The Ankle and Foot 337levels of plantar flexor strength. Although the triceps
surae muscles produce a large percentage of the
plantar flexor torque, other plantar flexors can help
slightly reduce the demands on the triceps surae and
help achieve the desired aesthetic. Two such plantar
flexors are the flexor hallucis longus and flexor digito-
rum longus. The flexor hallucis longus and flexor digi-
torum longus have been shown to have a shortening
effect on the foot in a front-to-back direction (Smith,
Weiss, and Lehmkuhl, 1996), and so can help achieve
the desired “high-arch” look in pointe. Three other
plantar flexors—the tibialis posterior, tibialis anterior,
and peroneus longus—function together to lift the
arch and help maintain balance on demi-pointe and
pointe. These three muscles can be termed the stir-
rup muscles because they run behind the medial
and lateral malleoli to converge to attach onto the
undersurface of the medial longitudinal arch in a
stirrup-like arrangement. All three muscles have
attachments onto the plantar surface of the cunei-
forms, with the tibialis anterior and peroneals also
both attaching onto the base of the first metatarsal,
while the tibialis posterior has additional attachments
on the navicular and other metatarsal bases. Their
attachments put them in a perfect position to lift the
midfoot higher up in plantar flexion, irrespective of
the position of the toes.
In terms of stability, the stirrup muscles can be
used to keep the body weight appropriately posi-
tioned in a medial-lateral direction over the axis
of the foot. Their co-contraction (in combination
with other muscles) can be used to allow the weight
to rise to the toes and lower from the toes without
undesired inversion or eversion, and to make subtle
adjustments of the body weight to enhance balance
and dance aesthetics. For example, contraction, or
pulling up, with the lateral stirrup muscles will shift
the body weight medially on the foot (eversion) and
prevent excessive rolling out (inversion) on the foot,
such as is commonly seen in “falling out” of multiple
pirouettes. Conversely, contraction, or pulling up,
with the medial stirrup muscles will shift the body
weight laterally on the foot (inversion) and prevent
excessive rolling in (eversion) on the foot. In terms
of these medial stirrup muscles, theoretically, the
tibialis posterior should be emphasized more than
the tibialis anterior when on demi-pointe or pointe
due to its additional desired action of ankle-foot
plantar flexion.Pointing the Foot
in Open Kinematic Chain MovementsThis same balanced use of the stirrup muscles can
be utilized during plantar flexion of the foot without
weight bearing, such as in a tendu. The peroneals
and tibialis posterior are used synergistically and in
accordance with the aesthetic of the given dance
form to create a neutral position or slightly “bev-
eled” position of the foot and to get a more fully
pointed position, with the desired “stretch” across
the instep. Due to their more distal attachment,
these stirrup muscles can be used to add slight
plantar flexion at the intertarsal joints and tar-
sometatarsal joints, while the gastrocnemius and
soleus, which attach proximally onto the calcaneus,
would primarily effect plantar flexion at the ankle
joint proper.
The flexor hallucis longus and flexor digitorum
longus can also be used to achieve this more fully
pointed look, and tension on the flexor hallucis
longus has been shown to increase the height of
the medial longitudinal arch (Femino et al., 2000).
These muscles can also increase the point of the foot
by bringing the MTP joint into flexion. However,
to prevent the undesired curling under of the toes
(IP flexion) accompanying use of these flexors, the
intrinsic toe extensors (lumbricals and interossei)
must be used synergistically to maintain the IP joints
in extension. Lastly, other intrinsic muscles can be
used to “lift the arch” and increase the point. Think-
ing of pulling the base of the toes and the underside
of the arch back with strings running behind each
side of the malleoli, while stretching across theFIGURE 6.40 (A) Hallux range of motion and demi-
pointe. About 90° of extension of the metatarsopha-
langeal joint is necessary for (B) optimal positioning in
demi-pointe.