The Ankle and Foot 329range of motion, pain, and the degree of deviation
often prohibit optimal mechanics and make these
approaches ineffective. Although surgery is often rec-
ommended in this later stage for other populations,
its use with performing dancers is controversial; and
some orthopedists recommended against it due to
the tendency to lose hallux extension that is neces-
sary for dance (Baxter, 1994; Dyal and Thompson,
1997; Howse, 1983).
Foot Type
The foot as a whole can be classified into different
types based on its shape and the relative length of
the toes. One classification divides feet into three
types: (1) the squared foot, in which the first and
second toes are the same length; (2) the Egyptian
foot, in which the first toe is longer than the second;
and (3) the Morton’s or Greek foot, in which the
second toe is longer than the first. It is generally held
that a relatively short, broad, square foot type is less
prone to injury, and there is some support for this
conjecture in dancers (Ende and Wickstrom, 1982;
Hamilton et al., 1997).
The foot type and relative lengths of the metatar-
sals and toes will also influence what bones of the foot
remain in contact during rising onto the ball of the
foot. The axis at which the foot bends (e.g., where
toes extend at the MTP joints), called the metatar-
sal break, is not perpendicular but rather makes an
oblique angle from about 50° to 70° to the long axis
of the foot (Sammarco, 1980). Thus, on demi-pointe,
the lateral two or three metatarsals will generally
not remain in contact with the floor, and contact
of the lateral toes will depend on the angle of this
metatarsal break and the length of the toes. Hence,
the directive sometimes given by dance teachers to
keep all the metatarsals and toes in contact with
the floor when on demi-pointe is not appropriate
for most dancers. Probably a better cue is to focus
on keeping the body weight centered over the first
and second metatarsal heads with the middle of the
back of the calcaneus in line with the middle of the
back of the lower tibia (i.e., neutral rearfoot position
without undue inversion or eversion of the rearfoot
or midfoot). However, this neutral positioning will
have to be modified slightly for schools of dance that
desire the beveled line on demi-pointe or pointe. With
pointe, the foot type, pointe shoe design, and aesthetic
concerns (neutral vs. beveled) will influence toe con-
tact and weight placement. One study that involved
performing relevés with pointe shoes showed that
the greatest pressures were over the hallux, and the
pressures over the second toe varied with the length
of the toe, such that greater pressures were present
with a long second toe or with capping of the second
toe (Teitz, Harrington, and Wiley, 1985).Mechanics of the Ankle and Foot
The design of the ankle-foot complex is such that
certain positions offer greater stability and certain
positions offer more mobility, important for meet-
ing the many functions this structure must serve.FIGURE 6.32 (A) Hallux valgus (anterior view) with (B) bunion formation (left foot, superior view).