Do you have foot pain? Are you a dancer? Whether dancer or not, we all use our feet daily. If you, your patient, or your client are having pain, continue reading tips from our January 2019 Pilates PT of the month to learn how to strengthen your feet and improve your posture from the ground up.
Facts
Lower extremity injuries comprise up to 91% of injuries in dancers, and the foot and ankle complex up to 57% of those. The towel curl exercise (where you curl a towel towards you on the floor with your toes) is often given in rehab, but recent evidence shows that the activation of the foot core, specifically a muscle called the abductor hallucis is over four times greater during the short foot or doming exercise when compared to towel curl exercises. According to one study, there is increasing evidence to suggest that training the foot core via short foot or doming exercise progressions can decrease foot pain, improve foot function, reduce arch collapse and improve balance ability. I think we would all benefit from these things, not just dancers! Who’s ready to try some foot pilates?!
Anatomy
In the foot, there are four layers of plantar intrinsics or local muscles that have the primary function of stabilising the arch. They act to control the degree and velocity of arch deformation. One of our primary goals in Pilates is correcting abnormal movement patterns. Why not use that same principle in the feet! When the feet are not functioning properly the foundation becomes unstable and malaligned resulting in abnormal foot movement and usually foot pain as well. The extrinsics or global movers cross the ankle joint and insert on the foot. These muscles are the prime movers of the foot. Often times issues develop because the smaller intrinsic muscles are inhibited and the extrinsic muscles which are designed to create bigger motion are also trying to stabilize which can result in injury, decreased balance, decreased proprioception and ultimately foot pain and poor mechanics.
Exercise
A common exercise that I see dancers and others given is curling the toes (Image A) – this is especially not good for dancers because it overworks the Flexor Hallucis Longus (FHL), and reinforces the incorrect mechanics of pointing the feet. FHL tenosynovitis is so common in dancers that it is referred to as “dancers tendonitis.” For those who aren’t dancers, the risks of FHL tenosynovitis may not be so much of a concern, however, if there is a more effective way of strengthening the foot, why not spend your time doing that instead?!
Practicing doming correctly or as I call it Pilates for the Foot – by activating the Flexor Hallucis Brevis (FHB), abductor hallucis and lumbricals of the feet is an extremely effective way to prevent this career threatening injury for dancers, as well as strengthen our arch and improve the ability of our feet to take load, whatever your ‘load’ of choice.
Doming
There should be no “crunching” of the big toe, as seen in Image A. There should also not be excessive anterior tibialis activity (Image B) which is used to ‘pull the arch’ up. Overuse can easily lead to medial tibial stress syndrome or ‘shin splints’. Image C is the correct movement. We are looking to create a triangle shape at the big toe joint without any movement at the ankle (inversion/eversion for healthcare professionals, sickling/beveling for dancers).
If you are a healthcare professional who treats dancers and would like a bit more information, The Australian Physiotherapy and Pilates Institute (APPI) runs a n online Pilates for Dancers course which may be found on their website.
Tools & Tips
Are you having some difficulty performing these? If it seems harder than it looks to get the correct movement, I promise you are not alone! It can be a bit of a pat your head and rub your tummy exercise. One tool that I have found to be extremely effective before doing any foot core exercises is using the spiky massage balls. They will wake up the little muscles that you are trying to work and get your nervous system primed to establish communication between your brain and your muscles! Keep at it, even if you have to use your hands to help your foot do the motion at first. Your body is amazing and with practice you will see noticeable improvement!
References
Weisler ER, Hunter DM, Martin DF, et al. Ankle flexibility and injury patterns in dancers. Am J Sports Med. 1996;24(6):754-7
Preston J. Smith, MD, Brayden J. Gerrie, BS, et al. Incidence and Prevalence of Musculoskeletal Injury in Ballet. The Orthopaedic Journal of Sports Medicine, 2015;3(7), 2325967115592621 DOI: 10.1177/2325967115592621
McKeon PO, Hertel J, Bramble D, et al., The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med 2015;49:290
Howell L, Advanced foot control for dancers. 2nd edition. 2011
Rudazsky, A. Cook, J. PGManips, Grad Cert Higher Ed, B App Sci (Phty), Department of Physiotherapy, Monash University. 2015. Managing Tendinopathy in Dancers and Dance Students. International Association for Dance Medicine and Science. www.dancescience.org
Hiemstra LA, Lo IK, Fowler PJ. Effect of fatigue on knee proprioception: implications for dynamic stabilization. Journal of Orthopedic Sports Physical Therapy, 2001;31:598-605
Black M. Pilates for Feet: Pilates-Pro.com; [10 October 2013]. http://www.pilates- pro.com/pilates-pro/2009/3/24/pilates-for-feet.html
Lynn SK, Padilla RA, Tsang KK. Differences in static- and dynamic balance task performance after 4 weeks of intrinsic foot muscle training: the short-foot exercise versus the towel-curl exercise. Journal of Sports Rehabilitation 2012;21:327-33
Jung DY, Koh EK, Kwon OY. Effect of foot orthoses and short-foot exercise on the cross-sectional area of the abductor hallucis muscle in subjects with pes planus: a randomized controlled trial. Journal of Back Musculoskeletol Rehab 2011; 24:255-31
ASK PILATES PT
Having difficulty finding the right position during exercises? Don’t understand a recent medical diagnosis? Want to know how to target a problem area? Interested in being the next PilatesPT of the Month? You have questions, WE have answers! Don’t hesitate to email askpilatespt@gmail.com!
With Love, Scrubs, and Sidekicks,
