JOURNAL OF SPORTS SCIENCES, 2016

VOL. 34, NO. 17, 1612–1618

http://dx.doi.org/10.1080/02640414.2015.1126672

Kinematic and kinetic analyses of the toes in dance movements

Danielle N. Jarvisa and Kornelia Kuligb
a
Department of Kinesiology, California State University Northridge, Northridge, CA, USA; bDivision of Biokinesiology and Physical Therapy,
University of Southern California, Los Angeles, CA, USA

ABSTRACT ARTICLE HISTORY

Due to the significant amount of time dancers spend on the forefoot, loads on the metatarsophalangeal Accepted 26 November
joints are likely high, yet vary between dance movements. The purpose of this study was to compare 2015
joint motion and net joint moments at the metatarsophalangeal joints during three different dance KEYWORDS
movements ranging in demands at the foot and ankle joints. Ten healthy, female dancers Dance; metatarsophalangeal
(27.6 ± 3.2 years; 56.3 ± 6.9 kg; 1.6 ± 0.1 m) with an average 21.7 ± 4.9 years of dance training joint; jumping
performed relevés (rising up onto the toes), sautés (vertical bipedal jumps), and saut de chat leaps (split
jumps involving both vertical and horizontal components). Metatarsophalangeal joint kinematics and
kinetics in the sagittal plane were calculated. Total excursion and peak net joint moments during rising
or push-off were compared between the three dance movements. Greater extension of the metatarso-
phalangeal joints was seen during relevés compared to sautés or saut de chat leaps, and the largest
metatarsophalangeal net joint moments were seen during saut de chat leaps. The metatarsophalangeal
joints frequently and repetitively manage external loads and substantial metatarsophalangeal extension
during these three dance movements, which may contribute to the high rate of foot and ankle injuries
in dancers.

Introduction
All forms of dance are highly demanding activities, with a lifetime
injury incidence of up to 95% (Hincapié, Morton, & Cassidy, 2008;
Werber, 2011). University dance majors who were monitored
over an 8-month period during the academic year experienced
a 97% injury rate, with 92 injuries experienced by the 39 partici-
pants during the time frame of the study (Kerr, Krasnow, &
Mainwaring, 1992). The majority of injuries experienced by
both university and professional dancers are chronic in nature,
typically attributed to overtraining or overuse (Kadel, 2006).
Professional dancers may practise or perform for up to 6 h
each day, 6–7 days per week, with very little time allowed for rest
(Allen, Nevill, Brooks, Koutedakis, & Wyon, 2012; Clarkson,
Freedson, Skrinar, Keller, & Carney, 1989; Kadel, Teitz, &
Kronmal, 1992; Shah, Weiss, & Burchette, 2012). In addition,
movements in dance are repeated with a great deal of frequency,
as the same sequences of movements are typically performed in
daily classes, and movement combinations in rehearsal and
performance are repeated over and over throughout the process
of learning and refining a piece of choreography.
Several positions and movements in dance require extreme
dorsiflexion and plantar flexion of the midfoot and ankle joints
and extension of the toes, and high repetition of such move-
ments may contribute to foot and posterior ankle pain in
dancers. The demi-pointe position (Figure 1) highlights the
range of motion requirements of the foot and ankle joints;
this position involves raising the heels off the ground while
the legs remain straight, requiring approximately 90° of ankle
plantar flexion (Russell, McEwan, Koutedakis, & Wyon, 2008)
and 90° of extension at the metatarsophalangeal (MTP) joints.
The long hours and repetitive nature of dance participation
likely results in the reported high number of overuse injuries
seen in dancers, with the foot and ankle reported as the most
common site of injury (Allen et al., 2012; Kadel, 2006;
Liederbach, Dilgen, & Rose, 2008; Shah et al., 2012).
Several studies have reported on the location of dance
injuries, with 40–60% of injuries in dancers reportedly occur-
ring at the foot and ankle region (Liederbach et al., 2008; Shah
et al., 2012). In modern dancers, injuries to the great toe or
lesser toes comprised 11% of self-reported injuries, but speci-
fic injuries to the toes were not reported (Shah et al., 2012).
Several different injuries may affect the toes, such as metatar-
sophalangeal joint sprains, hallux valgus and associated
bunions, hallux rigidus, or injuries to tendons crossing the
metatarsophalangeal joints (Conti & Wong, 2001). Tendon
injuries are of particular concern in dance, as posterior ankle
pain of tendon origin is common in dancers (Hamilton, 2008).
The flexor hallucis longus crosses both the ankle and the first
metatarsophalangeal joint and flexor hallucis longus tendino-
pathy is a common problem among dancers (Hamilton, 2008;
Hodgkins, Kennedy, & O’Loughlin, 2008; Kadel, 2006).
Repetitive use of a large range of motion or high peak net
joint moments at the metatarsophalangeal joints may contri-
bute to the high incidence of foot and ankle injuries seen in

CONTACT Danielle N. Jarvis danielle.jarvis@csun.edu Department of Kinesiology, California State University Northridge, 18111 Nordhoff St. CA 91330,
Northridge.
© 2015 Taylor & Francis
 JOURNAL OF SPORTS SCIENCES 1613

Figure 1. The demi-pointe position of the foot and ankle during relevé.
dancers (Kadel, 2006; Liederbach et al., 2008). However, to
study metatarsophalangeal joint kinetics a two-segment foot
model is required. The traditional single segment foot model is
broken into two segments in order to address more specific
motion and kinetic contributions of the metatarsophalangeal
joints (Goldmann, Sanno, Willwacher, Heinrich, & Bruggemann,
2013; Stefanyshyn & Nigg, 1997). Detailed characterisation of
metatarsophalangeal joint function during typical dance
movements is necessary in order to determine the potential
contributions of demands at these joints to foot and ankle
injuries in dancers. Biomechanics allows for an exploration of
the demands that movements place on joints, which may be
related to the development of overuse injuries in athletes.
Therefore, the purpose of this study was to compare joint
motion and net joint moments at the metatarsophalangeal
joints during three common dance movements ranging in
demands at the foot and ankle joints.
Instrumentation
An 11-camera three-dimensional motion analysis system
(Qualisys, Gothenburg, Sweden) was used to collect kinematic
data at 250 Hz, and ground reaction force data were collected at
1500 Hz (AMTI, Inc., Watertown, Massachusetts). Retroreflective
markers were used to define body segments and local coordi-
nate systems and to track three-dimensional segment motion.
Rectangular quartets of rigid tracking markers were securely
placed on the participant’s lateral thighs and lower legs.
Additional tracking markers were placed on each anterior super-
ior iliac spine, superior iliac crest, and acromioclavicular joint, as
well as on the jugular notch of the sternum and the C7 and L5
spinous processes. For the purposes of examining the demands
on the metatarsophalangeal joints in dance, the foot was
defined as two segments – the first including the five phalanges,
and the second as a traditional foot segment, spanning from the
calcaneus through the metatarsal heads (Goldmann et al., 2013;
Stefanyshyn & Nigg, 1998; Willwacher, König, Potthast, &
Brüggemann, 2012). Therefore, in addition to the traditional
lower-extremity marker set, markers were placed on the 1st
and 5th metatarsal heads and the distal hallux to track the
toes segment, and a rigid triad of tracking markers was placed
on the dorsum of the foot to track the foot segment (Hashish,
Samarawickrame, & Salem, 2014) (Figure 2). While the partici-
pant was on a force plate, a standing calibration trial was used to
derive the local coordinate systems and segment endpoints.

Methods
Participants
Ten healthy female dancers between the ages of 18 and 35
were recruited for this study. To participate, dancers needed
to be professional level dancers with more than 10 years of
formal dance training and a strong background in ballet and
contemporary dance. Dancers also must have been employed
as dancers or teachers within the past year and training at a
high level at the time of data collection. Participants were
excluded from the study if they were suffering from any
current injury that would impair their ability to jump. Ethical
approval for the study was received from the Institutional
Review Board of the University of Southern California, and all Figure 2. Retroreflective foot markers for inclusion of the metatarsophalangeal
participants provided written informed consent. joints in analyses.
1614 D. N. JARVIS AND K. KULIG
Procedures
Participants performed three different dance movements.
First, ten consecutive relevés (rising onto the toes) were per-
formed at a rate of 45 bpm with the dancer in ballet 1st
position with the preferred takeoff leg on a force plate; the
arms were held over the head in ballet 5th position (Figure 3).
Participants then performed ten consecutive sautés (bipedal
vertical dance jumps) at a rate of 95 bpm in ballet 2nd posi-
tion with each foot on a different force plate and the arms
held in ballet 5th position (Figure 3). Third, participants per-
formed saut de chat leaps (Figure 3) to music with a tempo of
106 bpm. These leaps involve taking off from one leg (take-off
limb) from one force plate, moving the legs into a split posi-
tion in the air, and then landing on the opposite leg (leading
limb) on a second force plate. Each trial involved a chasse step,
or four step approach, followed by two consecutive saut de
chat leaps with the arms extended above the head in a “V”
position while the participant was in the air (Figure 3); only
takeoff for the first leap of the series was used for analysis, and
five saut de chat trials were collected for each participant. All
movements were performed at a rate controlled by music to
replicate conditions in a typical dance class. Practice trials
were performed until participants were comfortable with the
procedures and wearing the markers. Trials were deemed
acceptable if the participants achieved proper body position-
ing for each movement (Figure 3) and foot placement on the
force plates.
Data analysis
Markers were manually identified using Qualisys software, and
then kinematic and kinetic data were imported into Visual3D
(C-Motion, Inc., Germantown, Maryland). Marker and ground
reaction force data were low-pass filtered using a bidirectional
fourth-order Butterworth filter with cutoff frequencies at 12 Hz
and 50 Hz, respectively. The joint kinematics of the model
were calculated by determining the transformation from
each segment’s reflective tracking markers to the position
and orientation of each segment determined from the stand-
ing calibration trial.
Kinematics, anthropometrics, and ground reaction forces
were used in standard inverse dynamics equations to calculate
sagittal plane net joint moments at the metatarsophalangeal
joints (Winter, 2009). The five phalanges were assumed to act
Figure 3. Body positioning during (a) relevés; (b) sauté jumps; (c) the saut de chat leap, including takeoff, flight, and landing.
as a single segment with a single centre of rotation. The axis of
the metatarsophalangeal joints was defined as a line between
the centre of the 1st and 5th metatarsal heads, using an
oblique axis, as this was determined to be an anatomically
appropriate representation of the joint (Smith, Lake, Lees, &
Worsfold, 2012). The inertial effect of the phalanges was con-
sidered to be negligible, as multisegment foot mass distribu-
tions and inertial tensors play a minimal role in inverse
dynamics compared to the large ground reaction forces
(Bruening, Cooney, & Buczek, 2012a; Smith et al., 2012;
Stefanyshyn & Nigg, 1997). The metatarsophalangeal joint
angle was defined as the angle between the foot and toe
segments in relation to the standing calibration trial to
account for individual differences in foot shape and arch
height (Smith et al., 2012). The metatarsophalangeal net joint
moment was considered to be zero until the ground reaction
force acted distally to the metatarsophalangeal joint line
(Goldmann et al., 2013; Miyazaki & Yamamoto, 1993; Smith
et al., 2012; Stefanyshyn & Nigg, 1997; Willwacher et al., 2012).
Net joint moments were normalised to body mass and
expressed as internal moments.
The relevé movement was divided into a rising phase and a
lowering phase based on the movement of the L5 marker;
metatarsophalangeal joint kinematics and kinetics were exam-
ined during the rising phase. The sauté movement was
divided into three phases: (1) takeoff (defined from the lowest
point of the L5 marker to the instant when the feet leave the
ground), (2) flight (defined from toe-off until touch-down), and
(3) landing (defined from the instant of touch-down until the
lowest point of the L5 marker). The saut de chat leap was also
divided into three phases: (1) takeoff (defined from initial
contact through toe-off of the takeoff limb), (2) flight (defined
from toe-off of the takeoff limb until initial contact of the
leading limb), and (3) landing (defined from initial contact
through toe-off of the leading limb). The cutoff for toe-off
and touchdown identification was defined as a vertical ground
reaction force of <20 N and >20 N, respectively. The duration
of each relevé, sauté, and saut de chat takeoff was normalised
to 100 intervals in the time domain using linear interpolation.
For both the sauté and saut de chat jumps, the takeoff phase
was chosen for analysis of metatarsophalangeal joint kine-
matics and kinetics. Peak metatarsophalangeal joint extension
and peak metatarsophalangeal net joint moments during the
rising or takeoff phase of each movement were identified. For
each participant, the mean of five trials was used for

comparison; the middle five trials of the relevés and sautés
were used to eliminate any effects of the initiation and termi-
nation of the sequence of movements.
Statistical analysis
Statistical analyses were performed using SPSS statistical soft-
ware (IBM, Chicago, Illinois), with significance levels set a priori
at α ≤ 0.05. Repeated measures ANOVAs were used to com-
pare peak metatarsophalangeal joint extension and peak
metatarsophalangeal flexor net joint moment across the
three tasks. Post hoc testing for significant pairs was per-
formed using paired samples t-tests with Bonferroni correc-
tions for multiple comparisons.
Results
Ten healthy, female dancers (mean age 27.6 ± 3.2 years;
mass 56.3 ± 6.9 kg; height 1.6 ± 0.1 m) with
21.7 ± 4.9 years of training participated in this study.
Kinematic and kinetic patterns for the metatarsophalangeal
joints differed between the three dance movements
(Figure 4). Greater metatarsophalangeal joint extension
occurred during relevés (54.3 ± 4.0°, P < 0.001, effect size
ƞp2 0.93) compared to sautés (32.1 ± 3.6°) or saut de chat
leaps (30.7 ± 3.0°) (Figure 5). The metatarsophalangeal joints
contributed flexor net joint moments during all three
Figure 4. Mean sagittal plane metatarsophalangeal joint angles and net joint moments during (a) relevé: entire relevé shown, with division into rising and lower
phases; (b) sauté: entire sauté, with division into takeoff, flight, and landing phases; (c) saut de chat leap: takeoff phase.
JOURNAL OF SPORTS SCIENCES 1615
movements. The peak metatarsophalangeal net joint
moments during all three movements were significantly
different from each other (0.13 ± 0.02 Nm/kg relevé;
0.22 ± 0.06 Nm/kg sauté; 0.48 ± 0.08 Nm/kg saut de chat;
P < 0.001, effect size ƞp2 0.95) (Figure 5). The largest peak
net joint moments at the metatarsophalangeal joints were
exhibited during saut de chat leaps, and the smallest peak
net joint moments were exhibited during relevés (Figure 5).
Discussion
Many common dance movements place high demands on the
foot and ankle joints, and lower extremity joint injuries are
extremely common in dancers (Kadel, 2006; Liederbach et al.,
2008). The purpose of this study was to compare metatarso-
phalangeal joint motion and peak net joint moments in dif-
ferent dance movements. Greater metatarsophalangeal joint
extension was seen during relevés compared to sautés or saut
de chat leaps, and the largest peak metatarsophalangeal net
joint moments were seen during saut de chat leaps.
A substantial range of motion at the metatarsophalangeal
joints was observed in all three dance-specific tasks. Extension
of the metatarsophalangeal joints is used during sautés and
saut de chat leaps during the push-off phase as the dancer
propels the body into the air, while the main focus of relevés is
controlled maximum ankle plantar flexion and metatarsopha-
langeal joint extension (Grant, 1982). The relevé, which
1616 D. N. JARVIS AND K. KULIG
Figure 5. (a) Peak metatarsophalangeal joint extension during relevés, sautés, and saut de chat leaps; (b) Peak metatarsophalangeal flexor net joint moment during
relevés, sautés, and saut de chat leaps.
*Indicates statistical significance at P < 0.001.
required the greatest metatarsophalangeal joint range of
motion, exhibited an average peak of 54 degrees of metatar-
sophalangeal joint extension. Metatarsophalangeal joint
extension during dynamic dance movements was lower than
the range of motion requirement of 90 degrees reported in
dancers (Wiesler, Hunter, Martin, Curl, & Hoen, 1996). However,
previous studies looking at range of motion in dancers have
measured passive range of motion at rest (Wiesler et al., 1996),
whereas the present study calculated the peak extension dur-
ing a dynamic, dance-specific movement.
While the amount of metatarsophalangeal joint extension
demonstrated in the activities studied was smaller than
reported range of motion requirements for dancers, it is still
greater than the 20–40° of metatarsophalangeal joint exten-
sion that has been reported in functional activities, such as
walking (Kim, Kim, Son, & Jeong, 2012; Leardini, Benedetti,
Catani, Simoncini, & Giannini, 1999; Smith et al., 2012;
Willwacher et al., 2012), running (Oleson, Adler, & Goldsmith,
2005; Stefanyshyn & Nigg, 2000), and vertical jumping
(Stefanyshyn & Nigg, 2000). The substantial range of motion
used in dynamic, weight-bearing activities indicates that dan-
cers are using a high degree of active metatarsophalangeal
joint motion in typical dance movements that may be
repeated a large number of times in a single class or rehearsal.
Other movements where the body’s centre of mass is over
only one foot, such as passé or arabesque, may require even
more metatarsophalangeal joint extension than was seen in
the bipedal movements used for this investigation; these sin-
gle-legged movements require further examination.
Saut de chat leaps are large jumps requiring the dancer to
jump high enough to be able to extend the legs into the split
position, which places larger demands on the metatarsopha-
langeal joints than sautés, which are a smaller jumping move-
ment, or relevés, which do not involve the body leaving the
ground. The net joint moment requirements at the metatarso-
phalangeal joints were most substantial during saut de chat
leaps, with a peak metatarsophalangeal flexor net joint
moment of 0.48 Nm/kg. This exceeded the peak metatarso-
phalangeal net joint moments of 0.1–0.3 Nm/kg reported
during forward leaning (Endo, Ashton-Miller, & Alexander,
2002), walking (Bruening, Cooney, & Buczek, 2012b;
Goldmann et al., 2013; Kim et al., 2012; MacWilliams, Cowley,
& Nicholson, 2003; Miyazaki & Yamamoto, 1993; Willwacher
et al., 2012), running (Goldmann et al., 2013; Oleson et al.,
2005; Willwacher et al., 2012), and vertical jumps (Goldmann
et al., 2013). The peak metatarsophalangeal net joint moments
seen during saut de chat leaps were closer to the peak net
joint moments of about 0.6–0.7 Nm/kg seen during horizontal
jumping (Goldmann et al., 2013). Jumping movements with a
horizontal component may require greater peak net joint
moments at the metatarsophalangeal joints as the centre of
mass moves further forward during the propulsion phase of
the jump, requiring a larger contribution from the toes
(Goldmann et al., 2013). While the metatarsophalangeal peak
net joint moments are small when compared to other lower
extremity joints, such as the peak ankle plantar flexor net joint
moment of 2.5 Nm/kg reported during running (Petersen,
Nielsen, Rasmussen, & Sorensen, 2014), it is crucial to take
metatarsophalangeal net joint moments into consideration.
The metatarsophalangeal joints likely do not have the capacity
for the magnitude of the net joint moments seen at the other
lower extremity joints, as the muscles crossing the metatarso-
phalangeal joints are smaller than the muscles crossing the
ankle, knee, or hip joints (Dozzi & Winter, 1993). The demands
on the metatarsophalangeal joints during dance are higher
than those seen in many other types of activities, and these
demands may be related to lower extremity injuries in
dancers.
The use of a two-segment foot model allows for an exam-
ination of movement and net joint moments at the metatar-
sophalangeal joints, and the two-segment model used for this
study was sensitive enough to identify differences between
three common dance movements: relevé, sauté, and saut de
chat. While inclusion of the metatarsophalangeal joints reveals
energetics that would be overlooked using a single segment
representation, this model is still a simplification as the foot is
clearly multisegmental and three dimensional in nature.
However, the two-segment model addresses the kinematics
and kinetics at the metatarsophalangeal joints, which have
greater capacity for motion than other joints of the foot.
The biomechanical analysis used for this study allows for
the identification of movements or phases of movements
that place higher demands on the metatarsophalangeal
joints and on muscles crossing the metatarsophalangeal
joints, and therefore may potentially be associated with
foot and ankle injuries. Dancers are loading the foot while

using not only a large range of motion at the metatarso-
phalangeal joints but also end ranges at the metatarsopha-
langeal joints, which may potentially contribute to painful
foot or toe conditions. The flexor hallucis longus plays an
important role in many dance movements, as it acts to press
the toes into the ground as the dancers rises to relevé, and
helps in pushing off from the ground in jumps (Hamilton,
2008). Flexor hallucis longus tendinopathy is a common
problem among dancers (Hamilton, 2008; Hodgkins et al.,
2008; Kadel, 2006), and examination of the function of the
toes in dynamic dance movements may be helpful in under-
standing potential contributions to this injury as well as
other injuries involving the toes.
Dancers may benefit from strengthening exercises targeted
at the toes and muscles such as the flexor hallucis longus, in
an effort to prevent foot and ankle injuries (Solomon,
Solomon, & Minton, 1990). Knowledge of which movements
require greater range of motion and net joint moments at the
metatarsophalangeal joints is also helpful for clinicians work-
ing to modify activity for dancers with foot and ankle injuries
to allow for sufficient rest and healing. Dancers may benefit
from relative rest to an injured metatarsophalangeal joint by
avoiding movements that require greater demands at the
metatarsophalangeal joints.
Range of motion requirements at the metatarsophalan-
geal joints are highest during relevés, while peak net joint
moments are highest during saut de chat takeoffs. The
method presented for looking at demands placed on the
toes is the first step in determining the importance of the
foot and toes in dance movements. The use of a two-
segment foot model to study dance movements allows for
an examination of demands at the metatarsophalangeal
joints, which may contribute to the high rate of foot and
ankle injuries in dancers.
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
This work was supported by the Far West Athletic Training Association
[Research Grant].
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