The Effect of Targeted Toe Flexor Training on Muscular Strength and Jump Performance in Adolescent Ballet Dancers: A Randomized Controlled Trial

Abstract

Background:

Toe flexor muscles (TFMs) play a critical role in ballet, contributing to stability and force transmission during pointe work and jumps. However, traditional training may not provide sufficient stimuli to maintain or improve TFM strength. This randomized controlled trial examined the effects of two targeted toe flexor training interventions on TFM strength and jump performance in adolescent ballet dancers.

Methods:

Forty-nine full-time vocational ballet students (age: 16.0 ± 1.2 years) were randomized into three groups (1:1:1). All students continued their regular dance and supplementary conditioning training. In addition, Group 1 performed foot-specific resistance training with a toe flexion device, Group 2 performed single-leg heel rises on an inclined board, and Group 3 served as controls. The 6.5-week intervention assessed maximal voluntary isometric contraction (MVIC) of the TFMs (primary outcome), with horizontal and vertical jump performance as secondary outcomes.

Results:

Repeated-measures ANOVA revealed significant Group × Time interactions for all toe flexor strength outcomes (P < .001). Group 1 improved TFM strength by 15% to 16% (P < .001), exceeding minimal detectable change thresholds. Group 2 showed no meaningful change, while the control group exhibited a small but significant decline on the right side (P = .046). Horizontal jump performance improved across groups, with the largest effects in Group 1 (r = .82), though between-group differences were non-significant. Vertical jump outcomes showed minor, inconsistent improvements with no clear group advantage.

Discussion:

These findings indicate that a short-duration, device-based foot training program can elicit meaningful gains in TFM strength and support functional performance. In contrast, dance training and general conditioning alone may be insufficient to preserve toe flexor capacity during periods of intensive training. Specific loading appears essential for maintaining foot strength in this population. This study highlights the potential of targeted, progressively loaded foot exercises for maintaining or improving foot strength in young dancers.