Monday, 14 January 2013

Over-pronation of the feet

A degree of pronation is normal, as the foot needs to adapt to contact with the ground, however over-pronation occurs when the arch of the foot excessively flattens or 'collapses', the heel rolls inward and the soft tissues stretch. This is a common problem in dancers of many genres including jazz, modern and theatrical dance, but the problem is most pronounced in ballet dancers.

Over-pronation in dancers is often a result of over-compensating for a lack of external hip rotation. Dancers who do not have 'perfect' 180 degree turn out will often work to achieve the illusion of it; in a bid to improve the appearance of their degree of turnout, dancers turn out from the knee or ankle as well as from the hip. This then leads to an adjustment of the foot position, digging into the floor with the big toe and collapsing the arch.

Over-pronation of the feet can lead to a number of problematic conditions, contributing to both foot and knee pain, shin splints, plantar fasciitis and achilles tendinopathy among others. Dance teachers and choreographers must know what to look for and know to correct it. It is reported that between 25-50% of all dance injuries are of the foot and ankle, in no small part due to alignment issues.

Photo showing excessive pronation of the right foot
Teaching dancers the difference between incorrect and correct foot alignment is key. All too often dancers are told their feet position wrong without having a clear explanation of what exactly the problem is, and what the correct alignment should be. Although clearly some lucky people are born with beautiful naturally high arches and some are not, exercises can be done to correct collapsed arches and improve foot and ankle alignment. Pronation is not a structural problem, it is technical; it may be due to a number of factors including weakness in various parts of the lower leg, incorrect technique due to compensating for low turn-out, injury, or a lack of understanding of correct alignment.

Ballet training in young dancers has been found to alter the normal anatomy of the foot and so allowing a student to progress with incorrect technique and alignment is liable to cause long-lasting problems. I would argue that if a dancer has issues with over-pronation, they should not be dancing on pointe until the issue is corrected. If a dancer already on pointe develops the problem, they must immediately work to correct it to avoid injury. This is yet another argument for physiological testing for the readiness of pointe work, and not judging on age alone.

A simple exercise to work on correcting slight over-pronation would be to stand in parallel, and pull your ankles into correct alignment so that that arch of your foot is not flattened but in it's natural curve. Bend your knees as far as you can go without altering the alignment of your ankles or feet, ensuring you keep your knees over your toes and hold for 10 seconds. You should still have the arch shape in your foot, and not be allowing your foot to collapse or your ankle to roll inwards. You're likely to feel a tightness in your calves as the stretch will engage the muscle at a different angle than when you plié with incorrect technique and allow your ankles to roll. Your toes should not be curled up while performing this, the small muscles of the foot should allow the toes to grip the floor without the foot rolling in; if you find your toes curling here then more general foot strengthening exercises will be required.

If you have concerns about over-pronation in your feet, find a physiotherapist who is experienced in working with dancers. While over-pronation is not necessarily a serious problem for sedentary individuals, it poses a major problem to both technique and alignment for the dancer and so finding a medical practitioner familiar with the physical demands of dance is key to correcting the problem. Dance UK have a directory of medical practitioners experienced in working with dancers which can be found here, however a web search of private physiotherapists in your local area is also likely to find physios with experience of dancers and performing artists.

If you also exercise out with dance and have problems with over-pronation, in a bid to avoid injury until you have corrected the issue ensure you have footwear that offers the correct support. I hear dancers complain a lot that they cannot run because it causes them knee pain, when the problem is often over-pronated feet and unsupportive trainers, it is a problem with alignment and not with the action of running. Go see a podiatrist, a physio and wear supportive footwear while you are working to correct the problem.

If your foot alignment is incorrect, you're opening yourself up to a lot of other things going wrong. The alignment of your foot and ankle affects the alignment of your entire lower body including your hips, which in turn affect your back and upper body. It is a fundamental problem that is far too common in dancers, both recreational and professional; the dancer, choreographer and dance teacher must all be aware of such issues and correct any problems before injury is allowed to occur.

1 comment:

  1. Yes experienced physiotherapist can help all over-pronation patients to solve their alignment problem properly.back and neck pain bergen county , low back pain bergen county