Lower-Leg and Foot Contributions to Turnout in University-Level Female Ballet Dancers

Carter, Sarah L.; Bryant, Alan; Hopper, Luke

doi:10.7547/15-142

Cited by 5 publications

(11 citation statements)

References 27 publications

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“…Limited hindfoot motion exposes the tibiofemoral joint to excessive external rotation. This supports our findings from earlier studies [3, 12], however the relationship only holds true to active measurements of external tibiofemoral rotation and static first position conditions. Therefore, our findings reject our hypothesis, as we solely stated passive measurements rather than passive and active measurements.…”

Section: Discussionsupporting

confidence: 92%

An analysis of the foot in turnout using a dance specific 3D multi‐segment foot model

Carter

Bryant

Hopper

2019

Journal of Foot and Ankle Research

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IntroductionRecent three-dimensional (3D) kinematic research has revealed foot abduction is the strongest predictor of standing functional and forced turnout postures. However, it is still unknown how the internal foot joints enable a large degree of foot abduction in turnout. The primary purpose of this study was to use a dance specific multi-segment foot model to determine the lower leg and foot contributions to turnout that female university-level ballets use to accentuate their turnout.MethodsEighteen female dance students (mean age, 18.8 ± 1.6 years) volunteered for this study. Retro-reflective markers were attached to the dancers’ dominant foot. Each dancer performed three repetitions of functional turnout, forced turnout and ten consecutive sautés in first position. Repeated measures ANOVA with Bonferroni adjustments for the multiple comparisons were used to determine the kinematic adjustments, hindfoot eversion, midfoot and forefoot abduction, navicular drop (i.e. lowering of the medial longitudinal arch) and first metatarsophalangeal joint abduction between natural double leg up-right posture and the first position conditions.ResultsHindfoot eversion (4.6°, p < 0.001) and midfoot abduction (2.8°, p < 0.001) significantly increased in functional turnout compared to the natural double leg up-right posture. Thirteen dancers demonstrated increased first metatarsophalangeal joint (MTPJ) abduction in forced turnout, however no statistically significant increase was found. Navicular drop during sautés in first position significantly increased by 11 mm (p < 0.001) compared to the natural double leg up-right posture.ConclusionOur findings suggest dancers do pronate, via hindfoot eversion and midfoot abduction in both functional and forced turnout, however, no immediate association was found between forced turnout and first MTPJ abduction. Foot pronation does play a role in achieving turnout. Further prospective research on in situ measures of the lower limb in turnout and injury surveillance is required to improve our understanding of the normal and abnormal dance biomechanics.Electronic supplementary materialThe online version of this article (10.1186/s13047-019-0318-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

An analysis of the foot in turnout using a dance specific 3D multi‐segment foot model

Carter

Bryant

Hopper

2019

Journal of Foot and Ankle Research

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“…3 Two studies included dancers with ankle injury to compare their movement patterns with healthy, uninjured dancers. 77,82 Twenty-one of the 25 studies explicitly stated which genre or style their participants practiced: 12 evaluated ballet dancers, 35,37,39,41,[74][75][76][77][78]80,82,84 three evaluated jazz dancers, 11,28,29 three evaluated both ballet and contemporary dancers, 2,48,49 and tap dancers, 79 Latin ballroom, 81 and Irish dancers 7 were evaluated in one study each (Tables 5, 6, and 7). The other four studies did not specify the style of dance their participants practiced.…”

Section: Study Participantsmentioning

confidence: 99%

“…Traditional dance styles, such as classical ballet, contemporary dance, jazz, tap, ballroom Latin dance, and Irish dancing, require dancers to possess excessive joint ranges of motion (ROM) for proper technique execution and desired aesthetics. [1][2][3][4][5][6][7][8] Although these dance styles have different technical demands and style-specific movements, all styles require excessive ankle and foot ROM that may put the dancer at increased risk for injury. For example, dancers frequently transition into demipointe relevé (standing on the balls of the feet with toes extended) from plié ("to bend"; full dorsiflexion of the ankles with the knees flexed).…”

Section: Introductionmentioning

confidence: 99%

Applications of Biomechanical Foot Models to Evaluate Dance Movements Using Three-Dimensional Motion Capture: A Review of the Literature

et al. 2022

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Dance movement requires excessive, repetitive range of motion (ROM) at the foot-ankle complex, possibly contributing to the high rate of injury among dancers. However, we know little about foot biomechanics during dance movements. Researchers are using three-dimensional (3D) motion capture systems to study the in vivo kinematics of joint segments more frequently in dance-medicine research, warranting a literature review and quality assessment evaluation. The purpose of this literature review was to identify and evaluate studies that used 3D motion capture to analyze in vivo biomechanics of the foot and ankle for a cohort of dancers during dance-specific movement. Three databases (PubMed, Ovid MEDLINE, CINAHL) were accessed along with hand searches of dance-specific journals to identify relevant articles through March 2020. Using specific selection criteria, 25 studies were identified. Fifteen studies used single-segment biomechanical foot models originally created to study gait, four used a novel two-segment model, and six utilized a multi-segment foot model. Nine of the studies referenced common and frequently published gait marker sets and four used a dance-specific biomechanical model with purposefully designed foot segments to analyze the dancers’ foot and ankle. Description of the biomechanical models varied, reducing the reproducibility of the models and protocols. Investigators concluded that there is little evidence that the extreme total, segmental, and inter-segmental foot and ankle ROM exerted by dancers are being evaluated during dance-specific movements using 3D motion capture. Findings suggest that 3D motion capture is a robust measurement tool that has the capability to assist researchers in evaluating the in vivo, inter-segmental motion of the foot and ankle to potentially discover many of the remaining significant factors predisposing dancers to injury. The literature review synthesis is presented with recommendations for consideration when evaluating results from studies that utilized a 3D biomechanical foot model to evaluate dance-specific movement.

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“…In contrast with these, Moller et al 42 reported ICC of 0.55 (intra-tester) and 0.50 (intertester) for measurement in a seated position. As to NHCTO, Carter et al 45 reported intra-tester ICC of 0.93 on their measurement of tibiofemoral anteversion (seated position), and Sutton-Traina et al 10 reported 0.95 for measurement of femoral version (supine position). No studies reported inter-tester reliability for NHCTO.…”

Section: Reliability Testingmentioning

confidence: 99%

“…Nine studies recorded NHCTO, including seven cross-sectional studies, [7][8][9]24,29,34,45 one cohort, 43 and one case-control study. 10 Dancers were again either prone, supine, sitting, or standing, but measurement protocols were more diverse.…”

Section: Non-hip Contributions To Turnout (Table 5)mentioning

confidence: 99%

An Updated Systematic Review of Turnout Position Assessment Protocols Used in Dance Medicine and Science Research

2021

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Turnout, or external rotation of the lower limbs, is an integral part of classical ballet technique. Contributions of lower limb structures to turnout can be separated into HER (hip external rotation) and NHCTO (non-hip contributions to turnout). This study aimed to review systematically methods used to measure turnout in dance medicine and science research, thereby updating the literature since the Champion and Chatfield review of 2008. CINAHL, EMBASE, PubMed, and Web of Science were searched in January 2018 by two independent reviewers. Peer-reviewed studies measuring turnout in dance were included, except those published prior to March 23, 2006, as that was the last date of publication included in the previous review. Abstracts, theses, and editorials were excluded. From each study, study design, population (sample size, sex, age, genre of dance, and level of training), details of the protocol used, and result of turnout measurement were extracted, as well as reliability data. All included studies were assessed for risk of bias, using either Newcastle-Ottawa scale, AXIS tool, or PEDro scale as appropriate for each study design. A total of 41 studies met the inclusion criteria. Twenty-eight studies measured HER, nine measured NCHTO, and 22 measured total turnout (TTO). An increased number of studies investigated TTO (N = 22; N = 4 passive TTO) and NHCTO (N = 9) since 2006. All studies scored above half the points attainable from their respective tools. Results suggest HER remains the most common protocol for measuring turnout (N = 28), despite the fact it disregards input from structures below the hip. It is concluded that researchers should focus on quality of reporting of protocols to ensure repeatability and facilitate comparison of results. Future studies should include absolute reliability and validity testing of all currently used protocols so that standardization can be fully achieved.

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Lower-Leg and Foot Contributions to Turnout in University-Level Female Ballet Dancers

Abstract: These findings suggest that the lower leg does contribute to dancers' overall position of functional turnout. However, current methods are not useful in predicting a dancer's lower-leg contribution and alignment in functional turnout in first position.

Cited by 5 publications

References 27 publications

An analysis of the foot in turnout using a dance specific 3D multi‐segment foot model

An analysis of the foot in turnout using a dance specific 3D multi‐segment foot model

Applications of Biomechanical Foot Models to Evaluate Dance Movements Using Three-Dimensional Motion Capture: A Review of the Literature

An Updated Systematic Review of Turnout Position Assessment Protocols Used in Dance Medicine and Science Research

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