A dancer complains having difficulty getting into pointe position on her left foot.

She presents with a more muscular on the left thigh and weakness/ instability on left pointe position. She had a history of a minor ankle sprain in a year ago. There was no pain.

On examination, we discovered that,

1.	Her ankle structure and mobility are satisfactory; however, the mid-foot supination ability is compromised with locking in the cuboid. With her cuboid being immobile, the form closure of the foot was incomplete during pointe, which means she needs extra support from the muscles to complete the stance.
2.	In triple extension, it is obvious that her ankle part does not reach full planter flexion in high speed, which indicates that the soft tissue length is compromised, limiting her joint motion range.

For the pre and post-treatment, neuromuscular training focused on knee-ankle communication was recommended.

Take-Home Message:

1.	Because it is a “closed kinetic chain”, foot mobility should be evaluated when ankle motion is limited.
2.	Joint coupling and soft tissue length should be restored in order to allow full function of the limbs.
3.	“Form closure” is a key for stability, or else “force closure” will have to contribute excessively, leading to early fatigue and injury.

一位舞者抱怨她的左腳在進入足尖站立姿勢時會遇到困難。

她目前呈現了左大腿肌肉較發達、左足尖站立姿勢無力或不穩定的情況。她在一年前曾有踝關節輕微扭傷的病史，但並沒有感到痛楚。

經過檢查，我們發現，

1.	她的腳踝結構和活動能力達到滿意程度，可是她的足中後旋能力卻受鎖定的骰骨拖累。在進行足尖站立時，由於她的骰骨不能挪動，導致足部的形封閉並未完成，所以她需要肌肉的額外支撐才能完成足尖站立的姿勢。
2.	在「三關節伸展」中，她的腳踝部分明顯沒有高速地達到充分的蹠屈。這代表她的軟組織長度已受到損害，因而限制了她的關節活動範圍。

在治療前後，我們均建議進行以膝踝協調為重點的神經肌肉訓練。

重要信息：

1.	由於腳踝運動是「閉鎖性動力鏈運動」，所以在腳踝運動受到限制時，我們應評估腳的可動性。
2.	我們應該恢復關節的連結和軟組織的長度，好讓四肢有充分完全的活動能力。
3.	「形封閉」是保持穩定性的關鍵，否則「力封閉」將會產生過多的作用，導致早期疲勞和受傷。