The Danger of Untreated Achilles Tendonitis

Photo: Thinkstock

Pliés shouldn't be excruciating. As a ballet conservatory pre-professional student, Taylor Gordon knew this, but when the back of her left heel began aching during pliés and jumps in 2007, she didn't think it was a big deal. She was dancing more than 20 hours a week and couldn't imagine pain bad enough to keep her from it. "I never understood why people I'd seen who were injured had to sit down and watch class," she says, remembering her determination. "Why can't you just push through it?"


Like many dancers, that's exactly what she did. Three years of Achilles tendonitis eventually led to surgery, due in part to her unwillingness to rest long enough to recuperate.

Achilles tendonitis is common among dancers. Caused by repetitive use, the tendon becomes inflamed. It nags before demanding attention, but leaving it untreated can lead to months of physical therapy or even surgery. Incorrect alignment and muscular weakness exacerbate the condition, but tendonitis can hobble even the most technically meticulous dancer who simply demands more than her body can give. Learning to recognize the symptoms and act quickly to treat them, plus building a self-care routine, can keep a dancer from being sidelined too long or facing a career-ending rupture.

Risk Factors

Pre-professional dancers are especially vulnerable to Achilles tendonitis when they increase their training, like starting a summer intensive, says Suzanne Martin, a doctor of physical therapy who works with Smuin Ballet and treats dancers at her private practice near San Francisco. "Suddenly they're doing full-day workouts, classes and rehearsals every day. They don't understand the amount of extra conditioning that's required for professional work."

According to Martin, the other group of tendonitis sufferers is those who develop the injury from overuse. This is more common among professionals, especially those in small companies who perform several roles in each show.

How It Starts

The Achilles tendon connects the calf muscles to the heel bone. It absorbs a lot of force when landing from jumps, and it stretches and contracts as a dancer moves from plié to relevé or flexes and points the foot. Excessive pronation (like rolling in over the arches), weakness in the lower legs and failing to get up to full relevé can cause extra strain on the Achilles, too.

Dancers will feel Achilles tendonitis differently, depending on the cause and their anatomy. Like Gordon's, it may be pain at the base of the heel, where the tendon connects to the bone, or it could be further up the back of the ankle, where the tendon joins the calf muscles. If a dancer feels tightness or a pull in the Achilles area while she's cold that then eases as she warms up, that could be an early sign of tendonitis.

Gordon's heel felt worse as she continued dancing, but when she graduated the following year, she was terrified of delaying her career. She remembers thinking, "I'm just getting started. I can't stop now." So she didn't. She danced in the Radio City Christmas Spectacular and other freelance gigs. "I was icing as much as I could, and using Icy Hot and Advil just to get through class and rehearsals," she says.

A Treatment Regimen

When treating tendonitis, the goal is to reduce inflammation. The rest, ice, compression, elevation (RICE) method and anti-inflammatory medicines or ointments can help. Martin favors contrast baths: immersing the affected area in warm water with Epsom salt for 10 minutes and then cold water with no more than four ice cubes for 10 minutes. Repeat the cycle once, for a total soak time of 40 minutes. This flushes out inflammatory fluids. Plus, she recommends dancers regularly roll out their feet on tennis balls and use foam rollers to massage their legs to release tightness in the muscles and the fibrous fascia that encases them. If discomfort persists for five days, or if squeezing the relaxed tendon is painful, it's time to see a doctor.

Traditional stretches should be part of a dancer's routine before tendonitis sets in. Once a tendon gets irritated, stretching will make it worse. "The way you rest a tendon is you don't pull on it," Martin says, which is why a sturdy shoe with a thick one- or two-inch heel can relieve Achilles tendonitis outside the studio. Constantly wearing heels is not good, though, because it shortens the Achilles over time.

Taylor Gordon battled Achilles tendonitis for three years before having surgery. Photo by Laura Keller, courtesy of Gordon

Worst Case Scenario

By the time Gordon saw a doctor in 2009, her Achilles tendonitis had developed additional bursitis, which is when the bursa, a small sac of fluid that cushions where the tendon joins the bone, also becomes severely inflamed. She did a year of physical therapy, with treatment focused on relief: deep calf massages and electrical muscle stimulation for the pain.

An MRI revealed a small tear in her Achilles, as well as a pointy protrusion on the back of her heel known as Haglund's deformity, which causes the Achilles to rub against the heel bone. It had been contributing to her condition, which was now extremely serious.

Gordon decided to have surgery. Doctors shaved down the pointy end of her heel bone and removed the inflamed bursa. She then returned to intensive physical therapy to strengthen her calf muscles and align her ankles. Within three months, she was taking classes and working to retrain her turnout, which she had been forcing all her life, a habit that caused her feet to pronate and irritated her Achilles.

Don't Count on Luck

Martin points out that a structural abnormality is far from the only cause of tendonitis, but it's another reason to see a doctor quickly. In a way, Gordon was lucky that her anatomy had been contributing to her tendonitis—it could be corrected with surgery.

Gordon, now a freelance dancer in New York City, says her left ankle is still not as strong as her right. She has to be careful when preparing for pointe work. She takes herself through barre exercises on flat before putting on pointe shoes, and if she needs to wait during an audition, she constantly rotates her ankles to keep them limber and warm. She also has developed more overall strength and anatomical knowledge through Pilates. "I'm much more body-aware now and doing everything I possibly can to avoid being in that situation ever again," she says.

Looking back, Gordon knows it was unwise to delay treatment, and Martin urges other young dancers to consider the long-term risks of that decision. "Try to see the forest for the trees," she says. "If you want to have longevity in this field, you have to look at it as this long trajectory. If you want to do this one thing, but it's going to take you out for the rest of your life, is it worth it?"

Gordon wouldn't recommend her own strategy. See a doctor soon, she says. "Don't let it last three years."

Technique
Nan Melville, courtesy Genn

Not so long ago, it seemed that ballet dancers were always encouraged to pull up away from the floor. Ideas evolved, and more recently it has become common to hear teachers saying "Push down to go up," and variations on that concept.

Charla Genn, a New York City–based coach and dance rehabilitation specialist who teaches company class for Dance Theatre of Harlem, American Ballet Theatre and Ballet Hispánico, says that this causes its own problems.

"Often when we tell dancers to go down, they physically push down, or think they have to plié more," she says. These are misconceptions that keep dancers from, among other things, jumping to their full potential.

To help dancers learn to efficiently use what she calls "Mother Marley," Genn has developed these clever techniques and teaching tools.

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Alwin Courcy, courtesy Ballet des Amériques

Carole Alexis has been enduring the life-altering after-effects of COVID-19 since April 2020. For months on end, the Ballet des Amériques director struggled with fevers, tingling, dizziness and fatigue. Strange bruising showed up on her skin, along with the return of her (long dormant) asthma, plus word loss and stuttering.

"For three days I would experience relief from the fever—then, boom—it would come back worse than before," Alexis says. "I would go into a room and not know why I was there." Despite the remission of some symptoms, the fatigue and other debilitating side effects have endured to this day. Alexis is part of a tens-of-thousands-member club nobody wants to be part of—she is a COVID-19 long-hauler.


The state of Alexis' health changes from day to day, and in true dance-teacher fashion, she works through both the good and the terrible. "I tend to be strong because dance made me that way," she says. "It creates incredibly resilient people." This summer, as New York City began to ease restrictions, she pushed through her exhaustion and took her company to the docks in Long Island City, where they could take class outdoors. "We used natural barres under the beauty of the sky," Alexis says. "Without walls there were no limits, and the dancers were filled with emotion in their sneakers."

These classes led to an outdoor show for the Ballet des Amériques company—equipped with masks and a socially distanced audience. Since Phase 4 reopening in July, her students are back in the studio in Westchester, New York, under strict COVID-19 guidelines. "We're very safe and protective of our students," she says. "We were, long before I got sick. I'm responsible for someone's child."

Alexis says this commitment to follow the rules has stemmed, in part, from the lessons she's learned from ballet. "Dance has given me the spirit of discipline," she says. "Breaking the rules is not being creative, it's being insubordinate. We can all find creativity elsewhere."

Here, Alexis shares how she's helping her students through the pandemic—physically and emotionally—and getting through it herself.

How she counteracts mask fatigue:

"Our dancers can take short breaks during class. They can go outside on the sidewalk to breathe for a moment without their mask before coming back in. I'm very proud of them for adapting."

Her go-to warm-up for teaching:

"I first use a jump rope (also mandatory for my students), and follow with a full-body workout from the 7 Minute Workout app, preceding a barre au sol [floor barre] with injury-prevention exercises and dynamic stretching."

How she helps dancers manage their emotions during this time:

"Dancers come into my office to let go of stress. We talk about their frustration with not hugging their friends, we talk about the election, whatever is on their minds. Sometimes in class we will stop and take 15 minutes to let them talk about how their families are doing and make jokes, then we go back to pliés. The young people are very worried. You can see it in their eyes. We have to give them hope, laughter and work."

Her favorite teaching attire:

"I change my training clothes in accordance with the mood of my body. That said, I love teaching in the Gaynor Minden Women's Microtech warm-up dance pants in all available colors, with long-sleeve leotards. For shoes, I wear the Adult "Boost" dance sneaker in pink or black. Because I have long days of work, I often wear the Repetto Boots d'échauffement for a few exercises to relax my feet."

How she coped during the initial difficult months of her illness:

"I live across from the Empire State Building. It was lit red with the heartbeat of New York, and it put me in the consciousness of others suffering. I saw ambulances, one after another, on their way to the hospital. I broke thinking of all the people losing someone while I looked through my window. I thought about essential workers, all those incredible people. I thought about why dance isn't essential and the work we needed to do to make it such. Then I got a puppy, to focus on another life rather than staying wrapped in my own depression. It lifted my spirit. Thinking about your own problems never gets you through them."

The foods she can't live without:

"I must have seafood and vegetables. It is in my DNA to love such things—my ancestors were always by the ocean."

Recommended viewing:

"I recommend dancers watch as many full-length ballets as possible, and avoid snippets of dance out of context. My ultimate recommendation is the film of La Bayadère by Rudolf Nureyev. The cast includes the most incredible étoiles: Isabelle Guérin, Élisabeth Platel, Laurent Hilaire, Jean-Marie Didière, who were once the students of the revolutionary Claude Bessy."

Her ideal day off:

"I have three: one is to explore a new destination, town, forest or hiking trail; another is a lazy day at home; and the third, an important one that I miss due to the pandemic, is to go to the Cathedral of Saint John the Divine, where my soul feels renewed by the sermons and the music."

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Annika Abel Photography, courtesy Griffith

When the murder of George Floyd in Minneapolis last May catalyzed nationwide protests against systemic racism, the tap community resumed longstanding conversations about teaching a Black art form in the era of Black Lives Matter. As these dialogues unfolded on social media, veteran Dorrance Dance member Karida Griffith commented infrequently, finding it difficult to participate in a meaningful way.

"I had a hard time watching people have these conversations without historical context and knowledge," says Griffith, who now resides in her hometown of Portland, Oregon, after many years in New York City. "It was clear that there was so much information missing."

For example, she observed people discussing tap while demonstrating ignorance about Black culture. Or, posts that tried to impose upon tap the history or aesthetics of European dance forms.

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