Ankle, Foot, and Folk Dance
By Cynthia and Sheldon Berrol
Folk dance is a movement activity in which the ankle and foot are particularly vulnerable to injury. More than most other movement forms, folk dance places concentrated stress on the lower extremities. Consider, for example, that so many basic patterns are of running, jumping, hopping and bouncing, all of which place weight-bearing stress on the joints, muscles, and ligaments of feet and ankles. Faulty alignment, over use, inadequate footgear, and/or non-resilient floors are potential culprits for causing lower extremity problems. In the following discussion we will examine some of the consequences and suggest, as well, some preventive measures.
Anatomically, the ankle is a sturdy structure, stabilized primarily by ligaments, the fibrous tissue that crosses over joints to connect one bone to another. Its articulating surfaces fit together like a cup and saucer, the distal ends of the tibia and fibula (leg bones) fitting into the superior portion of the talus (the uppermost bone of the foot). Operating as a hinge joint, ankle motion is restricted to flexion and extension.
The foot, on the other hand, is far more complex and vulnerable. Composed of 26 bones of varying dimensions, shapes and types, it is capable of numerous joint actions such as flexion, extension, gliding, abduction, adduction, inversion, and eversion. Moreover, it possesses several arches medial and lateral longitudinal arches plus the metatarsal (transverse) arch which provide stability in normal function. Located as it is at the base of the skeleton, the foot bears the awesome responsibility of supporting our entire body weight.
No discussion of any one part of the body is complete without attention to overall alignment or posture. The organization of the individual parts and their relationship to each other determine how the entire body functions. Like building blocks, if one segment is askew, the remainder of the segments are adversely affected. Good static and dynamic posture is therefore an important key to the prevention of a variety of troublesome yet often avoidable physical problems.
The body may be conceived as three structural units, the head, the rib cage, and the pelvis. This trio is united by the spinal column, strategic to the balance of all segments. The spine has three natural curves, the neck (or cervical area), the thoracic area (mid back), and the lumbar area (lower back). Any flattening or increase in the curve of one of these segments will similarly affect the others. Thus the delicate balance of the spinal segments must be maintained for good postural alignment.
Good posture really describes the efficient relationship of body parts for achieving any desired position (static) or movement (dynamic). Simply, it is that which places the least stress on bones, muscles, and joints. Ideally then, if we were viewing an individual in a sideways, upright position, proper alignment could be easily demonstrated with a plumb-line. Dropped from the lobe of the ear, it should bisect at mid-shoulder, the middle of the pelvis, just behind the patella (knee cap), and slightly forward of the lateral malleolus (ankle bone). The greater the deviation from this plumb-line, the greater the effort of the body to keep itself erect. Actually, other than some occasional activity in the gastrocnemius (the muscle which forms the calf of the leg), good static posture requires minimal supportive muscular action.
ANKLE AND FOOT ALIGNMENT PROBLEMS
Alignment problems may stem from one or a combination of factors such as heredity, poor habits, poor muscle tone, etcetera. Regardless, over a protracted period of time, problematic consequences are inevitable.
One of the most common mal-alignment problems of the foot is caused by ongoing weight-bearing in a pronated (the inward roll of the foot while walking or running) position, flattening out the long arch and similarly causing a visible bowing inward of the Achilles tendon. This flattened condition, known as pes planus, puts abnormal strain on the supporting ligaments of the foot and ankle. Moreover, pronation may cause deviation of the knee and hip region.
Unfortunately, ligaments do not possess the elasticity of muscle fibers. Consequently, when ligaments are overstretched, the stable joints they support are permanently weakened. In the case of the foot, pain at the site of the impaired ligament(s) (spring ligament and/or plantar) is not an uncommon side effect. An additional consequence is that the muscles of the lower extremity may become overworked, having to replace the lost support. Overworking of any group of muscles can cause a condition known as tenosynovitis, a localized inflammation of the tendon sheath which can be quite painful.
Exercise is recommended to bring the foot into proper alignment and to strengthen the surrounding musculature. D.D. Arnheim suggests placing a downward pressure on the toes while attempting to lift the arch as one method of preventing further dropping of the arch. He cautions against dancing on a non-resilient or rigid surface. Aligning of the knees over the second toe by slight outward rotation at the hip joint will also halt further weakening of the arch.
Other conditions often caused by mal-alignment of the foot include the troublesome bunion (Hallux Valgus). Poorly fitted, snug shoes worn over a long period of time displace the large toe, forcing it inward toward the second and third digits. The end result is a permanent structural deformation and severe pain upon pressure to the area. Surgical repair is a common treatment for bunions.
Callouses and corns, fairly classic problems, result from factors such as poor posture and weight-bearing in addition to pressure from ill-fitting shoes. Proper foot hygiene, correcting alignment, and comfortable shoes are traditional corrective measures.
Folk dancing is a form in which acute injuries are not an unlikely occurrence. A group activity in which people dance exuberantly, an accidental kick from a neighbor, the sudden twisting of an ankle, or a fall from an improper landing are all potential conduits for trauma. Needless to say, a weak, poorly aligned foot is more prone to injury than a strong, well positioned counterpart.
Most acute injuries can be grouped into the following categories: contusions, sprains, strains, and fractures. Briefly, all but the last are considered soft tissue injuries; all involve some degree of tearing of tissue; and all are classified according to level of severity ranging from mild (1st degree) to severe (3rd degree). Anyone sustaining either second or third degree trauma should receive immediate medical attention.
The rule of thumb for the immediate treatment of any acute problem is RICE: rest to relieve pressure and minimize shock; ice for the first 24 to 48 hours to keep swelling and localized bleeding under control; compression to keep swelling contained; and elevation to prevent the internal pooling of blood at the site of the injury. These first aid measures facilitate recovery and reduce the danger of more disabling complications. The actual recovery phase, regardless of the specific treatment requirements, typically calls for immobilization and inactivity of the involved body part.
Contusions, the bruising of soft tissue, stem from a direct blow to an area. While a mild bruising may produce slight discoloration and mild discomfort, more severe blows can be quite disabling. Symptoms may include muscle spasm, inflammation, swelling, and hematomas (a localized collection of blood outside the blood vessels within the tissue).
Sprain involves the abnormal stretching of ligaments. Any sudden twist can produce an over-stretching of ligaments. The ankle is a common site for sprains, especially at its lateral aspect. Localized swelling and difficulty with weight-bearing are frequent symptoms. As in most acute traumas, the level of disability depends on the degree of damage. In general, ligaments are slow to heal, not being endowed with a rich blood supply. Immobilizing the ankle by taping is standard treatment for sprains. Extreme pulls to a muscle and its tendonous attachment can lead to strain, the tearing of soft tissue. In folk dancing, strains to the ankle and foot are frequently caused by improper landings due to faulty alignment. An unyielding dance floor may be a compounding factor.
Strains are similar to contusions and sprains, and are divided into degrees of severity, that is, second and third degree. A mild strain elicits localized tenderness and may be accompanied by muscle spasm. In second and third degree strain there is loss of function to the area and severe pain. Strapping or taping are typical treatment approaches.
A fracture, commonly known as a broken bone, is any "disruption in the continuity of a bone." Fractures of the ankle and foot may be sustained in several ways. Falling, extreme wrenching of a ligament, or a direct blow (that is, being stepped on by a fellow dancer) may be considered causative factors. For example, a strong, sudden outward twisting of the foot in relation to the leg may cause a chip of the medial ankle bone. Likewise, a sudden torsion of the ankle can cause a fracture of the talus which, as noted earlier, joins with the tibia and fibula to form the ankle joint. Being stepped on is the most frequent cause of metatarsal fractures. The fifth metatarsal, which lies proximal (near or next to) to the little toe, is especially susceptible. An abrupt inward twisting of the foot may also cause a fracture of this bone.
The type of break (simple or compound) is a major criterion in determining the degree of injury. Although most fractures require casting, the toes are often treated by taping the injured digit to a proximal one.
Not to be overlooked in this category is the stress fracture which often goes undiagnosed. Although the individual is aware of pain, because he/she is still able to bear weight on the foot, the fracture goes unsuspected. The most common sites are the neck of the second and third metatarsals and the sesamoid (extra) bones of the big toe. Overuse, that is, chronic (protracted or constant) stress to a region and a poorly conditioned foot are prime contributions to this type of fracture.
Most dance forms are distinguished in part by standard codes of dress, right down to footwear. In modern dance, individuals don leotards and tights, keeping their feet bare. Ballet dancers wear similar costumes, however, their footwear consists of either the traditional soft-soled ballet slipper or the pointe shoe, whose hallmark is a stiffly boxed toe area. Aerobic dancers, similarly outfitted in leotards and tights or sweats, wear specially designed aerobic shoes to reduce the stresses placed on the body by impact of aerobic exercise. Runners, also conscious of wear and tear on the legs and feet, likewise use protective shoes.
Folk dance, a multi-cultural form, displays a wide variety of dress, dependent in part on the nationality represented. Shoes are correspondingly varied. Albeit, it is most common for the recreational dancer to choose a shoe purely on the basis of comfort, an entirely functional approach. Unfortunately, most folk dance classes are offered in studios whose floors are not constructed for dance. Furthermore, many folk dancers have not been trained in the principles of proper alignment. Consequently, the stresses to the body provide fertile turf for potential injury.
Rigid, non-resilient surfaces have been responsible for numerous injuries to dancers. Continuous dancing on unforgiving surfaces places enormous strain on muscles and joints. Potential problems range from increased muscle soreness and fatigue to the more serious shin splints and stress fractures. In short, dancing on improper surfaces increases, significantly, the chance of injury.
Features of a good floor include shock absorption and resiliency (or springiness). It is now possible to customize these features in designing floors for different types of dance.
Long overdue, greater attention is finally being given to dance surfaces. Until recently, only a limited number of dance studios or schools with adequate budgets, installed good floors. Currently, professionals engaged in all forms of dance are realizing the necessity of proper surfaces for the movement arts. With this increased awareness, it is probable that the floors of studios will be modified to accommodate the needs of respective dance forms.
Proper care of the ankle and foot is dependent on a combination of phenomena. First and foremost is proper body alignment. As noted above, the segments of the human structure are interrelated, one part affecting the other for better or worse.
Although it is perhaps a simpler task to position oneself correctly in a static posture, dance is a moving art. However, forces placed on the body multiply significantly when in motion, placing the body at risk. Soft tissue injuries and fractures are potential sequelae (any complication). It is therefore extremely important to strengthen supporting musculature to help maintain dynamic alignment. An individually designed weight class (using Nautilus, Universal, or free weights) might prove expedient for this purpose. Maintenance of a strong, well-positioned body cannot be overemphasized.
Another factor previously mentioned in the prevention of problems was footwear. Although shoes for folk dance are not constructed to protect the foot from injury, a well-fitting, non-restrictive shoe should be worn.
Finally, the ideal dance surface is a resilient floor which can deflect adequately, the downward forces imposed upon it. Since custom designed floors remain an unaffordable luxury for many studios, the prevention of injury must reside in the areas that can be controlled personally by each individual dancer.
Arnheim, D.D.; "Dance Injuries: Their Prevention and Care." St. Louis: The C.V. Mosby Company, 1975.
Reprinted from "The Ankle, the Foot and Folk Dance" by Cynthia F. Berrol, Ph.D. and Sheldon Berrol, M.D.
in Viltis Magazine, March-April, Volume 44, Number 6, V. F. Beliajus, Editor.