High arch of the foot as a potential risk factor for plantar fasciitis in ballet dancers in the context of a narrative review and clinical perspective
Keywords:
Foot biomechanics, Ballet dancers, Plantar fasciitis, Overload injuryAbstract
Plantar fasciitis is one of the most common causes of heel and plantar pain and is considered a clinical entity with multifactorial etiology. Current knowledge points to the importance of biomechanical predisposing factors, especially the morphology of the foot arch and its influence on the distribution of mechanical load during static and dynamic movement tasks. A high medial longitudinal arch of the foot (pes cavus) is associated with increased foot rigidity, reduced adaptive cushioning capacity, and a shift of plantar load to the heel and forefoot, which can lead to increased mechanical stress on the plantar fascia. Professional ballet dancers represent a specific population with extreme functional demands on the foot. Ballet technique, especially work on demi-pointe and en pointe, requires repeated extra-physiological plantar flexion, high demands on the stability of the medial longitudinal arch, and precise control of the foot axis. At the same time, the aesthetic and technical requirements of ballet promote the development of a pronounced arch of the foot, which can lead to structural and functional adaptations of the pes cavus type. The aim of this article is to synthesize the available biomechanical and clinical knowledge on the relationship between foot arch type and plantar fasciitis through a narrative review of the literature and to interpret it in the context of the specific requirements of professional ballet. A high arch reduces the contact area of the midfoot, limits adaptive dorsiflexion, and increases local mechanical stress on the plantar fascia. Data specifically focused on professional ballet dancers are limited in the available literature. This article therefore presents a hypothesis-generating framework and emphasizes the need for targeted prospective studies in the field of dance medicine and physiotherapy.
