How To Identify And Treat Common Ballet Injuries

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What About First MPJ Sprains?

A plantarflexion sprain of the first metatarsalphalangeal joint is a painful injury that is slow to heal. It is caused by the toe of the ballet shoe catching on the floor and forcing the toe into plantarflexion.

You should treat this condition very conservatively and give it whatever time it needs to heal because tampering with it can result in osteophyte formation on the dorsum of the first metatarsal head where the capsule has been avulsed. Later on, this spurring can result in a hallux rigidus.

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Author(s): 
By Mark Caselli, DPM

How Shoes And Surfaces Contribute To Injuries
Traditional ballet shoes cost between $40 and $75 a pair. However, they can break down and wear out after only one demanding performance. Each shoe is handmade of satin and ribbon. The shoe allows for shock absorption by having a stiff cardboard midsole, cotton insole and a stiff cardboard outsole. Forming the tip of the shoe is glued canvas that allows dancing on full pointe. Be aware that because these shoes are handmade, there are often irregularities in the construction and fit of each shoe. This in itself can contribute to injury.
Injuries may also occur when the ballet shoes have worn out. Dancers know the shoe is worn out when it becomes too soft and no longer supports them en pointe. Many times, the shoe will collapse, causing the dancer’s foot to roll over when en pointe.
The dance surface is another variable that has great bearing on the dancer’s ability to perform adequately. Dance surfaces must provide adequate shock absorption yet be firm enough to provide sufficient energy return to the dancer to enhance performance and reduce fatigue. Surfaces that are too firm with little or no give (such as concrete and asphalt) may lead to early muscular fatigue because the musculoskeletal system of the lower extremities must act to absorb most of the shock. Once this system fails to absorb shock adequately, afflictions of the feet (e.g., stress fractures) may follow.
On the other hand, if a dance surface is too soft, this too can lead to early fatigue. In this situation, there is adequate absorption but inadequate energy return to the dancer, thus requiring considerably more effort to perform the desired movements. Early fatigue often leads to injury.

Inside Tips On Evaluating Common Foot Injuries
One should evaluate the ballet dancer’s foot problem in a sport-specific fashion. Instruct dancers to bring their slippers and pointe shoes to the evaluation so you can examine them for signs of abnormal stress or use and worn when appropriate. A general foot assessment is best supplemented by asking the dancer to perform the maneuvers or assume the positions that aggravate or induce the symptoms. If the movement permits, you can carefully palpate the affected region during that athletic stress.
You should keep an eye out for some of the following conditions:
Epiphysitis. The necessity for 90 to 100 degrees of dorsiflexion in the first metatarsalphalangeal joint has been noted. People are rarely born with this much motion in this joint, so it must be obtained by some molding of the growing epiphysis. This motion can result in an epiphysitis of the proximal phalangeal epiphysis during adolescence, which presents with tenderness, inflammation and pain with activity that is relieved by rest. The condition tends to recur, but disappears when the epiphysis fuses at maturity.

This condition, in many ways, resembles Osgood-Schlatter disease that is commonly seen in the adolescent’s knee and is known as Osgood-Schlatter disease of the foot. As far as treatment goes, you should emphasize modified activities for four to five weeks until the symptoms subside and then allow gradual resumption of normal routines as tolerated by the patient.

Treatment Advice For Bunions
Bunions. Bunions are common in dancers. They begin to develop at the end of the teens and occur in both male and female dancers. They are often symptomatic at the end of class, since the foot is forced into a tight shoe.
Padding with lamb’s wool around the tender area is a simple and effective means of relieving pain. Placing spacers between the first and second toes will usually make the foot more functional, as this alignment maintains maximum motion in the MPJ. The young female dancers with this problem should be encouraged to wear wide shoes (e.g., boy’s sneakers) and to resize their toe shoes often. It should be done at least yearly and every six to eight months if they are in a growth spurt.
If you’re treating a serious dancer, you should never operate on bunions because the operation, no matter how carefully it is performed, will usually limit the motion in the first MPJ.

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Anonymoussays: August 14, 2009 at 9:00 pm

This is very useful information! Thank you ver ymuch for sharing it!

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