The Secret of Perfect Pointe Part 2

In part one, we have already talked about the importance of the flexibility of big toe flexors for maximum big toe extension in high demi pointe.

It actually also affect the height of a dancer's foot arch, formation of bunion and flat foot.

Demi Pointe to Full Pointe

i.e. Toe extension to flexion

This time in part two, we will talk about anatomy and how the tightness of the big toe flexors affecting the foot arch.

Big toe flexors included 2 muscles, a  shorter division and longer division:

1. Flexor Hallucis Brevis (FHB) and

2.  Felxor Hallucis Longus (FHL)

In anatomy, "FLEX" means to bend,

"Flexor" mean the muscle which bend the joint.

"Hallucus" means big toe or first toe.

"Longus" means the longer division of the muscle group.

"Brevis" means the shorter division of the muscle group.

Anatomy of Flexor Hallucis Brevis (FHB)
This muscle originate from a tendon at the medial side (inner side) of the foot arch and divides in two portions inserted into the base of the 1st phalanx of the big toe and there is a sesamoid bone at each insertion.





Anatomy of Flexor Hallucis Longus

Posteror view of leg
Green colour indicate the FHL

FHL muscle is a deep leg muscle at the posterior compartment situated on the fibular side of the leg (i.e. back of the outer side of the leg next to the calf). The muscle belly is at the lower two third of the back of the fibular bone.

FHL tendon lies in a groove crosses the posterior surface of the lower end of the tibia, posterior surface of the talus i.e. back of the ankle and the under surface of the calcaneus, into the sole of the foot and runs to the front between the heads of FHB and insert into the base of the big toe.

See the picture below:

That is why as mentioned before, a lot of the back of ankle pain in dancers were misdiagnosed as Achilles Tendinitis while it is actually FHL tendinitis.

Also when FHB and FHL becomes tight, it can cause the foot to pronate:

Posterior view of the ankle/foot
http://www.docpods.com/over-pronation

Therefore, it affects the weight bearing of the foot shifted to the medial (inner) side due to the tightness of FHB and FHL which means a drop of foot arch/ flat (pronated) foot.

flat foot

As the weight bear shift to the medial side of the foot, it can be one of the main factor of bunion in many dancers.

Bunion

Also when FHB and FHL are tight, the foot arch becomes stiff and difficult to tendu with nice pointe foot and cause sickling.

So we should self massage FHB and

FHL

For stretching of FHL,

it is important to keep FULL ankle dorsiflexion and big toe extension at the same time for good stretching effect.

In Part 3,  we will talk about the importance of the strength of FHL and FHB when pushing from high demi pointe to pointe and how to do strengthening in a more appropriate way and prevent injury.

Copyright © Perfect Pointe Physiotherapy Limited. All rights reserved. No portion of the article may be duplicated, redistributed or manipulated in  any form.

The Secret of Perfect Pointe - Part 1

In ballet, everyone wants perfect pointing feet. The big toe flexor is one of the keys that helps to point the foot perfectly and also one of the muscle groups that support the whole body weight en pointe in ballet.

As a dance physiotherapist, I always find out that the big toe flexors problem is one of the main reason for dancers suffering from back of ankle pain, decreased pointe range and drop of foot arch.

Also the big toe flexors tightness affect balance and sickle especially when demi pointe. As the foot weight bearing is not even due to the tight big toe flexor restricting the range of big toe extension.

(Pictures from: http://hjd.med.nyu.edu/harkness/patients/common-dance-injuries/footankle)

FULL Big Toe extension with
1st MTP joint extension at least 90 degree
Full demi pointe with flexible big toe flexors

RESTRICTED Big Toe extension
1st MTP joint extension limited less than 90 degree
Sickling demi pointe with tight big toe flexors

Another issue is that the long division of the big toe flexiors i.e. Flexor Hallucis Longus (FHL) runs across the back of the ankle. When it inflamed, it caused back of the ankle pain, limited pointe range and a lot of the time it can be misdiagnosis as Achilles Tendinitis. I have experience seeing quite a few dancers and dance students experiencing back of ankle pain and being misdiagnosis as Achilles Tendinitis (misdiagnosis by someone who do not know anything about sports or dancers) and wasted their time with treatment not targeting at the right structure.

A lot of dancers has big toe flexor tightness without knowing it until it becomes painful with tendinitis. It can be so painful that stop dancer dancing and affect their career. Most of the people do not know what it is and how important it is to stretch and massage it.

However, a lot of people do strengthening it by using a stretchy resistance band. If it is not perform cautiously (sometime even performed cautiously), the exercise increased the tension and tightness of the big toe flexors. It sometimes does more harm than good to a dancer's foot.

Also in this exercise, it is a pulling rather than push action. That is not simulating the dance movement when the foot is always pushing the floor. So this may affect the propioception (joint sense and balance) of our leg.

See this video to get more information in action:

If you insist to do this exercise for strengthening, please stretch and massage especially the big toe flexors afterwards.

I met one English dancer who did the surgery for the long big toe flexor (FHL) tendinitis and recovered. She continued the resistance stretchy band strengthening exercise. After sometime she got the exact same pain and tendinitis again! She was so glade that when she met me in Hong Kong during performance and I told her about the possible problem of big toe flexors (actually also other toe flexors) tightness aroused by this exercise. She stopped this exercise after my advice and treatment. She was back to the UK and email to tell me that the pain was gone.

Of course, surgery is always the last resort. The thing is dancers need to know how to prevent this from happening.

One of the way is not to do the wrong strengthening and also to do the right massage, keep relieving the tension of these muscles especially after dancing.

In the next article, we will talk about the anatomy of Big Toe Flexors and how to stretch and massage it. Also how to do correct strengthening exercise for foot pointing and pointe work.



Copyright © Perfect Pointe Physiotherapy Limited. All rights reserved. No portion of the article may be duplicated, redistributed or manipulated in  any form.