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Introduction

It’s very rare to find a ballet dancer without a foot/ankle injury. 34-62% of all dance injuries are reported at the foot and ankle (Kadel, 2006). Well, that’s not surprising, given that the long hours and days of ballet training involve strenuous, repetitive movements of the ankle e.g. en pointe, relievé, Grande jetes. This impact and stress through the foot and ankle pushes the foot and ankle complex to its absolute limit which over time has hindering effects.
There are many common foot/ankle injuries in dance. Kiri Norton looks into this.

Achilles Tendinitis

“My calf feels tight and it is painful down into my heel, it hurts during jump routines”

  • The Achilles tendon is what joins your calf muscles to your heel bone.
  • This is the most common tendon injury among dancers.
  • The Achilles helps with all foot movements; therefore it is constantly being irritated during dance.
  • This condition causes pain swelling, stiffness and weakness of the Achilles tendon (Brukner & Khan, 2009).

Dancers heel (Posterior impingement syndrome)

“I have pain in the back of my ankle when I pointe my toe and perform a relieve”

  • It is most common in dancers who are dancing on demi pointe or pointe (Kadel et al., 2000).
  • The tissues and bony structures become compressed in the posterior aspect of the ankle.
  • This condition causes pain and stiffness in the plantar/posterior heel area.
  • Pain may feel achy and sore in nature and is aggravated by long periods of sitting and increased activity.

Trigger toe/FHL tenosynovitis

“My big toe feels week during pointe work and it sometimes clicks and gets caught. I have to use my hands to move it around and release it”

  • FHL tendinitis is commonly associated or coexistent with posterior impingement, especially in those that undertake ballet (Maquirriain, 2005).
  • The condition can manifest its symptoms anywhere along its length starting at the hallux, up through the plantar foot and up the posterior aspect of the leg (Michelson & Dunn, 2005)
  • Symptoms include pain, stiffness, weakness, sickling (to avoid pain) and locking of the joint.

Anterior impingement syndrome

“It hurts at the top of my foot where the crease is when I perform pliés. Sometimes I can’t perform a full plié because of the pain”

  • Anterior impingement occurs through compression of the bony structures and soft tissue at the anterior aspect of the ankle.
  • The compression occurs when the foot is in full dorsi flexion (dance movements like pliés) (Talusan et al., 2014).
  • Pain may be achy in nature, when impinging it can also feel like a sharp pain.

Plantar fasciitis

“The bottom of my foot hurts when I get up in the morning and the pain increases after dance class”

  • Having flat arches, standing on your feet for long hours daily and having tight Achilles tendons can predispose you to this injury (Duff, 2004).
  • The facia underneath the foot thickens.
  • The bottom of the foot is often very tender to touch.

Shin splints

“It is painful on the front of my shins, especially after class when I have been repetitively jumping and running”

  • Symptoms include tenderness and aching along the front of your shin.
  • Symptoms are increased during exercise.
  • Dancers are susceptible to this condition due to the repetitive forces that occur in dance (Thacker et al., 2002) e.g. excessive jumping on hard surfaces or dancing on a raked stage.

Lateral ankle sprain

“I landed funny and rolled over on my ankle, it hurts on the outside of my foot and my ankle feels unstable”

  • This is when the lateral ligaments are overstretched or torn.
  • Symptoms include swelling, tenderness and an unstable ankle (Kennedy et al., 2007).
  • This injury occurs from rolling over on your ankle or landing on your ankle in the rolled out position.

Hallux rigidus

“My big toe is really painful, I find it really hard to move and it hurts when I go onto full relievé”

  • Hallux rigidus is characterised by pain and stiffness at the big toe (ACFAS, 2004).
  • Over time it becomes increasingly harder to bend the toe.
  • The most common cause for this is faulty biomechanics and structural abnormalities.
  • Individuals whose feet roll in are susceptible to this e.g. some dancers forcefully roll their foot in, to increase their turn out, over time this has detrimental effects.

Dancers fracture

“I landed awkwardly in class and now it hurts on the outside of my foot near my little toe when I walk”

  • The pain presented is very localised on the 5th metatarsal.
  • It can cause swelling and difficulty walking.
  • It is usually caused by a twisting action of the ankle much like the mechanisms for a lateral ankle sprain (Kennedy et al., 2007).

Metatarsalgia

“The balls of my feet are painful”

  • The pain presented can be described as a burning or aching sensation.
  • The pain often occurs in the area where the second, third and fourth toes meet the ball of the foot (Espinosa et al., 2010).
  • The pain gets worse when you are weight bearing.

Therapy for foot/ankle injuries

  • Sport and Dance therapy can be very good for looking after the dancer’s body. Not only is it good for treating current injuries, but it is also good for preventing those injuries from re-occurring.
  • Therapy can involve a range of treatment methods including deep tissue massage, manual therapy, ultrasound, electrotherapy, exercise therapy, stretching and strengthening.
  • Khan et al., (1995) suggests that for a speedy recovery in dance, the main focus should be on technique correction, manual therapy, strengthening and nutritional advice.

In ballet, “turn out” is used for many of the routines. Some dancers have a forced turn out where they use the floor and alter their biomechanics to increase their range. This can predispose dancers to injury.

  • Ellam (2000) says that floore barre is a very effective way to develop true turn out, and to help diminish forced turn out.
  • It also helps to maintain alignment without having to weight bear on the injury and allows the dancers to gently isolate specific muscle groups, therefore it is a good tool for injury prevention.

Benefits of having treatment from a dance therapist

  • They can adapt your treatment  to your dance style and training regime.
  • They can give you a dance specific training and rehabilitation program.
  • They can even tell you how to adapt your current dance classes to your injury, so that you don’t injure it further. But at the same time, you don’t have to miss any classes.

There is nothing worse that going to see a therapist/physiotherapist and them telling you that you have to stop your classes all together for it to get better. Rest is good for healing injuries, but as a dancer myself I know how behind you can get when missing out on rehearsals. So what is the point in missing them if you don’t have to!?

 

References

ACFAS (2004) Hallux Rigidus, American Journal of Foot and Ankle Surgeons, [ONLINE] available at: https://www.lakeviewhealth.org/upload/docs/Hallux%20Rigidus.pdf
Brukner, P. and Khan, K. (2009) Clinical Sports Medicine, Revised Third Edition, McGraw-Hill, Australia.
Duff, R. (2004) PLANTAR FACIITIS AND HEEL PAIN, Reports on the Rheumatic Diseases , Series 5 (2).
Kadel, N, J. (2006) Foot and Ankle injuries in Dance, Physical Medicine and Rehabilitation Clinics of North America, 17, pp. 813-826.
Kadel, N., Micheli, L., and Solomon, R. (2000). Os trigonum impingement syndrome in dancers. Journal of Dance Medicine and Science, 4(3): 99-102.
Khan, K., Brown, J., Way, S., Vass, N., Crichton, K., Alexander, R., Baxter, A., Butler, M. and Wark, J. (1995) Overuse Injuries in Classical Ballet, Sports Medicine, 19 (5) , pp 341-357.
Maquirriain, J. (2005) Posterior Ankle Impingement Syndrome, Journal of the American Academy of Orthopaedic Surgeons, 13 (6), pp. 365-371.
Michelson, J. & Dunn, L. (2005) Tenosynovitis of the flexor hallucis longus:a clinical study of the spectrum of presentation and treatment, Foot & Ankle International, 26 (4), pp. 291- 303.
Talusan, P, G., Toy, J., Perez, J, L., Milewski, M, D & Reach, J, S. (2014) Anterior Ankle Impingement: Diagnosis and Treatment, Journal of the American Academy of Orthopaedic Surgeons, 22 (5), pp. 333-338.
Thacker S, B., Gilchrist, J., Stroup, D, F. and Kimsey, D. (2002) The prevention of shin splints in sports: a systematic review of literature, The Official Journal of the American College of Sports Medicine.
Kennedy, J, G., Hodgkins, C, W., Colombier,J-A., Guyette, S. and Hamiltion, W, G. (2007) Foot and Ankle Injuries in Dancers, International SportMed Journal, 8 (3).

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