The Effect of Training on Hemodynamic Factors in Ballet Dancer

Study Overview
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Brief Summary
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Classic ballet dance is a demonstration of complex motor skills to be revealed in aesthetic combinations and repetitively, and it demands intensive use of the lower extremities within extreme of range of motion (ROM). Because ballet practice depends on advanced technical skills, it involves intensive physical training and causes an overload on the musculoskeletal system and foot deformities such as pes planus. Plantar venous pump (PVP) is a network of multiple venous vessels located between the muscles of the foot arch. PVP is considered the first step of venous return and discharges into the posterior tibial vein (PTV). PVP is reported to be active during gait while it is inactive in resting position. There are different views on the mechanisms enabling its activation 1-3. The general view is that during the stance phase of the gait, the flattening of the plantar arch with weight transfer causes the veins in this region to narrow and creates a force that pumps the blood up. The aim of this study is the investigation what kind of hemodynamic changes ballet training causes in the lower extremity

Official Title
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The Effect of Ballet Training on Plantar Venous Pump Activity in Ballerinas

Conditions
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Venous Insufficiency, Foot Drop (Acquired)

Intervention / Treatment
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* Other: Navicular drop measurement
* Other: Measurement of venous return parameters in supine
* Other: Measurement of venous return parameters in standing
* Other: measurement of midfoot pressure distrubition


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria (for balerinas): receiving ballet training at least 10 h per week for at least 4 years receiving formal dancing training system Inclusion Criteria (for non-dancer group) never receiving formal dancing training having sedentary lifestyle Exclusion Criteria: Participants with a history of foot or ankle surgery, Participants with connective tissue disease, Participants with rigid pes planus-cavus, Participants with chronic venous insufficiency Participants with acute ankle injury in recent 3 months

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 19 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Ballerinas<br>Balerina students who have trained at least for 4 years | Other: Navicular drop measurement<br>* The difference in navicular height between sitting and standing positions was recorded (mm) as the amount of navicular drop.<br>Other: Measurement of venous return parameters in supine<br>* Venous return parameters of posterior tibial vein was measured when participant applied force equivalent to their own body weight on plantar surface of their right leg in supine position<br>Other: Measurement of venous return parameters in standing<br>* In standing, venous return parameters was measured of posterior tibial vein when participants shift all of their weight to the right leg for 3 second with their leg muscles as relaxed as possible and their knee joint in full extension.<br>Other: measurement of midfoot pressure distrubition<br>* In standing, midfoot pressure distrubution was measured when participants shift all of their weight to the right leg<br>|
| Female students<br>Female students with sedentary lifestyle | Other: Navicular drop measurement<br>* The difference in navicular height between sitting and standing positions was recorded (mm) as the amount of navicular drop.<br>Other: Measurement of venous return parameters in supine<br>* Venous return parameters of posterior tibial vein was measured when participant applied force equivalent to their own body weight on plantar surface of their right leg in supine position<br>Other: Measurement of venous return parameters in standing<br>* In standing, venous return parameters was measured of posterior tibial vein when participants shift all of their weight to the right leg for 3 second with their leg muscles as relaxed as possible and their knee joint in full extension.<br>Other: measurement of midfoot pressure distrubition<br>* In standing, midfoot pressure distrubution was measured when participants shift all of their weight to the right leg<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of navicular drop | Navicular drop was measured in mm | Cchange from baseline navicular height in pre-intervention and immediately after the intervention/ | 
| Evaluation of diameter of tibialis posterior vein in supine | Diameter of tibialis posterior vein was measured in mm | Change from baseline diameter of tibialis posterior vein during intervention | 
| Evaluation of flow velocity of tibialis posterior vein in supine | Flow velocity of tibialis posterior vein was measured in cm/s | Change from baseline flow velocity of tibialis posterior vein during intervention | 
| Evaluation of volume flow of tibialis posterior vein in supine | Volume flow of tibialis posterior vein was measured in ml/min | Change from baseline volume flow of tibialis posterior vein during intervention | 
| Evaluation of diameter of tibialis posterior vein during weight bearing | Diameter of tibialis posterior vein was measured in mm | Change from baseline diameter of tibialis posterior during intervention | 
| Evaluation of flow velocity of tibialis posterior vein during weight bearing | Flow velocity of tibialis posterior vein was measured in cm/s | Change from baseline flow velocity of tibialis posterior vein during intervention | 
| Evaluation of volume flow of tibialis posterior vein during weight bearing | Volume flow of tibialis posterior vein was measured in ml/min | Change from baseline volume flow of tibialis posterior vein during intervention | 
| Evaluation of midfoot plantar pressure during weight bearing | Midfoot plantar pressure was measured in gr/cm2 | Change from baseline midfoot pressure during intervention |