IADMS New York 2002   [back to the Category]

The Cavus Foot: Help or Hindrance in the Dancer on Pointe?   [read the french version]

Author :   Suzanne Martin, MA, MPT

The Cavus Foot: Help or Hindrance in the Dancer on Pointe?


Suzanne Martin, MA, MPT
Smuin Ballets, School of the San Francisco Ballet, San Francisco, California, USA
St. Mary’s College, Moraga, California, USA

This presentation focuses on the biomechanical demands of the aesthetic of the cavus foot in the female ballet dancer, where the dance form often sacrifices structure over function. The cavus foot, whether it occurs naturally or has been nurtured, creates a ‘windlass’ effect, thereby intensifying the high loads and strains of ballet technique. Understandably, then, the ankle-foot complex is reported as the site of highest injury in a pointe dancer.

The morphology of the foot is a major biomechanical criterion in a dancer’s performance. This fact of ballet life often leads to a Darwinian prediction of who will be successful professionally. However, success can be a rose with the thorns of injury. All feet run a genetic spectrum between a cavus foot and a planus foot, just as all talo-crural joints run a spectrum of excursion of plantarflexion range of motion. The aesthetics of ballet line demand the closely fit acquisition if not the hereditary match of a perfect 180-degree line drawn between the central axis of the tibia and the mid-foot (transverse tarsals) in order to become fully on pointe.

In normal gait, the subtalar joint of the hindfoot (talus and calcaneus) must invert during the push-off phase. Then an interlocking mechanism occurs in conjunction with the mid-foot in order to create a rigid lever for not only acceleration and deceleration of the foot but also forward, back and lateral progression. In dance terms, this means the foot needs to assume the role of a rigid lever for jumping and landing as well as elevation up to pointe and its subsequent descent.

Weightbearing stresses ideally should travel down the mechanical axis of the tibia, talus, midfoot, and finally the metatarsals and phalanges. Plantarflexion of the ankle allows only minimal stability since the narrowest portion of the talus is congruent with the tibial-fibular mortise. In addition, the inversion of the cavus hindfoot limits eversion.

Since the cavus foot is more rigid structurally, the loads wind up being transmitted upward proximally, rather than dispersed distally. The dorsal aspect of the foot receives higher than optimal tensile forces. Add to this scenario the biomechanics of the repetitive stress of the professional, and an injury is waiting to happen. Dance screening, proper technique and judicious progression of pre-professionals toward pointe work are all necessary to avoid injury.

This presentation will focus on case studies of the injuries of professional ballet dancers with cavus feet. The biomechanics will be explained through charts and suggested conservative treatment will include both active and passive modalities. Manual therapy techniques will be explained and active treatment protocols will be demonstrated.