Common foot conditions associated with dance and their treatments

“Dancing is like dreaming with your feet” this age-old quote quite rightly reflects the beauty of dance. Many of us can vouch to have felt the same while dancing to our favourite beats. Dance can be an exhilarating experience, keeping us fresh and fit if done regularly. But without proper care and precautions, this dream can quickly turn into a nightmare for our feet.  

Dance is a form of art that has been around for centuries. It requires a lot of physical and psychological dedication. Professional dancers train for years to achieve the motor control and flexibility required to flawlessly execute complex dance routines. These training sessions can be extremely rigorous and last for several hours at a time. Foot and ankle injuries are extremely common amongst dancers, especially female ballet dancers. These can be a result of sudden trauma due to improper landing or more commonly due to repetitive insults during excessive training.  

The most common foot and ankle problems that plague dancers are: 

Ankle Sprain 

Almost every dance form from ballet to freestyle and even contemporary places importance on leg and foot stretches. Every dancer can claim to have had an ankle sprain at least once in their career. This usually happens due to any injury while performing dance moves. Improper training or overexertion can weaken the ankle and increase the risk of developing this problem.  

There are multiple joints, ligaments and tendons located in the foot and ankle region holding the ankle joint in its place and allowing up-down and side-to-side motion of the foot. In a typical ankle sprain, any one of these ligaments are torn or severely stretched. 

Based on the severity of the condition, ankle sprains can be classified into three different grades. Grade 1 means mild severity while grade III suggests severe injury to ligaments on both sides of the ankle. Common symptoms of an ankle sprain include inflammation, swelling, bruising, redness and rise in temperature of the affected ankle.  

But are ankle sprains serious? 

Many of us are guilty of underestimating sprained ankles and regretting the decision later on. Ankle sprains should always be checked by a medical expert. An untreated ankle sprain can result in far more severe problems such as: 

• Chronic pain 
• Loss of stability or balance resulting in recurrent sprains 
• Altered gain can cause injury to the other foot 
• Arthritis  

The initial management of ankle sprain is commonly remembered using the acronym “RICE”. It stands for 

• Rest to avoid worsening the injury 
• Ice to reduce swelling inflammation and redness 
• Compression to minimise swelling, an elastic bandage is generally used on the foot to control blood flow 
• Elevation to stimulate the body to soak extra fluid from the ankle 

If the pain in the ankle is extremely severe, the doctor may recommend other treatments such as a brace, cast etc. Physiotherapy may be required after the pain settles to combat stiffness, weakness and regaining stability of the ankle is needed to get back to pre-injury status. 

Stress Fracture 

Long gruelling practice sessions are almost synonymous with dance. These strenuous practice sessions result in a lot of pressure on the foot muscles and bones. Over a period of time, this habitual overexertion and recurring pressure or stress on the bones can result in a type of fracture called stress fractures. It is usually diminutive and as small as a tiny crack in the bone.  

Symptoms of stress factors include pain while performing any particular activity that involves the affected bone, pain in touching the affected area, and swelling over the region of fracture. 

If stress fractures remain untreated, they can worsen resulting in a major fracture. Experts generally suggest a reduction in activity and use of orthopaedic devices such as braces, walking boots, cast among others to reduce the load on the bone. For severe cases, surgery can also be performed.  

Dancer’s Fracture 

One tiny misstep or trip during a complex dance routine can result in a fracture in the outer aspect of the foot (fifth metatarsal bone). The fifth metatarsal bone is found below the little toe. The line of the fracture is usually spiral-shaped throughout the bone and can also cause cracking of the bone into smaller parts. This type of fracture is also commonly called the “dancer’s fracture”. Some of the most common mechanisms of dancer’s fracture include awkward landing after jumps or rolling on the outer border of the foot during demi-pointe position in ballet dancers.  

Dancer’s fracture usually presents as swelling, pain, and bruising in the outermost region of the foot. The treatment protocol is similar to other foot fractures and can take 6-12 weeks to heal. 

Dancer’s heel 

Notice a hard bump at the backside of your ankle? It is probably a “Dancer’s heel”. Dancer’s heel, also known as posterior ankle impingement syndrome, develops when the tissue and bone present behind the ankle gets compressed to form a hard bone-like bump. Ballet dancers who practice the pointe technique for prolonged periods of time often complain of the dancer’s heel. There might also be a bony growth at the back of the ankle (Os trigonum or Steida’s process) which may exacerbate the problem. In these dancers, achieving a full pointe position can trigger pain in the back of the ankle on the outer aspect. Many of them may have adjoining inflammation of the tendon (muscle) of the big toe. This condition is called FHL tenosynovitis and moving the big toe may cause pain. 

If the ankle pain caused by the dancer’s heel is limiting one’s daily activities and/or dance, they should seek medical attention for proper diagnosis. The treatment procedure generally includes physical therapy to strengthen and mobilize the ankle, avoiding movements and positions that trigger the pain and medication to manage the pain. If the patient does not respond satisfactorily to these treatments, the doctor can also suggest surgical treatments. 

Curled toes leading to Hammertoe 

After years of ballet, one may notice slight bending of the toes. This can result in a deformity called hammertoes. Hammertoes is a deformity where the middle joints of all the toes except the big toe bend. This deformity is commonly seen in ballet dancers attempting the full-pointe position as well as individuals wearing small/tight-fitting shoes. This deformity results in an additional force on the toes while wearing shoes. This in turn results in pain and callus formation on top of the toe.

Hammertoes, if untreated can become worse and more prominent with time. Doctors treat hammertoes through non-surgical methods like a change of footwear, padding and stretching exercises. Although if the condition becomes too severe, surgery might be the only treatment option. 

The sudden appearance of Ingrown toenail 

Anyone who has had an ingrown toenail can vouch for how uncomfortable and painful it is. Training in shoes that are too tight can result in this condition. Ingrown toenail refers to a medical condition wherein the nail grows into the skin from the edges and corners rather than outwards. This results in inflammation, pain, redness and even infection. This problem is especially dangerous for people suffering from peripheral vascular disease or diabetes. It is also a common issue amongst dancers with sweaty feet. Cutting nails too short, injury, history in the family are some other common causes of an ingrown toenail. 

But does ingrown toenails require medical intervention?

It would require medical intervention if the ingrown toenail results in an infection. In some cases, the doctor may pull out the nail from the affected region and apply medication to heal the wound and protect it from infections. But if the problem persists, then toenail avulsion may be recommended. Toenail avulsion is a surgical method to remove the nail partially or completely. If you frequently face the problem of ingrown nails, you should seek medical consultation to know the available treatment options 

Also, read: From bunions to hammertoes: How to avoid the shoes that kill your feet

Some foot care tips for dancers 

When it comes to personal grooming, we often overlook our feet. Little do we realise that if foot problems go untreated, it can result in lifelong disability. For dancers, their feet are their livelihood and are at a higher risk of injury. Dr Anuj Chawla who is known to be one of the best orthopaedic doctors in Gurgaon (at present, consultant – orthopaedics at the CK Birla Hospital, Gurgaon) suggests some preventive measures which can be helpful to avoid common dance induced foot conditions: 

• Follow a healthy balanced diet and keep yourself hydrated 
• Incorporate plenty of Vitamin D rich food into your daily diet. Get treated for Vitamin D deficiency and osteoporosis if detected 
• Choose a dance form that is more appropriate for you 
• Be careful not to overexert yourself and give yourself time to rest between practices 
• Make sure to train all the muscles of the body and not just your legs. This will help to strengthen all the muscles and prevent excessive stress on the feet 
• Wear professionally fitted shoes with good soles and support 
• Always perform warm-up exercises before practising the dance moves. 

Read: Severe pain in heels during the morning: do I have Plantar Fasciitis?