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Has anyone had much experience with complications arising from dancing, ballet, tap etc...? What are the most common foot injuries related to dance? and how are they best managed?
(I am being hounded by the PTs I work with for better management of dancing injuries they see through their clinic, and I haven't personally seen enough cases).
Any info would be appreciated. :)
Cheers,
Adam
Ballet:
Unique and specific repetitive high impact movements of ballet performed on a daily basis --> ? increased risk for injury.
For children --> popular activity – can improve mobility, co-ordination and confidence and can help as adjunctive treatment for gait disorders (eg in toe gait).
For adolescents --> the added burden of beginning to make a commitment to a career path in dance, with increased training loads, just as the adolescent growth spurt starts --> may temporarily affect technique and increase risk for injury. This is also a time in which a number of emotional issues are occurring for the adolescent --> challenge to manage.
Ages:
• no generally accepted lower age limit to start ballet training
• need to focus on “pre-ballet” up until about age 8 with more formal training after that
• toe (pointe) dancing should not be used in children unless they are planning on becoming a professional dancer and should be preceded by 3-5 years of proper ballet instruction. Should be at least 11 – 12 years old. This also assumes that the strength and range of motion is available to carry out this.
Demi pointe:
• stand on metatarsal heads – MPJ, are maximally dorsiflexed – need 80º to 100º
• should only begin when lower extremity is strong enough to maintain balance
En pointe:
• stand on end of toes
• foot is in extreme plantarflexed position --> predisposes to pathology
• forefoot is generally abducted relative to rearfoot --> foot pronated --> predisposes to pathology
Turn-out:
Turn out stance --> abductory force on foot --> subtalar and midtarsal joint pronation if cannot get full 180º at hip --> foot pathology associated with the excessive pronation. This also may be affected by variation the putative STJ and MTJ joint axes positions --> may be able to get more transverse motion (adduction) of foot with minimal calcaneal eversion.
Plie:
• flexed knee position with or without heels on the ground --> forced to end range of motion of ankle dorsiflexion --> increased risk for anterior ankle impingement problems.
• may pronate foot to flex knee more (incorrect technique)
Common injuries in ballet dancing:
• foot & toes (24%); ankle (13%); leg (6.1%); knee (6.8%)
• low back pain (up to 80% may have history of low back pain) – often associated with increased lumbar lordosis
• Dancer’s hip – a painful ‘snap’ on the medial and anteromedial aspect of hip when the leg descends from a position of full abduction and external rotation – tendonitis of iliopsoas tendon as it impinges on the neck of the femur.
• stress fractures – especially base of second metatarsal; cortex of first and second metatarsal thickens with time in response to pointe work --> stress fracture if sudden increases in workload or pointe work started prematurely
• overuse syndrome at base of second metatarsal seems to be a unique problem to ballet
• flexor hallucis longus tendonitis (especially at posterior medial aspect of ankle) – has been reported as being associated with trigger hallux
• os trigonum syndrome/posterior impingement (can be confused with flexor hallucis longus tendonitis).
• hallux abducto valgus has been shown to not be more common in dancers compared to non-dancers .
Footwear for ballet dancing:
• designed to fit foot like glove --> provide no shock absorption or stability to foot; different shoes have different amounts of flexibility/stiffness
• pointe shoes have rigid toe box and firmer shank – body weight is taken on tips of second and first toes on the toe box – broader toe boxes increase stability
• toe box is cardboard or paper mache --> when looses structural integrity, shoe should be replaced
• some brands do have a thermoplastic shank --> can be used to give some support
Orthoses management in ballet dancing:
- need to use strapping and other modalities
- molded silicone devices can be used in the end of shoes to accommodate digital problems
- orthoses can be used in everyday and warm up footwear, but not performance footwear
- may get away with thin insole/support with some balance/posting that fits in ballet shoes
- Braver (2000) described a foot orthoses for use in ballet with a sulcus length flexible shell with cut outs or posting adhered to the extended shell – it is attached to the foot with an elastic band around the midfoot and a “thong” strap between the first and second toes.
- Green has developed and orthoses to put pressure in the arch area to increased what is suggested as a contraction of the intrinsic muscles when the heel is off the ground via a sensory mechanism
Hi Adam,
years ago in London I lived in a house full of ballet dancers. I was interested in Pod but was told it was to be kept a male profession so I never looked further. But if you want to learn about them, put a flyer up in a dance school. Yoou will gets lots of enquiries. Carole P>S> love Burtitis.
Quote:
Originally Posted by Berms
Has anyone had much experience with complications arising from dancing, ballet, tap etc...? What are the most common foot injuries related to dance? and how are they best managed?
(I am being hounded by the PTs I work with for better management of dancing injuries they see through their clinic, and I haven't personally seen enough cases).
Any info would be appreciated. :)
Cheers,
Adam
Maintaining an Arch
Would you use basic taping techniques to create an arch or are there insoles suitable for ballet shoes. A ballet student has been told that aesthetically she needs a better defined arch. I would prescribe basic insoles for her anyway, but do not know how to deal with the problem of ballet shoes
Angela
Remember...dancers are real people too. :p Not all their problems are dance related. :)
__________________
''The bottom line is too many people prescribe devices who haven't got the faintest idea of what they are doing. There are certain unscrupulous labs supporting this. There are too many people in it for the money.'' paraphrasing Simon Spooner
Angela, apart from proprioceptive aspects, insoles really only work during weightbearing (many ballet movements involve the arch being out of contact with the ground) and would probably restrict the dancers' turn-out position. I think you'd get a better result from taping, particularly since toe shoes are so flexible that they wouldn't maintain the feet's position on the insoles in any case.
I agree with LCBL though. I'd deal with the issues when she's out of her ballet shoes separately...
Thanks for your advice guys. I have recommended insoles for other footwear. She feels that her jazz shoes may accomodate them but she did not bring them with her. I have also gone through taping with her. Low or high dye is best?.
Angela
Background: Although there is no ideal foot type for classical dancers, second-toe length seems to be a factor in the etiology of foot disorders in ballet dancers.
Methods: We investigated the relationship between second-toe length and foot disorders in 30 ballet dance students and 25 folk dance students. Second-toe length in relation to the hallux (longer or equal/shorter), hallux deformities, first metatarsophalangeal joint inflammation, number of callosities, and daily pain scores were recorded in both groups and compared.
Results: There was no statistically significant difference in toe length between the two groups (P > .05). Ballet dancers with equal-length or shorter second toes had lower pain scores, less first metatarsophalangeal joint inflammation, and fewer callosities in their feet compared with dancers with longer second toes.
Conclusions: Second-toe length seems to be a factor in the development of forefoot disorders in classical ballet dancers but not folk dancers. Dancers who have equal-length or shorter second toes in relation to the hallux may have fewer forefoot disorders as dance professionals.
The influence of second toe and metatarsal length on stress fractures at the base of the second metatarsal in classical dancers.
Davidson G, Pizzari T, Mayes S. Foot Ankle Int. 2007 Oct;28(10):1082-6.
Quote:
BACKGROUND: Stress fractures at the base of the second metatarsal frequently occur in female classical dancers. There is a strong belief that a foot shape in which the first metatarsal or toe is shorter than the second metatarsal or toe increases the risk of this injury in dancers. However, there is a lack of empirical evidence to support this theory. The objective of this study was to examine the influence of the relative length difference between the first and second metatarsals and first and second toes on the frequency of stress fractures at the base of the second metatarsal in elite, female classical dancers.
METHODS: Both feet of 50 elite female classical dancers were measured for length differences between the first and second toes and first and second metatarsals. Retrospective analysis of dancers' medical histories revealed 17 feet with stress injury and 83 without. The mean of the difference between the metatarsal and toe length for the stress-injury group was compared to that of the control group.
RESULTS: No difference between the groups was identified for first and second toe length difference (p = 0.865) and the relative difference between the ends of the first two metatarsals (p = 0.815).
CONCLUSIONS: Dancers who had a stress injury at the base of the second metatarsal displayed similar variances in the two independent variables as dancers who had not had such an injury.
Thanks for the advice everyone.
I will pass this on to the two dancers I am now looking after. One is much younger and not yet training full time, while the other is at college and arch height and shape is much more important
Angela
Injury patterns in elite preprofessional ballet dancers and the utility of screening programs to identify risk characteristics.
Gamboa JM, Roberts LA, Maring J, Fergus A. J Orthop Sports Phys Ther. 2008 Mar;38(3):126-36.
Quote:
STUDY DESIGN: Retrospective descriptive cohort study. OBJECTIVES: To describe the distribution and rate of injuries in elite adolescent ballet dancers, and to examine the utility of screening data to distinguish between injured and noninjured dancers. BACKGROUND: Adolescent dancers account for most ballet injuries. Limited information exists, however, regarding the distribution of, rate of, and risk factors for, adolescent dance injuries.
METHODS AND MEASURES: Two hundred four dancers (age, 9-20 years) were screened over 5 years. Screening data were collected at the beginning and injury data were collected at the end of each training year. Descriptive statistics were used to characterize distribution and rate of injuries. Inference statistics were used to examine differences between injured and noninjured dancers.
RESULTS: Fifty-three percent of injuries occurred in the foot/ankle, 21.6% in the hip, 16.1% in the knee, and 9.4% in the back. Thirty-two to fifty-one percent of the dancers were injured each year, and, over the 5 years, there were 1.09 injuries per 1000 athletic exposures, and 0.77 injuries per 1000 hours of dance. Significant differences between injured and noninjured dancers were limited to current disability scores (P = .007), history of low back pain (P = .017), right foot pronation (P = .005), insufficient right-ankle plantar flexion (P = .037), and lower extremity strength (P = .045).
CONCLUSION: Distribution of injuries was similar to that of other studies. Injury rates were lower than most reported rates, except when expressed per 1000 hours of dance. Few differences were found between injured and noninjured dancers. These findings should be considered when designing and implementing screening programs.
I am a former professionally trained ballet dancer in NYC and now a Certified Pedorthist. My career ended abruptly---attributed to what I found out was a fractured fibular sesamoid bone. Most of the pain in my feet as a dancer, occured on the ball of the foot with symptoms of neuroma as well.
I attribute the sesamoid fracture to a few things: 1) anorexia and low caloric intake/possible loss of bone mineral density 2) lots and lots of walking in Manhatten and 3) the nature of ballet and the hours and hours doing it.
Since the surgery my foot has never been the same. I have to limit my walking; cannot run; and cannot wear high heels. My foot tends to swell in the heat. I also have had fairly severe reynaud's syndrome in my toes only, and moved to the Southwest.
I currently work at eSoles in Scottsdale, AZ
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As a dancer myself (with a severe symptomatic pes planus), I've experemented with a couple of different ideas in terms of padding and insoles in my dance shoes. Grinding up some PPT poron/low density EVA into an arch cookie with other accomodations (i.e. cuboid notch ect) will often be enough to get the patient through the dance sessions, provided they are wearing their orthoses (if they have some) the rest of the time. I've had some really good success in my ballroom shoes and jazz sneakers with 120-150 density EVA custom devices. Keep them narroy, and slightly longer than you normally would for an every day pair of orthoses. They will bend sufficiently with the shoes, and are great for ballroom, latin, jazz, tap etc. Be aware, they will be too bulky for ballet. As for ballet dancers, there's a product called an 'Arch Angel' which I've used in pateints with some good success. basically they are a 2 part plastic plate with a bent piece of plastic in the middle. They fit into balet slippers and will move with them brilliantly. I get them from www.archangels.com.au Have a look, see how you go. Anyways good luck with it!!!
Cheers!
__________________
Adrian Misseri
B.Pod.,M.Hlth.Sci.(Pod.)
You know.. we could just cut it off.....?
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Has anyone had much experience with complications arising from dancing, ballet, tap etc...? What are the most common foot injuries related to dance? and how are they best managed?
(I am being hounded by the PTs I work with for better management of dancing injuries they see through their clinic, and I haven't personally seen enough cases).
Any info would be appreciated. :)
Cheers,
Adam
My experience is that ballet dancers do not like anything in their ballet shoes, as they cannot feel the ground as well. In the past I have used leather insoles, and felt pads to no avail.
I now do manual therapy, and this works well. I work on balancing the pelvis, eliminating equinus, and then concentrating on the various foot dysfunctions treated by manual therapy:posterior calcaneus, lateral talus, lateral cuneiform, 3rd met cuneiform, dropped cuboid, foot compression, and dropped metatarsals. I have my own techniques for these, as I do not like to manipulate. There is a lot more involved, including acupuncture/pressure to get the muscles to function properly.
Start small and learn as much as you can. I know of one podiatrist that just does Danenberg's manipulation for equinus before each performance on every performer for a professional ballet company.
Regards,
Stanley
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