The Ankle and Foot 353Intrinsic Muscle Strengthening
Many exercises can be performed for the intrinsic
muscles of the foot. Two that are particularly help-
ful for dancers are doming (table 6.6J) and towel
curls (table 6.6K). Both of these exercises focus on
strengthening muscles important for helping main-
tain the arches of the foot.Ankle-Foot Proprioceptive Exercises
Proprioceptive exercises are exercises designed to
challenge reflexes related to balance and movement
coordination. They often incorporate tools such as
balance boards, wobble boards, foam rollers, ankle
disks, or the biomechanical ankle platform system
(BAPS) board. Use of such exercises has been shown
to be important for developing better balance, quick
corrections of movements such as falling out of a
turn, and prevention of injuries such as ankle sprains.
Proprioceptive exercises are often advanced from
single-plane to multiplane movement, from two feet
to one foot, from eyes open to eyes closed, and from
using a flat foot position to incorporating a relevé.
Three examples of exercises with a proprioceptive
emphasis are provided in table 6.6, L-N.Stretches for the Ankle-Foot
Adequate flexibility in plantar flexion and dorsiflex-
ion of the ankle-foot is particularly important for
dancers. Table 6.7 provides average range of motion
for these movements in the general population as
well as the primary constraints to these movements.
As previously described, adequate range of the great
toe (MTP joint extension) is also important to allow
correct positioning on demi-pointe.Plantar Flexor (Calf) Stretches
Adequate flexibility in the plantar flexors and espe-
cially the gastrocnemius and soleus is essential forallowing the ankle-foot dorsiflexion needed in move-
ments such as pliés and lunges. When the knee is
bent, such as in a plié, the gastrocnemius is slackened
across the knee joint, and the soleus is generally
the primary constraint. When the knee is straight,
the gastrocnemius is stretched as well as the soleus.
Having adequate and symmetrical flexibility in the
calf muscles is vital to give the dancer adequate time
to absorb the large forces associated with landing
from movements such as jumps. Furthermore, when
the triceps surae is tight, the foot is often allowed to
excessively pronate in order to unlock the midtarsal
joint and allow greater apparent dorsiflexion. This
excessive pronation can increase injury risk at the
knee and foot.
Unfortunately, at least elite ballet dancers tend
to have lower ranges of motion in ankle-foot
dorsiflexion than even sedentary controls (Clip-
pinger-Robertson, 1991; Hamilton et al., 1992;
Liederbach and Hiebert, 1997). One study of elite
ballet students showed that 67% lacked the 10° of
dorsiflexion required for just normal walking gait
(Molnar and Esterson, 1997). Another study showed
a 50% reduction in dorsiflexion when compared
to general norms (Hamilton et al., 1992). In this
latter study, female ballet dancers with higher total
injuries were also associated with lower bilateral
plié and decreased ankle-foot dorsiflexion. In a
study that followed both ballet and modern dance
students for one year, those who reported previous
leg injuries correlated significantly with lower dorsi-
flexion values and with more new injuries (Wiesler
et al., 1996).
This research supports the strong need to incor-
porate regular calf stretching into the dancer’s rou-
tine to counter the effect of training and decrease
injury risk. Hamilton (1988) claims that just putting
stretching boxes (incline boards) in the studios and
encouraging regular stretching of the triceps surae
markedly reduced the incidence of Achilles tendinitisTABLE 6.7 Normal Range of Motion and Constraints for Plantar Flexion and Dorsiflexion of the Ankle-Foot
Ankle-foot joint movement Normal range of motion* Normal passive limiting factors
Plantar flexion 0-50° Capsule: anterior portion
Ligaments: anterior talofibular, anterior portion of deltoid
Muscles: dorsiflexors of foot
Bony opposition: posterior talus and posterior tibia
Dorsiflexion 0-20° Capsule: posterior portion
Ligaments: posterior talofibular, calcaneofibular, and deltoid
Muscles: plantar flexors of foot
Bony opposition: anterior talus and anterior tibia*From American Academy of Orthopaedic Surgeons (1965).