was 11.6 (8-16 years old) and 12.2 (8-16 years old) in group 2. Mean first metatarsophalangeal angle was 13.4° (10°-15°) in group 2 and 19.8° (16°-25°) in HV group respectively. A statistically significant difference was found according to the nonparametric Mann Whitney U test results in the comparison of HVA (Hallux Valgus Angle) between groups. According to Spearman Rho correlation analysis, it was determined that the increase in HVA caused deterioration in the static Flamingo test. (r=0.552 p=0.019). No significant relationship was found between HRQoL questionaries and the presence of HV. (p>0,05) Conclusions: Adolescent ballet dancers experience static balance impairment due to HV angle increase. Clinical measurement of HV and application of balance parameters made easy without need of set ups to perform evaluation with high numbers of participants in concordance with literature.
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NewsBot · Oct 14, 2022

Comparison of hallux valgus deformed ballerinas and sedentary individuals in terms of balance parameters
Okan Ozkunt et al
Medicine (Baltimore). 2022 Oct 7;101(40):e30915

Background: We aimed to compare static and dynamic balance parameters and health quality parameters in ballerina and non-ballerina adolescents with hallux valgus deformity.

Methods: Forty five volunteer female adolescent ballet students between the ages of 7 and 17, with hallux valgus were recruited. Group 1 = in the control group, 31 sedentary adolescents with hallux valgus were included. Group 2 = Romberg test and Flamingo test were used for static balance. The SEBT (Star Excursion Balance Test) was used to measure dynamic balance.

Results: Age, sex, and body mass index (BMI) characteristics were similar between ballerina and control groups (P < .05). The Romberg test stands upright with closed eyes, with a significant difference 47.22 in group 1 and 38.13 in group 2. In contrast there was a significant difference between the two groups in the Romberg test single limb with eyes open and closed. For open eyes single limb test mean score was 55.06 in ballerinas and 44.2 in sedentary group, similarly single limb test with closed eyes mean score was 25.68 in group 1 and 18.67 in group 2.

Conclusion: In conclusion, the results of this study show that ballerinas have better single-limb and closed-eye balance than sedentary individuals with HV deformities.
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NewsBot · Mar 7, 2024

The Effect of the Lateral First Metatarsal Head Shape on Hallux Valgus in Forced Turnout in Pre-Pointe Female Ballet Dancers: A Pilot Study
Paul H Doan et al
J Am Podiatr Med Assoc. 2024 Jan-Feb;114(1):21-129

Background: A rounded lateral first metatarsal head shape is associated with higher rates of hallux abducto valgus recurrence following corrective surgery; however, the effect of the lateral first metatarsal head shape on the hallux abduction angle (HAA) has not yet been explored in a nonpathologic, pre-pointe ballet dancer population. The primary purpose of this study was to investigate the effect of the lateral first metatarsal head shape on the HAA when pre-pointe female dancers force their turnout.

Methods: Seventeen female, pre-pointe ballet students (mean age, 10.8 ± 0.95 years) participated in this study. Fluoroscopic images of each dancer's dominant foot were taken, and the lateral first metatarsal head shape was classified visually. Each dancer performed three consecutive stances of natural double-leg upright posture: both functional and forced turnout. HAAs were obtained by marking medial bony landmarks on paper and were compared to photographic measurements.

Results: No significant difference was found between the round and angular lateral first metatarsal head shape for the change in HAA from natural double-leg upright posture to forced turnout. Hallux abduction angle significantly increased by 4.6° (P < .001) in forced turnout compared to the natural double-leg upright posture for the photographic method, whereas the paper method demonstrated an increase of 2.6° (P = .007). No statistical differences were found between the paper and photographic methods in measuring the HAA for all stances.

Conclusions: Our findings suggest no association between the HAA and lateral first metatarsal head shape; however, HAA does increase when a dancer assumes forced turnout. The paper method demonstrated similar reliability to the photographic method and shows the potential for future use as a clinical tool in assessing hallux abducto valgus.
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