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'Hyperpronation' in Dancers

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Sep 19, 2012.

  1. NewsBot

    NewsBot The Admin that posts the news.


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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)
  2. Admin2

    Admin2 Administrator Staff Member

  3. 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????
  4. 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?
  5. efuller

    efuller MVP

    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?

  6. 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.
  7. 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???
  8. efuller

    efuller MVP

    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.

  9. TL74

    TL74 Active Member

    There is a physiotherapist called Lisa Howell who does many series on you tube and has written a book with exercises for ballet dancers. She is great for information and advice.
  10. NewsBot

    NewsBot The Admin that posts the news.

  11. daisy

    daisy Active Member

    Hi Pierre,

    Does this dancer have hyperpronation as a result of hyperabduction? I've attached a picture of what I am talking about. [​IMG]
    Hyperpronation as a result of hyperabduction

    If this is what the dancer is doing then she will not be doing well in exams. Examiners hate dancers "overturning" (hyperabduction) their feet because it causes so many injury problems with ankles, knees, hips. "Turnout" or extension of the hips, legs and feet is one of the main requisites for ballet dancing. Dancers continuously work on their turnout for their entire dancing careers hence the high number of hip replacements in ballet dancers in later life. However, achieving turnout by hyperabducting the feet is a no-no and examiners will mark a student dancer down for this.

    I would probably be taking my child to another teacher. This is a technique problem and the teacher should be encouraging the student to work within her ability to achieve turnout safely. This is not something outsiders or the student can solve on her own. An orthotic would not work if the teacher is encouraging the child to hyperabduct

    This is an example of a dancer in the same position as above but not hyperabducting or hyperpronating. All five toes are on the floor, the heels should be together!! but the STJ is not overpronating.

    I hope I've understood what the problem is that you are describing (hence the pictures). If not, please ignore this post :)



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