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.