Ballerinas put their bodies through incredible physical demands. Their passion and commitment to their craft lead them to push their bodies to their limits, putting enormous force and stress through their feet. Unfortunately, this can result in several overuse and trauma injuries that can significantly impact a dancer's career. In this article, we will explore the most common conditions that ballerina's feet experience and explain how to manage these injuries.
Dancing En Pointe
Dancing en pointe is a technique that involves standing on the tips of the toes while wearing special shoes.
It is a hallmark of classical ballet, but it comes with significant risks. Ballet dancers who perform en pointe are more susceptible to different types of injuries depending on their gender.
Female Ballerina Feet Injuries
Female ballet dancers are more likely to develop conditions such as bunions, osteophytes, posterior ankle impingement, Morton's Neuroma, Stress Fractures or Metatarsal Joint Pain. On the other hand, male ballet dancers have a higher risk factor for tendon injuries such as Achilles Tendonitis, Posterior Tibial Tendonitis, and shin splints.
However, these are not exclusive and can occur in any gender. Here are the injuries we will cover that are most common to female ballerinas:
- Big Toe Joint Pain
- Bony Osteophyte Formation
- Posterior Ankle Impingement
- Morton's Neuroma
- Stress Fractures
- Flexor Hallucis Longus Tendonitis
Big Toe Joint Pain
Big Toe joint pain is a common injury among ballet dancers. It is caused by an overload on the joint through repetitive pointe movements or from jumping. The extra stress of your body weight placed on the big toe joint can lead to inflammation of the joint or the formation. Over time this can lead to a change in the position of the big toe joint, known as a Bunion or Hallux Valgus. While a bunion can be a genetic issue, it can also develop over time due to repetitive strain on the big toe joint.
Bony Osteophyte Formation
Bony Osteophyte formation is the body's response to a repetitive joint overload resulting in small bony growths on a joint that can pinch tendons in the area leading to pain in certain positions, or they can cause pain by rubbing off other joint surfaces.
Posterior Ankle Impingement
Posterior Ankle Impingement causes pain at the back of the ankle bone around the area of the Achilles Tendon. It differs from Achilles Tendonitis in that it is unusual to have morning stiffness, and pain is worse on your tip toes for Posterior Anke Impingement and relieved when moving the foot into dorsiflexion. Treatment for Posterior ankle impingement is through strengthening and mobility exercises.
Morton's Neuroma
Morton's Neuroma is a condition affecting the forefoot where nerves within the webspace of your forefoot can become inflamed and painful, the most common of these being between the 3/4th metatarsals. Patients describe a burning feeling or the sensation of a pebble within their shoe. Morton's Neuroma can sometimes be quickly resolved with a metatarsal pad or custom insoles, while some may require a steroid injection.
Stress Fractures
Stress Fractures are common in the second and fifth metatarsals for ballet dancers, especially if your second toe is longer than your first toe. The second toe joint is not designed to tolerate full body weight when en pointe, and it can be easily overloaded when combined with impact activities such as jumping. We expect a pattern of pain that is present immediately with impact activities, and there may be some swelling and bruising in the area. An x-ray is required to confirm the diagnosis, and 4-6 weeks in a walking boot is normally recommended before returning to activity.
Flexor Hallucis Longus Tendonitis
Flexor Hallucis Longus Tendonitis is pain and inflammation of the tendon of the big toe joint that assists in flexion of the toe. It is required of all Pointe movements and is regularly overloaded in ballet dancers. The pain location is typically under the big toe and along the midfoot, while there may be some pain in the inner ankle joint. It is common for sesamoiditis to be present alongside this condition.
Male Ballerina Feet Injuries
Male ballet dancers have a higher risk factor for tendon injuries such as Achilles Tendonitis, Posterior Tibial Tendonitis, and shin splints.
Achilles Tendonitis
Achilles Tendonitis results in pain on the back of the ankle joint along the Achilles Tendon. The pain can be in the midportion of the Achilles or on the insertion to the heel bone. It is essential to get the correct diagnosis as both are treated with strengthening exercises, which differ for each condition. A heel raise is a simple but effective method of pain relief.
Posterior Tibial Tendonitis
Posterior Tibial Tendonitis can cause pain on the inner ankle and along the foot's medial arch from repetitive jumping activities. The Posterior Tibialis provides stability to the arch of the foot and helps to turn the foot inwards. We expect this condition to follow a typical tendon pattern of worsening first thing in the morning, improving during physical activity, but worsening afterwards. Strengthening exercises work best for this condition alongside taping and insoles.
Shin Splints
Shin splints (medial tibial stress syndrome) can occur on the front or inner aspect of the heel bone and result from repetitive impact. Irritation of the shin bone (tibia) leads to inflammation of the outer aspect of the tibia (periosteum) which can lead to sharp pain on impact. Shin splints are an overload issue and are treated with a reduction in impact activity, rehabilitation exercises, and a graded return to physical activity.
Sprained Ankles
Sprained ankles occur regularly for ballet dancers, ranging from mild sprains that recover within a few days to the inability to walk. Establishing the severity of an ankle sprain as quickly as possible is of utmost importance as it will determine treatment routes and the necessity for a walking boot or an x-ray.
Management
Effective management and prevention of ballet-related injuries involve several strategies that are tailored to each individual's needs.
Footwear
Choosing the correct footwear is essential for the prevention of ballet-related foot injuries. Ballet shoes should be snug-fitting and provide adequate support to the feet. Dancers who perform en pointe should ensure that their shoes are correctly fitted and do not put excessive stress on the toes.
Strengthening and Conditioning
Ballet dancers should incorporate strength and conditioning exercises into their training regime to maintain foot health and prevent injuries. Exercises such as calf raises, ankle strengthening, and balance training can help improve foot strength and prevent injuries.
Rest and Recovery
Rest and recovery are crucial for preventing and managing ballet-related foot injuries. Ballet dancers should take adequate rest between performances and training sessions to allow the body to recover fully. Proper warm-up and cool-down exercises are also essential to prevent injuries and improve recovery time.
Pain Management
Pain management is a critical aspect of managing ballet-related foot injuries. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and reduce inflammation. Ice therapy can also be helpful in reducing pain and swelling.
Professional Medical Assistance
Ballet dancers who experience foot injuries should seek professional medical assistance immediately. A qualified medical professional can provide an accurate diagnosis, recommend the appropriate treatment, and provide guidance on rehabilitation exercises. Delaying treatment can result in long-term damage and even chronic conditions that can prevent the dancer from performing.
Preventative Measures
Preventative measures can help reduce the risk of ballet-related foot injuries. These measures include proper warm-up and cool-down exercises, proper technique, wearing appropriate footwear, and gradually increasing the intensity and duration of training. Additionally, maintaining proper nutrition and hydration can also help prevent injuries.
Physical Therapy and Rehabilitation
Physical therapy and rehabilitation play a crucial role in managing and preventing ballet-related foot injuries. Rehabilitation exercises can help improve strength, flexibility, and balance, as well as alleviate pain and prevent further injuries. A qualified physical therapist can design a tailored rehabilitation program that addresses the dancer's specific needs.
Support and Encouragement
Ballet dancers require support and encouragement to help them through the physical and emotional demands of their profession. Dancers should have access to counseling and support services that can help them cope with the stresses of their profession.
Conclusion
Ballet is a beautiful and demanding art form that requires tremendous dedication and commitment. Ballet dancers put enormous amounts of force and stress through their feet, resulting in several overuse and trauma injuries. While some of these injuries can be resolved quickly and easily with the correct management, others can result in long-term changes to a ballet dancer's feet.
It is important for ballet dancers to take preventive measures to reduce the risk of foot injuries, including proper footwear, strength and conditioning exercises, and rest and recovery. Additionally, seeking professional medical assistance and rehabilitation services as soon as an injury occurs can help prevent long-term damage and chronic conditions.
With proper management and prevention, ballet dancers can continue to perform and excel in their craft while maintaining healthy and strong feet.
