In 2013, when Helen Mirren showed up on the red carpet, in a pair of chic exotic platform shoes, she elicited whispers and significant controversy: Helen Mirren & Her Exotic Shoes . In that one singular moment, she bestowed on all pole dancers, as exotic dancers, a shield to be who they want to be and not to feel shame for choosing an unusual method for exercising which is NOW internationally recognized as a sport. It is also currently on “observation status” according to the GAISF (Global Association of International Sports to be admitted to the Olympics as an official sport.
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Pole dancers covet their feet, not because they love them, but because when they slip into those exotic platform high-heeled stiletto shoes, they have stepped into a world of seduction, power, and attraction. “THE shoes” convey a mindset of feeling beautiful, sexually attractive, and empowered, all wrapped up into one emotional moment . It just IS what happens for them when they instantly add 6, 7, or 8 inches to their height. It is an expression of their own personal style, revealing the crowning glory of the aesthetic “dancer’s line” of the curvaceous legs. Men, too, have been found to alter their behavior by “helping” women who wear high heels. Researchers found that as heel height increased, so did men’s effort to “help” a woman with whatever she “needs”. (1) Effortlessly, and with grace, they “step” into the dance realm, and are overcome, uncompromisingly, with the passion for The Dance. Not much thought, if any, is given to the pain, agony, and the risk they undertake as they don “those forbidden shoes”. Ankle injuries and instability, gait mechanics and kinetic energy costs, muscle and knee injuries, postural compensation and chronic back pain, along with impingement and tarsal tunnel syndromes are but only a few of the potential risks and side effects they voluntarily accept when they persevere for the passions to dance. (2-7)
The exotic platform shoe, unlike a ballet slipper, an “en-pointe” ballet toe-shoe, or a ballroom-styled dance shoe, tightly restricts the foot from any movement while placing it in a “demi-pointe” position, a transitional state midway between the extremes of pointing the foot (plantarflexion) and flexing the foot (dorsiflexion), at the ankle joint. There is no “give” or soft fabric in an inflexible platform exotic shoe, as in other styled dance shoes. Other dance shoes also compromise the ankle-foot complex, but, a sizable difference follows in that the exotic platform shoe forces a static position, potentially increasing the compounding energy forces which drive an already risky foot position to another level of a previously potentially complex injury. It becomes further prone to injury. The dancer is now forced to balance on the stiletto heel, measuring no greater than 0.156 in. (2, 3)
The compulsory position does not allow for strengthening of the dancer’s kinetic chain of movement, in fact it stresses an already strained in-between stance, from her foot up to her knee, hip, pelvis, spine, shoulder, and jaw. Hence, the platform shoe’s obligatory position resembles an already familiar silhouette, recognizably described as “The Barbie® Foot”. (Circa 1959)
To understand the precarious position of the foot, held in place, the skeletal and muscle anatomy along with normal biomechanics of the ankle-foot complex are briefly explained relative to the “line of influence” of the kinematics of dance.
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This article will focus on the “closed kinetic chain” (CKC) of movement over “open kinetic chain” movement (CKC movement means the foot comes into contact with the ground, affected by gravity and the normal force, from the ground up). Additionally, I offer suggestions on how to avoid injury of the ankle-foot complex during dance. Categorically, CKC movement and exercises have a resounding impact on the “plum line” of the dancer (known as the line of gravity, passing through the ear-jaw-line, shoulder, spine, pelvis, knee and ankle joint), thus producing greater pressure through the dancer’s feet, subsequent posture, and the potential for injury intensifies.
The foot is divided into 3 areas and is comprised of 26 bones, total:
1. The Hind Foot:
**Delineated by the calcaneus (heel bone) and talus bones
2. The Midfoot:
**Consists of 5 tarsal bones plus 5 metatarsal bones (the long bones)
**During movement, the midfoot, specifically, the first long bone, transfers forces generated by the leg muscles to the forefoot.
3. The Forefoot:
**Comprised of 14 bones, known as “digits”
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The foot’s architectural structure has been described as a “triple-arch” structure, forming three arches which support the body’s weight and force production. (8) The medial and lateral longitudinal arches cross with the transverse arch and all three arches are maintained by the interlocking shapes of the foot bones, ligaments, and the pull of tendons during muscle activity. Ligaments and tendons provide necessary resiliency while the muscles act as springs, recoiling for power and force production. (8)
The ankle joint (talocrural joint) consists of 3 bones: the talus, tibia, and fibula. It creates a “mortise” joint allowing for the placement of the head of the talus bone to insert, snugly and tightly, resulting in a “locking” of the joint. By design, the joint is particularly strong but only in the extremes of range of motion, maximally pointed or maximally flexed. The “in-between” positioning, “demi-pointe”, establishes significant risk for the dancer. (2) Twenty-five muscles act on the lower leg and ankle-foot complex, and facilitate all movement while allowing the dancer to display elegance, beauty, and grace.
As a doctor of physical therapy, the dedication to health, wellness, and quality of life is principal for my patients, family, and friends, as well as myself. Dancers should be committed to a program for strength and flexibility, to protect the feet and ankle joints, devotedly. Undeniably, the health and well-being of the feet and ankle joints sets the stage for the health of the entire body. As exotic dancers, they should undertake a consistent program of strength and flexibility, no less than 3 times per week, for about 30 - 40 minutes per session (yes! - added to our already hectic schedules) to care for the 52 bones of the feet which “hit the ground running” every day, to carry the body's entire weight, relentlessly, and to perform every task demanded of them. The mind and body deserve nothing short of the full attention and dedication. As a healthcare professional, I recommend the following “Exotic Dance Shoe Protocol” along with some tips to strengthen your feet and ankle joints while working to avoid injury. Your feet, legs, pelvis, spine, shoulder and jaw-line will benefit significantly and enhance the quality of your life as well as develop your dance performance.
Exotic Dance Shoe Protocol (Frequency: 3days/ week):
1) Releve’ or Calf raises, with a ball: parallel & turned out, bilateral & unilateral (on both legs & one leg alone, & with straight legs & bent knees (20 repetitions, all positions)
2) Calf stretches with Foam Rolling: bilateral & unilateral (on both legs & one leg alone & with straight legs & bent knees.
(Moderation - No overstretching. See “Tips in performing exercises” (4-5 minutes / 1-minute per leg per position)
3) Walking lunges with Theraband®* or Versa Loop*/** (forward, backward, & sideward;) ( 3-4 repetitions of 8 steps in all directions)
4) Jump rope (bilateral & unilateral)** (8-10 minutes)
5) Balance – Proprioception Tandem training Image - Tandem Stance (4 minutes (R & L foot in front); 2 times/foot
6) Yamuna® Foot-Wakers foot work in all varied foot patterns, both bilateral and unilateral*/*** (8-10 minutes)
Tips in performing exercises while avoiding injuries:
During releve’, keep consistent timing, don’t go too fast and keep a steady pace. Set a metronome app on your phone or pick your favorite song with a steady beat, to help pace yourself. Be sure to rise up and down smoothly and without jerky execution.
Be sure to go absolutely vertical, not allowing your knees to bend, and avoid rocking forward or backward. Compensations occur due to muscle and joint weaknesses. Keep your knees in a “neutral” position, not flexed or hyperextended.
Perform heel-calf raises in parallel and turned out, to engage all muscles, in varied muscle recruitment patterns.
Maintain good alignment and posture during the performance of all exercises, throughout the program.
During releve’, focus on you midfoot, and the first long bone before your big toe, for meticulous alignment to sustain midfoot-ankle position.
Do NOT overstretch the calf muscles as this can cause loss of “recoil capacity”, weakening potential kinetic energy and power output of all the lower leg muscles. Balance is the key!
During lunges, keep your knees in line with the first and second toes while your shins are perpendicular to the ground. Do not allow the knee to go over, and past, the foot.
During balance training, stand in a corner with your arms crossed, or stretched out at your side, for fall prevention.
During jump roping or hopping, be sure to flex your knees sufficiently, land on the ball of your foot, first, then roll through the whole foot, avoiding hard and concrete surfaces.
Regularly inspect the rubber sole of your platform shoe, both at the heel and the platform, to ensure that it is securely adhered to the plateau and that the heel tap is intact.
Inspect the plastic ankle straps to verify there are no broken buckles or torn straps.
Avoid buying your shoes too big as the plastic straps and front section stretches, eventually loosening around both the ankle and top of the foot, resulting in the foot sliding forward in the shoe. Generally, dancers buy a size smaller than their street shoe for a snug fit at first, and they loosen up, “just enough”.
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SPECIAL NOTES:
*I do NOT represent any company or benefit, in any way financially, from my professional recommendations. I support and endorse, and recommend strongly, ONLY the companies and products I use, in my personal life, for exercises, which I have tested and practiced with, throughout my personal life, and as a healthcare professional.
** Hopping/jumping with no rope in place of a jump rope works just as well. This exercise helps in building up the “spring-like” reaction time, speed, power, and strength of all the muscles acting on the feet, legs, pelvis, and spine. You can perform lunges with no band or Versa Loop, as well.
***I spend time working on the Yamuna Foot-Wakers every day, for no less than 10 minutes. It is impossible to express the immeasurable health benefits of using these exercise props every day. The mobility, flexibility, and strength gained by regular practice will undoubtedly restore your foot health.
References:
Wiedemeijer MM, Otten E. Effects of High-heeled Shoes on Gait: A Review. Gait & Posture Journal, January 2018.
Morton J. The Virtuoso Foot. Clinical Rheumatology, February 2013.
Mika A, et. Al. The Influence of Heel Height on Lower Extremity Kinematics and Leg Muscle Activity During Gait in Young and Middle-aged Women. Gait & posture. December 2011.
Ebbeling CJ, Hamil J, Crussmeyer JA. Lower Extremity Mechanics and Energy Cost of Walking in High-Heeled Shoes. Journal of Orthopedics & Sports Medicine Physical Therapy. December 2020.
Kadel NJ. Foot and Ankle Injuries in Dance. Physical Medicine Rehabilitation Clinics of North American, 2006
Rein S, et al. Postural Control and Functional Ankle Stability in Professional and Amateur Dancers. Clinical Neurophysiology, March 2011.
Coetzee JC, et al. Management of Posterior Impingement in the Ankle in Athletes and Dancers. Foot and Ankle International, 2015.
Ahonen J. Biomechanics of the Foot in Dance: A Literature Review. Journal of Dance Medicine & Science, July 2008.
DISCLAIMER:
Injuries of all types can occur when participating exercise, physical fitness and/or training programs. I strongly encourage all readers to obtain a comprehensive physical examination by a licensed physician PRIOR to undertaking any exercise or training protocol to determine if it is right for their needs. This is particularly true if you (or your family) have a history of high blood pressure or heart disease, if you have ever experienced chest pain when exercising or have experienced chest pain in the past month when not engaged in physical activity, smoke, have high cholesterol, are obese, or have a bone or joint problem that could be made worse by a change in physical activity. Do not start this fitness program if your physician or health care provider advises against it. If you experience faintness, dizziness, pain or shortness of breath at any time while exercising, you should stop immediately.
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Dr. Erica Nelson, PT_DPT, MSSM, BSc, MLD