Pictures posted below
I once asked a ballet dancer how long she had had her foot pain. She laughed and said, "the better question is when
haven't I had foot pain." Studies of ballet dancers show that 90% of professional dancers and 63% of student dancers
have had a dance-related injury at some point in their ballet career.
Of these injuries, 60% - 80% include the knee, ankle, and foot.
While ballet dancers may appear to dance with ease, ballet is physically demanding, taxing, and potentially injurious.
There are numerous and varied explanations for the high incidence of ballet dance injury. It appears, however, that the majority
of ballet injuries are related to training errors and biomechanical imbalances caused by technique flaws. Ryan and Stephens
in their book, Dance Medicine a Comprehensive Guide, report that forcing the feet to achieve turnout position beyond what
the hips will allow is probably the most serious training error a dancer can make.
Figure1: Functional turnout in the first position
Ballet turnout refers to the outward rotation of the legs and feet. There are five basic ballet positions of the feet. All
ballet movements begin, end, or pass through at least one of these positions. In all five positions, the knees are straight
and the legs rotated outward from the hips (figure 1).
In ballet, the generally recognized ideal turnout of 180 degree took several centuries to become commonplace. In fact,
in the 17th century the standard angle of turnout was only 90 degrees. Greater degrees of turnout gradually developed because
of their aesthetic appeal and the freedom of movement they allowed the turnout leg. By the 18th century, the angle of ideal
turnout had reached the present-day standard of 180 degrees.
Dancers ideally achieve 180 degrees of turnout by rotating each hip out 70 degrees, rotating the knee out 5 degrees,
and rotating the feet out 15 degrees, thereby adding up 180 degrees of 2 - legged turnout. Typical ballet dancers have significantly
less than 70 degrees of outward hip rotation. Studies demonstrate measurements between 40-52 degrees of outward rotation.
Realistically, few dancers can achieve this angle without compensations else where in the body. These compensations may be
allowed and even encouraged by dance instructors who stress the importance of ideal turnout. Unfortunately, forceful compensation
for reduced hip outward rotation can, and often does, lead to many of the injuries seen in dancers.
Many patterns of compensation can increase a dancer's ability to turn out. Three of the most common patterns of compensation
are through the back, knees, and feet. Ironically, these three areas are also the most commonly injured in dance.
How can you determine if a ballet dancer's turnout is being compensated inappropriately? Have a physical therapist
or certified athletic trainer measure the actual passive external rotation of both hips. Then have the dancer assume their
standing turnout first position. Trace their feet and measure the angle of turnout (figure 2). If the total functional turnout
of both feet is greater than the total passive external rotation of both hips, then the dancer is compensating at the back,
knee, or feet. Dancers should have at least 70 degrees of passive hip external rotation at each hip to obtain 180 degree turnout.
Figure 2: Measuring functional turnout position in standing
I recommend that dance instructors reduce the potential risk of injury to dancers by encouraging students to limit their functional
turnout to a position that does not markedly exceed the total amount of outward rotation present at the hips. Teachers should
encourage students with compensated turnout to decrease their turnout, and to increase their stretching and strengthening
regime with the goal of improving their hip outward rotation as much as possible over time. Many dancers will never achieve
the ideal turnout, yet can still enjoy the practice and performance of ballet.