Stability of Lisfranc joint in ballet pointe position

Kadel, Nancy; Boenisch, Mark; Tietz, Carol; Trepman, Elly

Affiliations

¹Associate Professor, Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA

²Department of Radiology, New England Baptist Hospital, Boston, MA

³Professor, Department of Surgery, University of Washington, Seattle, WA

⁴Associate Professor, Department of Surgery, Professional Associate, Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada

Abstract and keywords

Background: Ballerinas develop stress fractures at the second metatarsal base associated with dancing en pointe. The purpose of this study was to evaluate the relative importance of the pointe shoe and the tarsometatarsal ligaments in Lisfranc joint stability en pointe.

Methods: Eleven cadaver feet were dressed with pointe shoes, loaded in foot flat with ligaments intact, and loaded en pointe before and after sequential sectioning of the dorsal, interosseous, and plantar ligaments between the first and second metatarsals and cuneiforms. Relative motion between the first and second metatarsals and cuneiforms was determined radiographically.

Results: No significant displacement of the Lisfranc joints occurred when the shod foot with intact ligaments was loaded in the foot flat or en pointe positions. Serial sectioning of the ligaments from dorsal to plantar in the shod foot en pointe demonstrated no change in alignment after the dorsal and interosseous ligaments were cut, but a significant change in alignment between the second metatarsal and second cuneiform was noted after the plantar ligament was cut (p < 0.0001). Removal of the pointe shoe after cutting the ligaments and applying a minimal (1 to 2 kg) load resulted in complete subluxation and diastasis through the first-second intermetatarsal and intercuneiform region. Replacing the shoe improved alignment en pointe with similar loading.

Conclusions: Both the pointe shoe and Lisfranc ligaments are important for Lisfranc region stability in feet en pointe. The plantar ligaments are major stabilizers of the Lisfranc region in the loaded, shod foot en pointe. Selection of a pointe shoe with adequate support may limit susceptibility to stress fracture of the second metatarsal base in ballerinas.

Keywords: Dance; Foot; Instability; Tarsometatarsal

Links

DOI: 10.1177/107110070502600510

PubMed: 15913525

WoS: 000229009200010

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Cited By (12)

Year	Entry
2015	Salzar RS, Lievers WB, Bailey AM, Crandall JR. Leg, foot, and ankle injury biomechanics. In: Yoganandan N, Nahum AM, Melvin JW, eds. Accidental Injury: Biomechanics and Prevention. 3rd ed. New York: Springer; 2015:499-547.
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