About the author

Kablukov Denis Aleksandrovich - neurologist, chiropractor, sports doctor.

Graduated from Vladivostok State Medical University with a degree in Pediatrics in 2012, internship in Neurology in 2013, residency in Manual Medicine in 2015, postgraduate study in Clinical Medicine in 2019, in parallel with postgraduate studies underwent several professional retrainings in the specialties “Sports Medicine” and “Health Care Organization”.

After graduating from university, I had experience working with athletes, including children. From 2016 to 2020, he worked at the Primorsky branch of the Mariinsky Theater as chief physician and physician providing medical and biological support to the ballet troupe. There I had the opportunity to observe and study changes caused by special physical training in the foot of a ballet dancer.

In 2019, he wrote and published the book “Health in Ballet,” where he described the need for adaptive physical activity to minimize the negative impact of special physical training on the child’s body.

Preface

After the release of the first book I wrote, “Health in Ballet,” I received a great response, and it became clear that such a book had been awaited for a long time. Many people wrote reviews, which were overwhelmingly positive. I received words of gratitude for not writing a panacea for all ballet problems, but writing about maintaining health in the profession. There is little talk about this. In general, it is generally accepted that physical activity is beneficial. And not everyone writes about the principles of movement of the human body and the biomechanics of the movement of its joints and, most importantly, what happens if these principles are violated. Therefore, in “Health in Ballet,” I focused on selecting physical exercises aimed at minimizing the negative impact of special physical training and improving general physical qualities, which play a key role in maintaining health.

This book is aimed at highlighting the problem of ballet foot development. This topic is on the lips of many. I think everyone has seen those terrible pictures of a ballerina’s deformed feet, and this creates a certain opinion that ballet is to blame for this. Of course, the movement of the center of mass, especially at an early age, leaves its mark on the fragile transverse arch. Foot ballerinas have much greater mobility than the average person's foot, and everyone understands that this is the result of daily training. That is, the result of labor is the acquisition of a certain adaptation, and we see greater mobility. So, maybe those terrible deformations of the ballerina’s foot, observed in pictures on the Internet, are simply a failure of this adaptation or an incorrectly selected load during the critical periods of the formation of the child’s foot?

Or the use of incorrectly selected ballet shoes at the stage of arch formation, which will provoke these changes. The foot, like everything else in our body, is changeable. The function defines the structure, not the other way around. Our body, just like our brain, is plastic. The structure will adapt to thousands of repeated movements. And here it is important to pay attention to the little things. “Picking” children’s feet. Identify certain functional features of the development of the foot and pay attention to them in a timely manner so that they do not continueinfluenced the formation of the child’s motor stereotype and did not lead to a violation of the principles of movement of the normal human body. Which, in turn, being consolidated by thousands of repetitions, would not affect the structure!

Few people think about this. Nowadays there is a fairly widespread opinion that children should be brought into a sports section or choreography as early as possible. And there's nothing wrong with that. Please. But when giving a child, you need to clearly distinguish between specialphysical training (GPP) and general physical training (GPP). More and more children's competitions and contests are being held in order to get customers (children, parents). I have even seen general physical training competitions for children 4-5 years old. Children run at speed, abruptly changing the direction of movement like a shuttle run, perform endless body lifts with fixed lower limbs, showing prepared “abdominal” muscles, and so on.

This can be repeated for a very long time. But what do children learn? During the period when they must learn to technically correctly change the direction of their movement, stabilizing the knee joint, or control the position of their lumbar region, children simply perform these movements quickly. And they like to be champions since childhood. General physical fitness champions at 5 years old. Where are these children then? Then they, with operated knees and sore lower backs, stand in the fifth row of swans. Because injuries do not allow me to continue at the proper level. And this is a fairly common problem.Ambitious parents urging the coach/choreographer: “Why does Masha do it, but mine doesn’t? Drive her harder!” Or ambitious coaches/choreographers trying to assess a child’s potential in so many competitions where the children who lift their legs higher win. Sometimes without thinking or without knowing that a child is not a smaller copy of an adult. The nervous system in children is designed in such a way that to perform one simple movement, a huge number of nerve cells will be activated, activating all possible surrounding muscles. This is how we are made. The brain learns, and thousands of repetitions form a pattern for a given movement. And How result of learning, it will take much less brain energy to perform the same movement. And the whole problem of early specialization is that children learn to perform elementary movements with completely different muscle groups than they should. And those children who, for example, hold their leg higher, hold it not with the gluteal muscles, but with the muscles that straighten the spine, strengthening this with thousands of repetitions. Forming the structure of a plastic child's body.

The same thing happens with the foot. If we skip proper preparation and start performing elements to shift the center of mass, then at first we will not see any changes. It will look quite fun - the kids follow each other on their toes, like ducklings following a choreographer. We will see changes during critical periods of foot growth. At 7-9 years old, for example. Everything was fine, and then at one point the orthopedist talks about flat-valgus placement of the foot. And the child begins to walk even more on half toes or, as is very common, pick up pencils with his foot or train his foot with a rubber band. But for some reason, everything in the foot gets worse over time. Each time, the orthopedist insists more and more on ending a sports/ballet career that has not yet begun. Sound familiar?

With this book I want to shed light on basic things. As you already understand, our body is plastic. It will adapt to changing conditions, and the task of the choreographer, coach, parent is to create such conditions so that the foot develops correctly. Not only in ballet and other sports, but in all children. This is the most difficult thing.

Happy reading!

Introduction

Every child who dreams of becoming an artist, every parent who presents their child on the big stage, wonders how to achieve beautiful ballet feet and at the same time maintain their health.

Issues of maintaining health are increasingly brought to the fore in the process of a child’s sports training. In some countries this is noticeable, in others not so much, but this is the trend, and more and more accessible literature is appearing on how not to harm. This is good news. Coaches are beginning to pay attention to the need for staged sports specialization, to the formation of a healthy musculoskeletal system of the child, starting from early childhood.

There is a clear understanding in the world that the formation of a healthy child occurs under the influence of many factors, including optimal physical activity. There’s no way without her. A child's brain develops and learns from experience. Through the first touches, through the first movements, he forms his body map. And the more attention we pay to the impact of external stimuli on a child, the more complete the picture his brain receives. Of course, everything is within reasonable limits. But this is a necessity for a child. If we do not stroke a child and limit certain movements, then on what basis does his brain recognize the world around him and adapt to it?

But where is the line of permissible impact? In what periods should you give increased load, and in what periods should you wait a short pause or roll back a little? The answers to these questions simply need to be known to the coach, the parent, and everyone who is even slightly involved in the physical development of children.

There are critical periods in the formation of the musculoskeletal system. They are directly related to growth spurts and puberty of the child, and during these periods you should be especially careful in selecting special physical exercises. As I mentioned earlier, our body is formed as a result of certain influences, adapting to them. And As a result of adaptation, we see optimally formed arches of the feet. For a more complete understanding, I will present a variant of foot adaptation in the form of a graph, where the x-axis will be time, and the y-axis will be the stress level. The critical level of stress is shown by a horizontal line, distinguishing the permissible level of impact (stress) on the child’s brain and the level of impact that will be perceived as extreme, that is, causing an extreme impact on the child’s nervous system and musculoskeletal system (Fig. 1).









Figure 1 - Adaptation to stimulus

Let's say the child is two and a half years old. The main task of his brain is to form a map of the body. The child irritates his foot in different ways, walks on different surfaces, adapting to it. The skin and tendon-ligamentous apparatus transmit all kinds of impulses to the brain about the child’s changing body weight, about changing points of support. Everything that happens to the foot leaves its mark, causing certain adaptations. Body weight increases gradually, thereby keeping the stress on the brain within an acceptable range. And in children at this age, the arched structure of the foot begins to form. This is adaptation of the foot to increasing body weight in order to soften the axial load on the musculoskeletal system. That is, the arch of the foot will not appear when using orthopedic shoes, but only under changing conditions, so that the child’s brain understands that he needs to form those same arches of the foot. Sometimes we see the appearance of an arched structure a little earlier, and sometimes a little later, and therefore no one makes a diagnosis. Until the formation of the foot is complete, we can only talk about functional changes that can be corrected by selecting the optimal load. If we decide to use additional instep supports (orthopedic insoles) to form arches, then the first question to ask is what exactly are we teaching the child’s brain in this way? Obviously, do not maintain your arch by activating your own forces. And this intervention, in the form of orthopedic products, on the child’s healthy feet can be perceived as the absence of this stress for the brain. That is, it does not cause any adaptations at all. And sometimes wearing orthopedic shoes only aggravates existing functional changes in the feet. Here it is very important to monitor and imagine (Fig. 1) the curve of adaptation to the stimulus over time, selecting different stimuli in such a way that during critical periods they do not become prohibitive.

This question is the most important in the formation of the entire musculoskeletal system. After all, it changes with age; in some periods we will see strong changes, in others less pronounced. It is the selection of those very irritants, those very stimuli that is necessary to obtain the result of what we call a ballet foot.

A ballerina's foot differs from the normal foot of an average person, and the norm in society is what is observed in the majority of its representatives (Gauss-Laplace curve). The ballet foot itself is the result of adaptation to a certain load. And naturally, a child is not born with such anatomy of the foot, with such mobility of the foot, but acquires it in the process of regular training (Fig. 2).










Figure 2 - The foot of an ordinary person and the foot of a ballerina

And here it is important to stop and think. How to induce this adaptation without harming upstream regions of the body. After all, in addition to getting those same ballet changes in the foot, I would like to eventually get a healthy lower limb. So this is where knowledge of anatomy, physiology, and age-related features of the formation of the foot will help us, so that we can act in a targeted, targeted manner and select the load and physical exercises, maintaining the health of the feet.

Below we will analyze in order the structure of a normal human foot; We’ll find out how a child’s arches are formed and during what periods we should be especially wary; what movements are possible in the foot and which ones should be paid more attention to; Let's analyze the conditions and diseases of the foot so that we can see these red flags when it's time to run to the doctor; and, of course, what to do so that the foot develops healthy, beautiful and does not bring unnecessary worries.

CHAPTER 1. Anatomy and physiology of the foot

Knowledge of elementary anatomy is vital for every artist, every athlete, because the musculoskeletal system (not only it, but significantly) is the most important tool, and, of course, you need to know its structure.

This may seem complicated and unnecessary, but it is not. First of all, in order not to perform any exercises that negatively affect the formation of the musculoskeletal system, you need to know how and why they negatively affect it. And here we need knowledge of normal anatomy, normal biomechanics of movement. After reading one chapter after another, you will have a complete understanding of the changes taking place in the ballerina’s foot. And then an understanding of the shown load.

The human foot is a rather complex apparatus that, together with the ankle joint and shin bones, allows it to perform several important functions. One of them is movement, where the foot works as a moving mechanism. The other is the support, where the foot plays the role of a stable region to support the body in an upright position.

Human anatomy is represented by rigid structural formations (bones), interconnected by ligaments - structures that have almost no elastic properties, and this entire apparatus is supported and driven by concentric, isometric and eccentric muscle contraction, which is the result of the work of the brain. The brain, based on the information received from a certain region, will decide which movements to perform and how to perform them. Therefore, I will also describe a little the structure of the nervous system, which I consider more important than the musculoskeletal system, since bones, ligaments, muscles are all unimportant without optimal control from the central nervous system.

Next, for a more complete understanding, we will separately analyze the anatomical structure of the ankle joint and foot joints and talk a little about the physiology of muscle contraction and the transmission of nerve impulses. As soon as you understand how everything is arranged and how everything works, many questions about the selection of physical exercises will simply disappear by themselves.

How does a muscle work?

Many people have the understanding that a muscle stretches and contracts, but this is completely wrong. The muscle does nothing by itself. Whatever command she receives, we will see the movement in her execution. If you shock it, increasing its action potential, it will contract in response. Roughly the same thing happens when a nerve impulse enters a muscle.

In the end, what do we know about the muscle? Each muscle is a separate organ, which is supplied with everything it needs through blood vessels and is controlled by the nervous system. A muscle consists of many fibers collected in bundles. There are several types of muscle tissue in the human body. Some of them will perform voluntary movements, such as the muscles of the musculoskeletal system, which are controlled consciously in most cases. Others will work without conscious control, for example, the muscles of internal organs, which work constantly, and their function cannot be influenced only by wanting it.

Muscle contraction is caused by the structure of the muscle cell - myofibril. Each muscle cell has structural elements with the help of which it performs its function, in this case contractile. The structural elements of myofibrils are two types of contractile proteins - actin and myosin. And cross bridges are formed between actin filaments and myosin filaments. So, the result of sliding of actin filaments relative to myosin filaments due to contact with these bridges, in the form of rowing movements, will be the contraction of the muscle fiber. The largest number of actin-myosin contacts are formed when the muscle is slightly stretched to a certain optimal length. Therefore, before intense physical activity, you need to stretch a little. But when the muscle is significantly stretched, the actin filaments diverge far from the myosin filaments and cross bridges cannot form. You should always remember these features of the interaction of contractile proteins. The greatest muscle strength will be achieved after slight stretching (Fig. 3).











Figure 3 — Interaction of actin and myosin filaments

There are several types of muscle work that you need to know.

1. Concentric work of a muscle is when, as a result of muscle work, we see a reduction in the distance between the places of its attachment, that is, the force of the muscle action potential is greater than the reaction force. We will see this work by performing an active movement, contracting a specific muscle fiber. For example, we bend the upper limb at the elbow joint - here the muscles of the anterior surface of the shoulder work concentrically.

2. Isometric work of a muscle is when, as a result of muscular work, we will see the maintenance of a constant distance between the places of its attachment, that is, the force of the muscle action potential is equal to the reaction force. This work is clearly visible when we need to hold something: there is muscle work, but we do not observe visible movements.

3. Eccentric muscle work is when, as a result of muscle work, we will see an increase in the distance between the places of its attachment, that is, the force of the muscle action potential is less than the reaction force. We will observe this work when we do squats. The muscles on the front of the thigh, holding the body weight, allow the knee to slowly bend under the influence of gravity.

In fact, we will see every type of muscle work in any movement. For example, you want to take a glass of water from the table. When you reach for a glass, your brain controls every muscle group. When you take the glass, it commands the muscles of the front of the shoulder to work concentrically, bringing the glass closer to the head. At the same time, he instructs the muscles of the back of the shoulder to control the smoothness of movement, that is, to work eccentrically. And then the back muscles will work isometrically, controlling the position of the body so that we do not fall with our whole body behind the glass. We don’t notice all this; our brain protects us from this unnecessary work. But knowing this is extremely necessary for selecting exercises, training certain deficiencies. For example, it is important to train the eccentric work of the muscles of the back of the lower leg, because these are all landings. Or isometric work of the tibialis anterior muscle to maintain the optimal arch of the foot, but let’s not get ahead of ourselves.

Of course, the structure and work of the muscle are much more complex and interesting than presented here. More detailed information can be obtained from textbooks on normal human physiology.

How does the nervous system work?

We perceive all influences exerted on our body through receptors. Receptors are unique sensors, located mostly on the periphery in the organs of perception (eyes, tongue, nose, skin, muscles, etc.). Each stimulus will have its own type of receptor. Receptors are very selective! One type of receptor will perceive a certain type of stimulus (sound, light, touch). For example, a person’s auditory organ of perception is adapted to the effects of sound, where, depending on the vibration of sound waves, a hammer knocks on an anvil. If we take the inner ear (vestibular apparatus), then there are cones (semicircular canals and otolith bodies) with fluid (similar to a building level), and depending on the angle of inclination of these cones, the fluid flows from one section of the bulb to another, thereby transmitting information about the position of the head in space. The same receptors are present in the skin, only there are many more of them in the skin, since the area of ​​the skin is very large. Skin receptors will perceive information about touch, temperature, movement of hair follicles, etc.
"Ballerina's foot" excerpt from a book