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Effect of Footwear on Dancers: a Systematic Review

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Effect of Footwear on Dancers: a Systematic Review Original Article Effect of Footwear on Dancers A Systematic Review Alycia Fong Yan, B.App.Sc., Claire Hiller, Ph.D., Richard Smith, Ph.D., and Benedicte Vanwanseele, Ph.D. Abstract accomplishment. Therefore, the foot- percussive characteristics of flamenco Dancers need their feet to be healthy and wear that dancers use is very impor- and tap dancing, for example, can have pain-free; therefore, the footwear they use tant. Dance shoes range in design and an effect on the health of the dancer.3-5 is of great importance. Footwear has the construction depending on the dance The shock absorbing qualities of the potential to enhance or restrict move- style and purpose.1 The stiffness and shoes used in these styles should be ment and impact the dancer’s body in thickness of the sole, materials used in examined for their role in amplifying various ways. To evaluate the effects of construction, and overall design con- or reducing these forces. Both flamenco footwear on dancers, in particular the tribute to the flexibility and function- and some jazz routines require heeled effects on foot motion and injury dur- ality of the shoe. Research examining shoes, and the resultant forward move- ing dance movements, we undertook a systematic review of the literature. The the effects of footwear on the general ment of the center of mass can change population has found that stiffness body alignment and have implications major databases were searched for articles 2 6-8 on theatrical dance styles and dance affects the mechanics of walking ; it for posture and lower back pain. Bal- footwear. Sixteen articles were selected can restrict the amount of forefoot let dancers spend a large proportion of for inclusion in this study, ten on ballet plantar flexion required during the their training and performance with and the remainder covering a variety of propulsive toe-off phase of gait and their feet in maximal plantar flexion of other genres. The contribution of dance cause excessive rear foot motion inside the ankle and foot. The ability of the shoes to the quality of dance movement the shoe. Similarly, footwear has the ballet shoe to protect the pointed foot, is a relatively unexplored subject; little potential to enhance or restrict dance including the shoe’s effect on impact experimental research has been done. movement and impact the dancer’s forces during jumps and pointe work, Prospective scientific evidence is needed body in various ways. needs to be understood. to support or disprove traditional beliefs regarding the effects of footwear on dance The dance style being practiced and As the requirements of dance styles performance and dancers’ health. its technical requirements dictate what cannot be modified too greatly, foot- types of movement are of particular wear should be designed to minimize ancers are on their feet most importance, and the footwear used may impact forces and injury risk to danc- of the time, and healthy, require special capabilities beyond those ers and to assist them in achieving pain-free feet are imperative associated with the genre’s aesthetics. maximal performance. Therefore, Dfor dancers regardless of age or level of Vibration and impact forces from the the aim of this systematic review was to evaluate the current state of ex- Alycia Fong Yan, B.App.Sc., Exercise, Health and Performance Research Group, perimental evidence for the effects of Faculty of Health Science, University of Sydney, Lidcombe, Australia. Claire dance footwear on dancers, in particu- Hiller, Ph.D., is a Post-doctoral Fellow with the Faculty of Health Science, lar the effect on foot motion and risk University of Sydney, Lidcombe, Australia. Richard Smith, Ph.D., is a Professor of injury during dance movements. of Biomechanics, Exercise, Health and Performance, Faculty of Health Science, University of Sidney, Lidcombe, Australia. Benedicte Vanwanseele, Ph.D., is at the Methods University of Sidney, Australia, and Health Innovations and Technology, Fontys Search Strategy University of Applied Sciences, Eindhoven, The Netherlands. Database searches were carried out Correspondence: Alycia Fong Yan, B.App.Sci., Exercise, Health and Performance, through May 2009 using MedLine, Faculty of Health Science, University of Sydney, PO Box 170, Lidcombe NSW SPORTDiscus, CINAHL, PubMed, 1825, Australia; [email protected]. PEDro, Scopus and Embase. Key- 86 Journal of Dance Medicine & Science • Volume 15, Number 2, 2011 87 aim, objectives, or hypothesis clearly stated; a clear description of the sub- jects, with inclusion or exclusion crite- ria stated; main outcomes of the study adequately described; main findings of the study well defined; variability figures given; methodology validated and reliable, or at least an attempt to validate the methodology with refer- ence to previous work or a pilot study; actual probability (p) values given, unless p < 0.001; correct statistical tests chosen, and a power analysis performed. Criteria were based on those described by Downs and Black.9 Data Analysis Cohort descriptors, study design, outcome measures, results and conclu- sions were extracted from the articles by two investigators and compared to ensure there were no errors or dis- agreements. Articles were categorized by dance style for analysis. Results Ultimately, a total of just 16 articles (out of 242 searched) were found to be acceptable for review. The number of articles examining the different dance styles were: 12 ballet; 2 flamenco; 1 Figure1 Literature search methodology. Irish; and 1 modern or contemporary. Six of the studies were retrospective, words used in the search were: dance, contemporary, flamenco, or Irish), and using questionnaires to obtain infor- dancer, dancers, dancing, dances, examined the role of footwear or shoes. mation on footwear use and injury ballet, shoe, shoes, and footwear. All Articles were excluded from selection histories of dancers.10-15 The relation- searches were limited to full articles in if they indicated disease, pre-existing ship between dance footwear and the English language. or congenital deformity, or examined injury was directly addressed in four Articles were eliminated using set subjects aged 50 years or older. These articles.12-14,16 Most of these acknowl- inclusion and exclusion criteria based population characteristics describe a edged that pointe shoes lead to painful on title, then abstract, then full text minority of people who participate feet13,14,17,18 and nail trauma.14,16 Only (see Fig. 1). The reference lists of the in theatrical dance styles. Aerobic one study investigated the effect of included articles were then searched dancing and dancing for fitness were different types of footwear on ankle to ensure that relevant literature was excluded because their movement style injury rate, and found that there was not missed. The Journal of Dance and technique are not closely related to a decreased risk with the use of jazz Medicine and Science, Dance Medicine theatrical dance. All abstracts, clinical sneakers in Irish dancers.12 Eleven and Science Bibliography (4th edition), commentaries, reviews or letters were articles concluded that footwear might and The Dancer as Athlete: The 1984 excluded. Two investigators indepen- be a contributing factor in lower limb, Olympic Congress Proceedings were dently reviewed all articles identified foot, or ankle injuries.10-12,14,15,17-22 hand searched for any relevant ar- by the search criteria, and any disagree- None examined the effects of dance ticles. Any articles that could not be ments were resolved by consensus or footwear on foot motion. retrieved were eliminated from review. by a third party. Quality Assessment Inclusion and Exclusion Criteria Quality Assessment The overall quality of the papers was Articles were included if they were Two investigators performed a simple quite poor. All of the studies but one14 experimental, referred to theatrical quality assessment of the included clearly described their aim and objec- dance styles (ballet, jazz, tap, modern, studies using the following criteria: tives or hypotheses, but only 10 stud- 88 Volume 15, Number 2, 2011 • Journal of Dance Medicine & Science ies were able to sufficiently describe in proportion to the cross-sectional design fixed the shank against the sole their participants by stating the inclu- areas of the muscles.21 The forces at of the foot during rise to the pointe sion or exclusion criteria.7,11-13,15,20-24 the extremes of ankle joint range of position, and the memory foam lining Methodology of the studies was motion were found to be comparable accommodated the individual dancer’s reasonably described, but only four to the bone–on–bone forces occurring toe lengths and alignment in the toe reported on the validity or reliability during running25—i.e., up to 13 times box. of the measurement tools used.7,13,21,25 body weight.27 Only two studies examined the The main findings were adequately A study of the mechanical proper- effects of the pointe shoe on joint identified in most studies, but only ties of pointe shoes demonstrated that stability and injury.13,16 Bentley- half reported standard deviation, axial strength was greater than vertical Phillips and associates found that a standard error, or confidence inter- strength across all shoes tested. Over- group of ballerinas (n = 150) did not vals,7,11,13,15,17,20,23,24,26 or provided exact all, there was variability between the present with any cases of koilonychia, p values in their results.7,12,13,15,19,20,26 brands tested for stiffness, strength, a unique form of toenail deformation No power analysis was performed in and durability. One type of pointe where the toenail becomes concave any of the quantitative studies. shoe stood out among the five mod- due to trauma.16 However, the balle- els tested; the shoe manufactured by rinas did have a number of other types Ballet Shoes Gaynor Minden withstood ten times of foot and nail trauma.
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