Int J Sports Med 2015; 36(13): 1093-1099
DOI: 10.1055/s-0035-1554633
Orthopedics & Biomechanics
© Georg Thieme Verlag KG Stuttgart · New York

Does Wearing Textured Insoles during Non-class Time Improve Proprioception in Professional Dancers?

N. Steinberg
1   Faculty of Health, University of Canberra, Canberra, Australia
2   The Wingate College of Physical Education and Sports Sciences at the Wingate Institute, Israel
O. Tirosh
3   College of Sport and Exercise Science, Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
R. Adams
4   Faculty of Health, Sydney University, Sydney, Australia
J. Karin
5   Health, Australian Ballet School, Melbourne, Australia
G. Waddington
1   Faculty of Health, University of Canberra, Canberra, Australia
› Author Affiliations
Further Information

Publication History

accepted after revision 06 May 2015

Publication Date:
02 September 2015 (online)


This study sought to determine whether textured insoles inserted in the sports shoes of young dancers improved their inversion and eversion ankle movement discrimination. 26 ballet dancers (14 female, 12 male) from the Australian Ballet School, ages 14–19 years, were divided into 2 groups according to sex and class levels. During the first 4 weeks, the first intervention group (GRP1) was asked to wear textured insoles in their sports shoes during non-class periods, and the second intervention group (GRP2) followed standard practice. In the next 4 weeks, GRP2 was asked to wear the textured insoles and GRP1 did not wear the textured insoles. Participants were tested pre-intervention, after 4 weeks, and at 8 weeks for both inversion and eversion ankle discrimination. In both inversion and eversion testing positions, interaction was found between the 2 groups and the 3 testing times (p<0.001), with significant differences between the first testing and the second testing (p=0.038 and p=0.019, respectively), and between the third testing and the second testing (p=0.003 and p=0.029, respectively). In conclusion, the stimulation to the proprioceptive system arising from textured insoles worn for 4 weeks was sufficient to improve the ankle proprioception of ballet dancers, in both inversion and eversion movements.

  • References

  • 1 Abdel-aziem AA, Draz AH. Chronic ankle instability alters eccentric eversion/inversion and dorsiflexion/plantarflexion ratio. J Back Musculoskelet Rehabil 2014; 27: 47-53
  • 2 Arnold BL, Linens SW, de la Motte SJ, Ross SE. Concentric evertor strength differences and functional ankle instability: a meta-analysis. J Athl Train 2009; 44: 653-662
  • 3 Ashton-Miller J. Proprioceptive thresholds at the ankle: implications for prevention of ligament injury. In: Lephart S, Fu F. (ed.) Proprioception and neuromuscular control in joint stability. Champaign: Human Kinetics; 2000: 279-289
  • 4 Batson G. Update on proprioception: considerations for dance education. J Dance Med Sci 2009; 13: 35-41
  • 5 Baumhauer JF, Alosa DM, Renstrom AF, Trevino S, Beynnon B. A prospective study of ankle injury risk factors. Am J Sports Med 1995; 23: 564-570
  • 6 Bronner S. Differences in segmental coordination and postural control in a multi-joint dance movement: developpe arabesque. J Dance Med Sci 2012; 16: 26-35
  • 7 Cameron M, Adams R. Kicking footedness and movement discrimination by elite Australian Rules footballers. J Sci Med Sport 2003; 6: 266-274
  • 8 Cameron ML, Adams RD, Maher CG. The effect of neoprene shorts on leg proprioception in Australian football players. J Sci Med Sport 2008; 11: 345-352
  • 9 Cheng HS, Law CL, Pan HF, Hsiao YP, Hu JH, Chuang FK, Huang MH. Preliminary results of dancing exercise on postural stability in adolescent females. Kaohsiung J Med Sci 2011; 27: 566-572
  • 10 Collins DF, Refshauge KM, Todd G, Gandevia SC. Cutaneous receptors contribute to kinesthesia at the index finger, elbow, and knee. J Neurophysiol 2005; 94: 1699-1706
  • 11 Corbin DM, Hart JM, McKeon PO, Ingersoll CD, Hertel J. The effect of textured insoles on postural control in double and single limb stance. J Sport Rehabil 2007; 16: 363-372
  • 12 Courtney CA, Rine R, Jenk DT, Collier PD, Waters A. Enhanced proprioceptive acuity at the knee in the competitive athlete. J Orthop Sports Phys Ther 2013; 43: 422-426
  • 13 Daneshjoo A, Mokhtar AH, Rahnama N, Yusof A. The effects of comprehensive warm-up programs on proprioception, static and dynamic balance on male soccer players. PloS one 2012; 7: e51568
  • 14 Dvir Z. (ed.) Isokinetics: Muscle testing, Interpretation and Clinical Application. London, England: Churchill Livingstone; 1995
  • 15 Feuerbach JW, Grabiner MD, Koh TJ, Weiker GG. Effect of an ankle orthosis and ankle ligament anesthesia on ankle joint proprioception. Am J Sports Med 1994; 22: 223-229
  • 16 Han J, Anson J, Waddington G, Adams R. Proprioceptive performance of bilateral upper and lower limb joints: side-general and site-specific effects. Exp Brain Res 2013; 226: 313-323
  • 17 Han J, Waddington G, Adams R, Anson J. Ability to discriminate movements at multiple joints around the body: global or site-specific. Percept Mot Skills 2013; 116: 59-68
  • 18 Harriss DJ, Atkinson G. Ethical standards in sports and exercise science research: 2014 update. Int J Sports Med 2013; 34: 1025-1028
  • 19 Hertel J. Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability. J Athl Train 2002; 37: 364-375
  • 20 Hiller CE, Refshauge KM, Beard DJ. Sensorimotor control is impaired in dancers with functional ankle instability. Am J Sports Med 2004; 32: 216-223
  • 21 Hiller CE, Kilbreath SL, Refshauge KM. Chronic ankle instability: evolution of the model. J Athl Train 2011; 46: 133-141
  • 22 Hohne A, Stark C, Bruggemann GP, Arampatzis A. Effects of reduced plantar cutaneous afferent feedback on locomotor adjustments in dynamic stability during perturbed walking. J Biomech 2011; 44: 2194-2200
  • 23 Hughley LKMP, Fung J. (eds.) The effects of dance training on postural control in multi-directional voluntary leg lifts. Society for Neuroscience. New Orleans, Louisiana: 2000
  • 24 Hutt K, Redding E. The effect of an eyes-closed dance-specific training program on dynamic balance in elite pre-professional ballet dancers: a randomized controlled pilot study. J Dance Med Sci 2014; 18: 3-11
  • 25 Jola C, Davis A, Haggard P. Proprioceptive integration and body representation: insights into dancers’ expertise. Exp Brain Res 2011; 213: 257-265
  • 26 Kiefer AW, Riley MA, Shockley K, Sitton CA, Hewett TE, Cummins-Sebree S, Haas JG. Lower-limb proprioceptive awareness in professional ballet dancers. J Dance Med Sci 2013; 17: 126-132
  • 27 Lephart SM, Giraldo JL, Borsa PA, Fu FH. Knee joint proprioception: a comparison between female intercollegiate gymnasts and controls. Knee Surg Sports Traumatol Arthrosc 1996; 4: 121-124
  • 28 Li JX, Xu DQ, Hoshizaki B. Proprioception of foot and ankle complex in young regular practitioners of ice hockey, ballet dancing and running. Res Sports Med 2009; 17: 205-216
  • 29 Lin CF, Lee IJ, Liao JH, Wu HW, Su FC. Comparison of postural stability between injured and uninjured ballet dancers. Am J Sports Med 2011; 39: 1324-1331
  • 30 Maher CG, Adams RD. Stiffness judgments are affected by visual occlusion. J Manipulative Physiol Ther 1996; 19: 250-256
  • 31 Marmeleira JF, Pereira C, Cruz-Ferreira A, Fretes V, Pisco R, Fernandes OM. Creative dance can enhance proprioception in older adults. J Sports Med Phys Fitness 2009; 49: 480-485
  • 32 McKeon PO, Hertel J. Diminished plantar cutaneous sensation and postural control. Percept Mot Skills 2007; 104: 56-66
  • 33 McNair PJ, Heine PJ. Trunk proprioception: enhancement through lumbar bracing. Arch Phys Med Rehabil 1999; 80: 96-99
  • 34 Muaidi QI, Nicholson LL, Refshauge KM. Do elite athletes exhibit enhanced proprioceptive acuity, range and strength of knee rotation compared with non-athletes?. Scand J Med Sci Sports 2009; 19: 103-112
  • 35 Newcomer K, Laskowski ER, Yu B, Johnson JC, An KN. The effects of a lumbar support on repositioning error in subjects with low back pain. Arch Phys Med Rehabil 2001; 82: 906-910
  • 36 Pappas E, Kremenic I, Liederbach M, Orishimo KF, Hagins M. Time to stability differences between male and female dancers after landing from a jump on flat and inclined floors. Clin J Sport Med 2011; 21: 325-329
  • 37 Perlau R, Frank C, Fick G. The effect of elastic bandages on human knee proprioception in the uninjured population. Am J Sports Med 1995; 23: 251-255
  • 38 Pontaga I. Ankle joint evertor-invertor muscle torque ratio decrease due to recurrent lateral ligament sprains. Clin Biomech (Bristol, Avon) 2004; 19: 760-762
  • 39 Rein S, Fabian T, Zwipp H, Rammelt S, Weindel S. Postural control and functional ankle stability in professional and amateur dancers. Clin Neurophysiol 2011; 122: 1602-1610
  • 40 Richie Jr DH. Functional instability of the ankle and the role of neuromuscular control: a comprehensive review. J Foot Ankle Surg 2001; 40: 240-251
  • 41 Salles AS, Gyi DE. An evaluation of personalised insoles developed using additive manufacturing. J Sports Sci 2013; 31: 442-450
  • 42 Schmitt H, Kuni B, Sabo D. Influence of professional dance training on peak torque and proprioception at the ankle. Clin J Sport Med 2005; 15: 331-339
  • 43 Simmons RW. Sensory organization determinants of postural stability in trained ballet dancers. Int J Neurosci 2005; 115: 87-97
  • 44 Smitt MS, Bird HA. Measuring and enhancing proprioception in musicians and dancers. Clin Rheumatol 2013; 32: 469-473
  • 45 Waddington G, Adams R. Discrimination of active plantarflexion and inversion movements after ankle injury. Aust J Physiother 1999; 45: 7-13
  • 46 Waddington G, Seward H, Wrigley T, Lacey N, Adams R. Comparing wobble board and jump-landing training effects on knee and ankle movement discrimination. J Sci Med Sport 2000; 3: 449-459
  • 47 Waddington G, Adams R. Football boot insoles and sensitivity to extent of ankle inversion movement. Br J Sports Med 2003; 37: 170-174
  • 48 Waddington GS, Adams RD. The effect of a 5-week wobble-board exercise intervention on ability to discriminate different degrees of ankle inversion, barefoot and wearing shoes: a study in healthy elderly. J Am Geriatr Soc 2004; 52: 573-576
  • 49 Willems T, Witvrouw E, Verstuyft J, Vaes P, De Clercq D. Proprioception and muscle strength in subjects with a history of ankle sprains and chronic instability. J Athl Train 2002; 37: 487-493
  • 50 Witchalls JB, Newman P, Waddington G, Adams R, Blanch P. Functional performance deficits associated with ligamentous instability at the ankle. J Sci Med Sport 2013; 16: 89-93