From Pointe to Pain: Ballet Foot Injuries

Foot injuries are the bane of a ballet dancer; they appear out of the blue and can put dancers on the sidelines for weeks or even months at a time.

Ballet dancing puts a tremendous amount of strain and pressure on each part of the foot. Hard work may pay off for many dancers but too much can cause serious damage. Excessive practice, fatigue, not enough time to properly heal previous injuries, ill-fitting gshoes and other reasons can all cause different injuries for dancers. These injuries may then result in harming a dancer’s professional career if left untreated or not properly cared for.

ANKLE SPRAINS

A high percentage of all ballet dancers will experience an ankle sprain. This is the most common foot injury dancers experience according to Dr William Hamilton (the orthopaedic consultant to the famous New York City Ballet and the School of American Ballet).

Ankle sprains can be devastating since they are a repetitive injury. Ballet dancers can experience several sprains over a year. One reason for this could be fatigue. Dancers put a lot of energy into rehearsals and tiredness does have a role to play in slipping on stage or landing improperly.

The good thing about ankle sprains is that most are easily treatable. The RICE technique (rest, ice, compression and elevation) is the favoured option. However, there are times when the RICE technique cannot be used.

Repetitive ankle sprains can drastically harm the ligaments in the ankle and feet. Dancers may experience a bit of looseness and a pop, but a serious injury (where the ligament is completely torn) can require surgery, resulting in weeks or months of recovery.

THE SUBLUXING CUBOID

The subluxing cuboid is a common foot injury that presents itself similar to a sprain. It occurs as pain in the midfoot. It is caused by a slight disturbance to the structural consistency of the calcaneocuboid section of the midtarsal joint.

When this injury presents itself dancers are unable to go from foot flat to relevé. They are then unable to run, dance or jump without feeling pain and unsteadiness. Pressing on the plantar surface is particularly painful as the normal dorsal-plantar is either lacking or not present.

Subluxing cuboid is noticeable by a shallow depression on the dorsal portion and a fullness on the on the plantar. A cuboid whip is the usual treatment by a physician who is familiar with this type of injury.
It's done by bending the knee and putting the foot and ankle in a "toes-up" or dorsiflexed position. The patient is face down on a table. The operator's thumbs are on the bottom of the foot under the cuboid bone.

The knee is straightened while the ankle is pointed down. The operator turns the foot slightly inward and applies a thrust force to the cuboid. This action moves the cuboid bone back into its proper place. It's usually a painless manipulation.

An alternate way to do the same thing is called the cuboid squeeze. The foot and ankle are slowly stretched into a plantar flexed position (toes pointing down). When everything relaxes the examiner squeezes the cuboid with the thumbs putting it back in place.

The cuboid squeeze works best for people with cuboid syndrome from overuse. If the problem was caused by an ankle sprain, the joint manipulation is still the best way to go.

METATARSAL STRESS FRACTURE

Branded as ‘dancer’s fracture’, a metatarsal stress fracture is an overuse injury. Aside from the foot,
fractures can occur in any bone of the ankle, shin, knee, hip, or spine. It is caused when dancers lose balance on demi-point and their feet tips over onto the external parts. A stress fracture can only be diagnosed with an x-ray, but can take over a week for it to show up after it occurs.

In young dancers, medical advice is to simply refrain from performing grand plies and jumps until the pain has gone. A plaster cast is not usually necessary for this injury. Time heals all; modifying young dancers’ routines for around eight weeks will allow the fracture to heal. On the other hand, a severely displaced fracture will result in a cast for up to eight weeks.

Full recovery can take up to to four months after treatment begins. At first, complete rest is necessary, but as symptoms subside, you can resume partial weight=bearing exerises and then gentle ballet barre movements.

TENDINITIS

Achilles tendon injuries are very common in dancing. Weakness of these tendons can be caused by tight fitting shoes or ribbons cutting into the tendons. The gastrocnemius and soleus muscles become tight, resulting in poor weight distribution, inferior dancing and pain.

Tendinitis can present itself in the foot as discomfort in the toes and arch pain. Like an ankle sprain, the dancer may experience a popping sensation in the ankle, or the big toe ‘locking’ when they point their foot or goes from the fully pointed position to a more relaxed stance.

Treatment of tendinitis generally consists of contrast baths, NSAID medication and plenty of rest. In more severe cases, physical therapy, a boot brace or a course of steroids may be warranted. Tendinitis can be a reoccurring and disabling ailment. In this case, operative tenolysis may be an option. However, this alternative should only be considered after a year of therapy in young dancers or six months for professionals.

BUNIONS

Bunions are not only painful. They are particularly ugly as well.. They present themselves as a bony protrusion on the foot when the big toe has been forced to angle towards the other toes. Tight fitting shoes and increased pressure to create a more ‘turned out’ point will cause bunions to appear. Surgery to remove bunions is not a welcomed option in young dancers. Instead, a well fitting shoe and anti-inflammatory gel applied to the area can reduce the pain.

Injuries are a common occurrence in ballet dancers. However, prevention, rather than cure, is the best option. Dancers should ensure that they wear appropriate footwear, do not force their bodies to go to the extreme and seek medical attention as soon as injuries appear.