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I was wondering if anyone had any thoughts or ideas on this case study.
I am currently treating a 21 year old female who is a competitive highland dancer. She is extremely hypermobile! Abnormal subtalar joint pronation is extreme.
She has a previous history of achilles tendonitis and now currently has shin splints. She is currently taking time out from her dancing with a hope to return in the future.
I have managed to provide her with an orthotic providing her with adequate correction which she wears all the time. She was also advised ice, rest, NSAIDs etc. Her symptoms had greatly improved until she decided to back to dancing. The shin splints began to creep back!
Her sports therapist has provided her with a strapping technique which aims to limit pronation but this has so far been unsuccessful!
I was wondering if anyone had any experience of adapting flimsy dance shoes to provide more support? Adding valgus domes? Or if anyone had ever used some sort of ankle support?
Long answer. Highland dancing is mainly up on demi point. As such any rearfoot of midfoot support relying on ground reaction force is going to struggle (on account of this bit of the foot no being on the ground). Also if the shoes are rounded underneath then the whole unit can bounce around as it likes. Putting an orthotic in that is like putting a seatbelt on a bicycle.
I would suggest a good firm ankle support would be worthwhile. There are lots to choose from, I've been know to use a support designed for inversion sprains in the opposite foot. Or, at a slightly gentler level, you could try Nustimwrap. Works more often than you might think.
Also be aware that if what you describe as shin splints is Medial tibial stress syndrome it may not be so much the pronating as the landing which is causing the problem. There is a very good thread on MTSS on here if you do a search (or if a kindly mod happens by with a link).
Long answer. Highland dancing is mainly up on demi point. As such any rearfoot of midfoot support relying on ground reaction force is going to struggle (on account of this bit of the foot no being on the ground). Also if the shoes are rounded underneath then the whole unit can bounce around as it likes. Putting an orthotic in that is like putting a seatbelt on a bicycle.
I would suggest a good firm ankle support would be worthwhile. There are lots to choose from, I've been know to use a support designed for inversion sprains in the opposite foot. Or, at a slightly gentler level, you could try Nustimwrap. Works more often than you might think.
Also be aware that if what you describe as shin splints is Medial tibial stress syndrome it may not be so much the pronating as the landing which is causing the problem. There is a very good thread on MTSS on here if you do a search (or if a kindly mod happens by with a link).
I would suggest that after reading the MTSS thread and you think it could be the bending moments on the Tibia causing the problem - you may want to try a FF varus wedge in the dance shoes.
If the shoes are basically leather socks - ghillies I presume - some FF varus wedge taped to the foot might work as the shoe has no structure to hold it but reducing the bending moments will be key.
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Maybe check out Arch Angels - they are shock absorbing, heat moldable insoles designed to specifically fit into ballet and pointe shoes so I presume they would fit into highland shoes.
I have not actually used them or seen them but came across their website recently.
As a dancer myself, with a symptomatic pes pancakus, I've fiddles with a while lot of bits and pieces for dance shoes. In my shoes (which are ballroom pumps and jazz sneakers), I'be had success with a very thing multidensity EVA device, almost like a casted insole. It's not as supportive as my everyday orthotics, but it will get me through a night of dancing without too much pain. As for a ladies dance heel, I have had a play with a little something, built around the idea of a tri-planar wedge which I've use successfully with a few ladies now. I'm having trouble attaching a picture, but am more than happy to email through a couple of the devices I've made.
Bear in mind they're not perfect. It's not going to be as supportive or corrective as a propper orthotic device, however it can shift forces enough to limit the discomfort and get a dancer through a session without too much discomfort.
Cheers!
I have had some success with taping. Starting from the lower third medial tibial border and spiralling laterally up the leg, applying tension when moving laterally and relaxing when coming back round medially, as a quick fix/get me though a session.
Shin splints can mean anything in the leg and is a very poor term (sorry just a bugbear of mine), it can sit in the box with metatarsalgia
Shin splints can mean anything in the leg and is a very poor term (sorry just a bugbear of mine), it can sit in the box with metatarsalgia
Have to aggree with you on this!!! I steer clear as much as I can... A pet hate when a patient says I have shin splints because suchnsuch (insert medical profession) told me I did...
I have tryed using the Neurodyn pluss ankle brace but using the Lt on the Rt and vice vesa (because the design is to limit supination) and that worked quite well but it was in a less active pt or you coudl try the Ossur Bio skin ankle brace with fig 8 wrap and it will provide some support.
Last option and i havet tryed it but it looks interesting is Jobskin are making a dynamic lycra lower leg garment to resist over pronation so you could contact them to see what they think.
If yu are going into ankle bracing ect i woudl recomend a refferal to an orthotist though.
Hi Nikki, im not sure if you have tried anything like this before but it has worked for my dance/ trampoline sports patients in the past.
http://footcareunlimited.com/FS6
(Hope im aloud to post that kinda thing up. appologies if not.)
(( and no i dont work for or have any affiliation with this product haha))
Limiting pronation in a dancing shoe!
Re: Limiting pronation in a dancing shoe!
Re: Limiting pronation in a dancing shoe!
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