Alignment of the metatarsal heads affects foot inversion/eversion during tiptoe standing on one leg in demi–pointe position: A cross–sectional study on recreational dancers

Classical ballet dancers stand on tiptoe in the demi-pointe position where the ankle is plantarflexed, and the toes extend around a mediolateral axis passing through the second metatarsal head. Foot sickling, the foot inversion/eversion when the forefoot is grounded, should be avoided to achieve esthetics and prevent injuries during tiptoe standing. The foot inversion/eversion angle may change depending on the metatarsal heads through which the toe extension axis passes. This study investigated the relationship between metatarsal alignment in both load positions and foot inversion/eversion angle during tiptoe standing. Nine recreational female ballet dancers performed tiptoe standing on a single leg in the demi-pointe position. The foot inversion/eversion angle, the centre of pressure (COP) positions, and angles between adjacent metatarsal heads in the horizontal plane were investigated using motion-capture data and magnetic resonance imaging of the forefoot. As the angle between the second and adjacent metatarsal heads became more acute during tiptoe standing on the non-dominant leg, the dancers everted the foot more and significantly loaded the first toe-side more, and vice versa (r = -0.85 and -0.82, respectively). Then, the load positions were distributed on the distal side of the second metatarsal head. These were not seen during standing on the dominant leg with COPs more proximal to the second metatarsal head. In conclusion, dancers load the distal part of the second metatarsal head during tiptoe standing on the non-dominant leg. When the angle at the second metatarsal head was acute, within the triangle formed by the first, second, and third metatarsal heads, even slight mediolateral shifts of load positions altered the toe extension axis around that metatarsal head; the dancers loaded medial to the second metatarsal head and everted the foot and vice versa. Therefore, the angle between the second and adjacent metatarsal heads influenced the foot inversion/eversion angle.