Dancer Health

Tappers may use their feet more than any other type of dancer, as they slide, jump, slap, stomp and balance on the balls of their feet, quickly shifting into various positions. “Tappers use all points of the foot in contact with the floor in different percussive or frictional ways,” says Megan Richardson, a clinical specialist and certified athletic trainer at the Harkness Center for Dance Injuries at New York University Hospital for Joint Diseases in New York City. The percussive nature of tap dance poses special issues when it comes to injury and foot care. Help your students prevent the following common tap-related problems.

Blisters

Friction, moisture and poor-fitting shoes cause blisters. If a student reports redness and sensitivity around an irritated spot, have them place a gel patch or blister pad on the inflamed area and do 10-minute-long cold foot soaks until the pain is gone. Wearing properly fitted shoes and moisture-wicking socks will ultimately help prevent blisters.

Tendonitis

Tendonitis is caused by repetitive stress or overuse. It commonly occurs when students first begin tapping or increase their dance load, since their muscles and tendons may not have sufficient strength to endure repetitive classes and performances, says Terry Sneed, owner and director of Elite Physical Therapy & Wellness Center in Washington, DC. (Sneed also served as a touring physical therapist for Bring in ’da Noise, Bring in ’da Funk.) A gradual build-up is necessary, she adds. Watch out for chronic soreness around the ankle joint or a nagging pain in the heel. This pain is usually not severe and worsens after activity. Relative rest, icing feet, NSAIDs (non-steroidal anti-inflammatory drugs), stretching, strengthening, taping and correction of technical faults are a few necessary actions to avoid tendonitis. For further prevention, always take students through a thorough warm-up, and encourage them to stretch before and ice after activity.

Ankle Sprains

Ankle sprains happen with traumatic force as the result of missed steps or untreated injuries. “Some injury-causing movements unique to tappers include ‘flash’ steps, like wings, and turns and jumps that require constant, intricate foot and ankle movement,” says Kendra Sakamoto, a tap dancer and athletic trainer for Cirque du Soleil’s KOOZA. The constant pounding of the foot and ankle, the type of footwear and poor technique are all factors that can contribute to ankle sprains. Be aware of sharp pain, noticeable swelling and difficulty continuing activity. Advise students to take the same precautions as with any muscle injury. Some treatments may call for crutches, stabilizing braces and professional medical assistance. Take extra time for ankle-strengthening exercises, and pay special attention to body alignment, especially when the student is wearing heeled tap shoes.

Stress Fractures

Tappers are prone to metatarsal stress fractures, because they jump, pound and stomp their feet in shoes that lack shock absorption. “At first, the muscles absorb the vibration of the floor, then the bones,” says Richardson. “Wear and tear of that nature can give tappers stress fractures.” These fractures can be tricky to spot, but if a student complains of constant pain that doesn’t go away and worsens with weight-bearing activities, look for swelling and point tenderness as a sure indicator. Sometimes these injuries are better diagnosed with an X-ray or MRI. Rest, ice and NSAIDs will help ease the pain, but a walking boot with crutches may be needed, depending on severity.

Ingrown Toenails

Tight or poorly fitted shoes that allow the foot to slip and slide can cause ingrown toenails (as will toenails that are too long). Along with discomfort, tappers might notice redness and swelling around the affected area, typically in the big toe. Soak feet in a tub of warm, salty water two to three times per day and pad the toe for relief. Have students see a doctor if there is an infection. Keeping toenails trimmed and wearing the right shoes (or at least padding) can alleviate the pressure. DT

Nina Amir is currently writing a book about mentoring boys who want to become professional dancers.

Foot Care Tips from Famous Tappers

Chloé Arnold

“I aim to stretch before dancing, and that definitely includes rolling through my foot. I soak my feet when I can. I try to know when to rotate my shoes out and get a new pair to protect my feet. In high heels, I always have a gel pad. If I am sore, I try to ice. It brings down the pain and reduces the swelling. I have a foot roller and use that, and I’m in the process of trying out different insoles that address my high arch.”

Derick K. Grant

“Stretching. It took a while for me to make the connection with this one—I’m lazy by nature. But since the feet have all the nerve endings, pain is usually the result of something going wrong somewhere else in the body. So, when I experience cramping in my feet, I start stretching right away.”

Dormeshia Sumbry-Edwards

“If I am dancing every single day, I’ll rub my feet every day, especially the parts that are tender. I use a hard ball or a rolling pin and roll it back and forth. I make sure my toe nails are cut low, and I try to wear shoes that are comfortable for my feet. I have to be able to wiggle my toes in the shoes. I have a wide foot and narrow heel, so sometimes I need a heel grip. If the shoes are hard at the bottom, I’ll go a half size bigger and put an insole inside to help with the pounding and pressure.”

iStockphoto

Dancer Health

To keep their precious instruments in top condition (and injury-free), tappers must develop a sound stretching practice that incorporates strengthening exercises, especially for the lower extremities and core muscles—the abdomen, hips, buttocks and lower back areas. “Most tappers’ lower extremity injuries are significantly influenced by the strength of their core,” says Megan Richardson, a clinical specialist and certified athletic trainer at the Harkness Center for Dance Injuries at New York University Hospital for Joint Diseases in New York City. Stretching on a regular basis—both before and after dancing—will help with overall movement, allowing the smaller muscles to better articulate the fancy footwork involved in tap dancing. “Most importantly, stretching their calf muscles, quadriceps and hamstrings will help prevent stress fractures and overuse injuries,” says Richardson.

It’s also vital for tap dancers to stretch out each foot and set of toes, adds Richardson. Strengthening the feet will help develop extra muscle to cushion each foot while in motion. One of the most beneficial exercises for tappers is “doming” their feet, advises Richardson. To do this exercise, sit in a chair with your back straight and knees and hips bent at a 90-degree angle. Keep bare feet flat on the floor while sliding (or scrunching) the toes back toward the heels, so that the top part of the arches rise into a dome shape. Make sure that your body weight is evenly distributed across the feet and avoid letting the toes curl under. Hold this position for 10 seconds, then release, relax and do five more repetitions. Tap dancers should build onto this exercise slowly until they are able to do 100 reps daily. If done correctly on a regular basis, this exercise will strengthen the muscles between the metatarsal bones and better equip the balls of the feet to absorb forces, says Richardson.

Dancer Health

Pointed. Flexed. Calloused. Blistered. Tired. Beautiful. Dancers’ feet are many things, but most of all, they must be strong and healthy. Yet with the rigors of training—turning, jumping, relevéing and pointe work—it’s no wonder they take a beating.

While acute injuries, like fractures and sprains, constitute five percent of all foot injuries, 95 percent are caused by overuse. Tendonitis, strains and stress fractures are common ailments that result from repetitive action. Chris E. Chung, PhD, a sports medicine specialist at South Bay Sports & Preventive Medicine Associates, Inc., in San Jose, California, likens stress fractures to bending a paper clip. If it’s bent once or twice in the same place, it won’t break; when bent repeatedly it will weaken and eventually break.

Overuse injuries can be caused by the amount of time spent dancing, sudden increases in the difficulty of the dance or by simply doing “too much too soon,” adds Chung, whose patients include company members of Ballet San Jose. Students are also at risk if “the intensity of the activity is greater than the dancer’s body’s ability to strengthen itself to compensate, such as during intense rehearsals or when a student changes to a higher level class,” explains Remy Ardizzone, DPM, a podiatrist at the Center for Sports Medicine at Saint Francis Memorial Hospital in San Francisco and a consultant for the San Francisco Ballet School.

With young dancers most prone to these ailments, it’s important for dance teachers to monitor their activity levels and take time to increase their strength in order to prevent permanent damage. Here, we look at some common foot injuries, as well as their warning signs and techniques to avoid them.

Plantar Fasciitis and Tendonitis (of the Achilles, flexor hallucis longus or tibialis posterior )

Warning Signs: Pronating while standing or in plié; landing jumps with the heels never quite touching the floor or bouncing into the plié; incomplete use of the foot when pushing off the floor; landing flat-footed; “sickling” (supinating) in relevé, on demi-pointe or full pointe

Symptoms: These inflammations come on slowly. “It starts with pain that comes and goes, and then is more present,” explains Kim Gardner, a former professional dancer, ballet teacher and lead dance medicine specialist at South Bay Sports.

Solutions/Exercises: Strengthening the foot and ankle muscles; increasing students’ proprioception, i.e., self-awareness of postural alignment and functional turnout from the hip (see “Building Strong Feet” on page 163 for suggested exercises); proper warmup and cool-down

Strains and Sprains (most commonly inversion ankle sprains)

Warning Signs: No warning signs exist, other than previous ankle instability and poor technique. However, certain habits, such as pronating while walking or in plié, or sickling the foot, put students at greater risk of spraining an ankle, Gardner says. Weaker students are more prone to such injuries, adds Chung.

Symptoms: Intermittent pain that becomes more constant; out-of-the-ordinary muscle soreness, swelling or muscle fatigue

Solutions/Exercises: Paying attention to body alignment and ankle strength and stability; proper warmup and cool-down

Stress Fractures or Bruised Bones (most commonly of the lesser metatarsal, called “the dancer’s fracture,” navicular or fibula bones)

Warning Signs: Watch for dancers who have become overly thin, or dropped enough weight to stop menstruating. Their bones can start becoming thinner. “That, on top of being very active,” Chung explains, “can increase the risk of stress fractures, especially in the feet.”

Symptoms: Abnormal pain after dance, night pain and pain at the time of a particular incident, followed by swelling or some irregularity or deformity. “Achy pain in the general area that comes on with activity could be a precursor,” says Marika Molnar, director of physical therapy services at New York City Ballet and the School of American Ballet, as well as president of Westside Dance Physical Therapy in NYC. “It goes away after rest, but then comes back again.” Adds Chung, “If you can’t put weight on the foot, that’s sign of a possible acute injury.”

Solutions/Exercises: Pay attention to technique, body alignment and ankle strength and stability. In addition, dance teachers should make sure students are eating enough and building bone density. “Low energy availability due to insufficient food intake can have deleterious effects on bones and the endocrine system,” says Molnar. “Rest, proper nutrition and cross-training will help prevent these problems.”

Calluses, Corns and Bunions

Warning Signs: Improperly fitting shoes and poor technique

Symptoms: Rough or thickened skin, changes in skin color or increased pain or sensitivity in the skin can all point to the formation of calluses and corns, says Chung. For female students wearing pointe shoes, pronation and the manner in which they point their toes can cause these problems as well. “If they are curling their toes instead of using the intrinsic arch muscle and forefoot to point, that’s going to predispose them to these issues,” says Gardner. She notes, however, that ballet dancers need some callusing for pointe work, so it is not always indicative of poorly fitted shoes or bad training.

Solutions/Exercises: Smooth corns and calluses with a pumice stone or see a podiatrist, says Chung. Additionally, massaging the feet or soaking them in warm water each day for 10 minutes can prove helpful. Dance teachers should also make sure students are wearing the correct size shoes, and remind them to get their feet measured regularly if they are still growing. “Bunions are usually hereditary,” adds Molnar, “but are often exacerbated by tight-fitting shoes.”

When toes are sore, Chung also suggests massaging them or putting tension on them by gently pulling. Placing cotton between toes can help keep them straighter as well. To avoid bunions, give feet a break by taking off dance shoes every so often. “And make sure your non-dance shoe is one with a wide front and plenty of space for the feet,” he says. “The regular shoe shouldn’t be pointed like a dance shoe.”

Arthritic Changes in the Big Toe (especially for males)

Warning Signs: Teachers should look for incorrect alignment of the foot, says Molnar, “such that too much of the weight is borne on the big-toe joint during relevé.”

Symptoms: Spur formation on the top of the foot at the joint line, then pain

Solutions/Exercises: “Teachers need to watch the alignment of foot to leg to make sure students are not turning with the big toe twisted in any way,” says Molnar. It’s a good idea to ask male students to remove their shoes and actually observe how they are using their feet. DT

 

Nina Amir is a freelance writer, nonfiction editor and writing coach who lives in Northern California. She is currently working on a book about how to mentor young boys who want to become professional dancers.

How-To

Many male dancers have been laughed at for going to the dance studio rather than the football field, teased for wearing tights onstage or otherwise struggled with the feminine stereotypes associated with dance, ballet in particular. As the parent of a 10-year-old who is the only boy in his ballet, jazz, tap and hip-hop classes and the only boy in his elementary school who would rather dance than play sports, I understand these frustrations.

While some male dancers get past these difficulties, many others decide it’s easier to quit. Both male and female dance teachers play a major role in helping young male students deal with the special issues they face. Often, it is the teachers’ care and attention that mean the difference between keeping boys’ interest alive and letting it fizzle. The following tips can help you keep those dancing boys dancing.

Provide Role Models

Inspire young male dancers by taking them to see shows that feature men dancing, whether local musical productions or performances by touring groups such as Alvin Ailey American Dance Theater or Bill T. Jones/Arnie Zane Dance Company. Kenny Jimenez, founder of Motion Underground in Boulder, Colorado, suggests showing and discussing videos of famous male dancers such as Gene Kelly, Mikhail Baryshnikov, Gregory Hines, Savion Glover and even Michael Jackson.

Male dance teachers provide positive role models for their male students, and can relate to their students’ problems and offer advice gleaned from experience. Anthony LoCascio, an eight-year veteran of Tap Dogs who teaches in San Jose, California, and is on the faculty of Professional Dance Teachers of America and Hoctor’s Dance Caravan, stresses that boys need male teacher involvement in their dance studies. He talks to his male students about his own positive and negative experiences: “I tell them stories so they won’t feel alone, and I tell them that even though I went through all that, I’ve been on Broadway and I’m still standing here as a dance teacher.”

Let Boys Be Boys—Together

Treat boys like boys in class, recommends Jerry Rose, a teacher at Beckley Dance Theatre in Beckley, West Virginia, and the assistant director of Hoctor’s Dance Caravan. “Boys, if you’ve noticed, are always jumping,” Rose says, noting that instructors should play on those natural interests and abilities. “Teach them both little and big jumps early in their dance career. [Jumping] is so much fun for them, and is something they can start before their technical ability has been realized both intellectually and physically.”

In addition, consider giving boys a class or classes of their own. According to Bethany Hooks, director of the dance program at Center Stage in Brandon, Mississippi, all-male classes can help boys become less self-conscious about their dancing. “As long as it’s just the boys in class they even seem pretty comfortable with doing ballet.” Jimenez adds, “Boys will find different ways to release [their inhibitions] when they are in that type of environment. Sometimes their expression [may be] hampered by the females.” Taking class with other boys also gives male dancers the chance to make friends with similar interests and build camaraderie.

Make sure you offer boys classes in a wide range of genres, not just ballet—for example, tap, jazz and hip hop—and encourage the younger boys to take a combination class, which might be less intimidating than a full hour of ballet.

Deal With Teasing

When young male dancers find themselves the brunt of bad jokes, dance teachers should offer not only an ear to listen and a shoulder to cry on, but strategies for dealing with these situations as well.

Jimenez suggests reminding boys that dancing is every bit as physically challenging as football or soccer. “[Tell] them that dancing is a sport and that it takes a lot of strength and [other] physical attributes that other sports require as well,” he explains. Plus, it enhances their ability in other sports.

Rose tells boys that dancing, even ballet, is not for “sissies” or just for girls. After all, it’s a man’s job to lift and turn the girls. If boys feel self-conscious in tights, Rose suggests pointing out they’re not much different from spandex football pants or wrestling unitards. Increasingly, some high school and college athletes are even taking dance classes to improve their alignment, muscle control and movement coordination. (For more on one teacher’s experience teaching sports teams, read “Out of the Studio, Onto the Field” in DT January 2003.)

Many young male dancers might also be comforted by the fact that, unlike most male athletes, they’ll be surrounded by girls. If the boys are ever asked, “Why would you want to go dance when you could be out on the football field?” Hooks suggests that they answer, “I can play football with the other guys or I can go dance with a bunch of beautiful girls. Whose shoes would you rather be in?” LoCascio tells his male students, “All the guys who play sports will be watching you dance with the girls at the high school dances, because you’ll know how to dance and they won’t.”

Be Prepared to Talk About Tough Subjects

If male dancers come to you upset by being called “gay,” “queer” or “fag,” LoCascio says, “You have to be very honest and treat them maturely. Tell them what those words mean, and don’t beat around the bush.” Explain that dancing does not make anyone gay, but also let them know that there’s nothing wrong with homosexuality. Hooks adds, “Help the boys know who they are. The number-one thing is for them to have confidence in themselves and to be able to stand up to the other guys, to take the hassling and teasing.”

Male dancers also often face a lack of support or even open opposition at home, particularly from their fathers. If you come across fathers who would rather have their sons playing football or baseball, schedule a meeting with them to explain their support will help their sons feel good about themselves and their interests. “The father has such an important role,” Hooks confirms. “I’ve had to sit down with fathers and tell them, ‘Maybe in time your son will want to play football, but for right now this is what he wants to do. You need to encourage him.’”

Allow Boys Their Freedom

If your male students are struggling with peer pressure, feeling uncomfortable in class or finding it difficult to handle the negative issues associated with their dancing, stay positive. Don’t force them to continue. “If they truly like it and they leave, they’ll come back,” reassures LoCascio. “If you try to keep them there, they might end up hating dance.”

Nina Amir is a freelance writer and book editor based in Los Gatos, CA. Her book Chicken Soup for the Famous and Not-So-Famous is scheduled for publication in 2005, and she is working on several others.

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