May 1, 2008

Dancing Smart Newsletter: 5/2/08

Dancing Smart Newsletter: Pronation –vs.- Supination
May 2, 2008

Only one question for this week from Shirley. Thanks for giving permission for me to use your photos in the newsletter!

It always cheers me up when I get the email notification of a new post. Because I will get to learn something new or have a better understanding of the body (so important to us).

Have written to you earlier on, regarding my painful navicular accessory bone at my instep area. I went on further and keep reading and searching information related to this condition. But what puzzled me was that with my flexible flatfeet condition I pronate, and I notice that from the back, my heel bone DO look like this (but my right is worse than my left feet) which worsen my arch pain and pain of my accessory bone.

But when I check my shoes, they are worn out on the outside edges, which means that I supinate? And sometimes I realize that I will shift my weight to the outer edges of my feet and have to intentionally bring my weight in, so that I can feel more weight beneath the ball of my feet near the big toe area.

How is it possible that I pronate but show signs of supination?

I did a foot ink print recently. My feet have all right arch areas. I am now protecting my feet through regular massage, ball rolling and arch supports, and proper footwear. Yet, I still suffer from pain, which gets worse when rehearsal gets long and strenuous.

FYI, I am dancing professionally in a contemporary dance company. mainly dancing barefooted.

Thanks so much, Shirley

Delicious question! Let's begin with looking at the photos you sent. You're having pain in the arch of the foot around the navicular area. Without an x-ray it is impossible to know if you have an accessory navicular bone, which would be an extra navicular bone in your foot. Everyone has a navicular bone, it's the keystone of the medial arch of the foot. When that navicular bone drops in pronation you lose the integrity of the arch and begin to strain the plantar fascia because the weight is no longer evenly divided on the three points of the feet.

When you look at the the picture notice the bunion beginning and the big toe shifting over. The bone that is sticking out on the inside of the foot is the navicular bone and/or an accessory navicular bone. It's a common pronation pattern to see a bunion and shift of the big toe like this.

When we look at the photo of her feet and ankles from behind you can see there is a difference in the angle of the calf between the two legs. Do you see that the right calf is angled to the outside as if it is more bowed? That is one of the structural reasons that is making the right foot pronate more than the left foot. You want to make sure that you aren't allowing the knees to press back into hyperextension, Shirley as that sometimes creates a 'bowing' effect to the lower leg as the leg rotates inward.

Even with dancers who pronate it isn't unusual to find them hitting the outside edge of their shoes first and then rolling towards the big toe - creating a diagonal path of weight rather than having the weight transfer from the middle of the heel through the second and third toes. If there is some bow to the lower legs it will be challenging to feel that you are square and flat on your feet - sometimes you'll naturally following the subtle bowing and feel as if you are sickling your feet when pointing. Always, though, you want to attempt to have even weight between the 3 points of the feet.

When we look at the photo of your first position you can see the pronation, more on the right than the left. I would have to check the amount of turnout in your hips and see if you have either a tight right iliopsoas muscle influencing your turnout, or if the right hip simply has less range. It is a common mistake to set up the first position for the greater turnout side - which is opposite of what it should be. Just something to check:)

You are doing all the right things with foot massage, etc. What I would suggest that you try is taping your arch for a few classes or rehearsals. The tape can't hold you totally out of pronation but it does a good job of reminding the foot not to roll in.
You may need to go to a physical therapist or athletic trainer to show you how to tape for pronation.

See if having some pressure taken off the navicular decreases your pain. I'm hoping so! I'm glad you are able to continue dancing and the pain has not limited your motion. Do pay very close attention while wearing the tape to how your feet feel in jumping, doing first position, etc. The movement that bothers you the most may give you some clues to what else you might be able to shift and change.

If you are having some swelling or pain after moving, make sure you are also de-inflamming the area with ice and/or some form of anti-inflammatory. One the feet get inflamed it is hard to calm them down. Healthy feet whether they belong to dancers or nondancers are essential to well-being!

Let us know how the taping goes, Shirley!

Best wishes for a speedy recovery,


"Education is the key to injury prevention"