Treating Foot And Ankle Injuries In Ballet Dancers

By Mark A. Caselli, DPM
The dancer is unable to run, cut, jump or dance without a marked increase in discomfort or a feeling of weakness and lack of intrinsic support in the foot. Pressing on the plantar surface of the cuboid in a dorsal direction is painful. The normal dorsal-plantar joint play is reduced or absent when compared to the uninjured side. Severely subluxed cuboids leave a shallow but definite depression you will see on the dorsal aspect and a palpable fullness on the plantar aspect of the cuboid. Treatment usually involves a manual reduction called the cuboid whip. This reduction should be performed by a practitioner who is familiar with the condition. You may also need to repeat the maneuver. How To Address Metatarsal Stress Fractures Metatarsal stress fractures do affect ballet dancers, but the most common one you’ll see is at the base of the second metatarsal. As with many stress fractures, it is often difficult to see these injuries on the X-ray film, especially within a week or so of the onset of the symptoms. Persistent tenderness in the proximal first web space or around the base of the second metatarsal in a dancer usually indicates a stress fracture until proven otherwise. This condition is usually an indication for a bone scan. However, if the dancer is very young, you would simply instruct her or him to refrain from jumping and doing grand pliés until the pain and tenderness are gone. You usually don’t have to put this fracture in a plaster cast. Activity modification for six to eight weeks is usually sufficient for the fracture to heal providing the dancer has not been working on it for a prolonged period of time while it was hurting. If she or he has, it will probably take longer to heal. The most common acute fracture you’ll see among dancers is the spiral fracture of the distal one-third of the fifth metatarsal, also known as the “dancer’s fracture.” Dancers sustain this fracture when they lose their balance while on demi-pointe and roll over the outer border of the foot. If it’s a displaced fracture, it may be necessary to put the dancer in a walking cast for four to six weeks while it heals. (One can accept a considerable amount of displacement with this fracture.) In fractures that are minimally displaced, it is often sufficient to emphasize a comfortable running shoe and restricted activities until the fracture heals. This approach will allow dancers to swim and stay in shape while they are waiting to dance again. Occasionally, you may see a markedly displaced and comminuted fracture. In this case, performing reduction and internal fixation will be necessary. A Guide To Anterior Ankle Impingement And Os Trigonum Syndromes The extreme dorsiflexion required by the demiplié position in ballet can lead to impingement of the anterior lip of the tibia on the talar neck. Anterior ankle impingement results from osteophytes occurring on the anterior tibia and talar neck. The dancer’s first recognition of the syndrome is lack of depth in the plié, which is often associated with poorly localized ankle pain. With time, the dancer may experience more localized symptoms to the anterior aspect of the ankle. These symptoms often include mild swelling. You can attain symptomatic improvement by encouraging the use of a 1/4-inch to 3/8-inch heel lift in street shoes, antiinflammatories and having the dancer discontinue forced plié. Definitive treatment consists of excising the offending osteophytes, either arthroscopically or through an anterior arthrotomy. Keep in mind that you’ll often see secondary inflammatory changes involving the capsule, the fat pad and local synovium. An exostectomy merely extends the dancer’s career. Repeated impingement will invariably lead to recurrent exostoses, usually within three to four years. Repeat excision may therefore be required in some cases. While it is rare in the general population, posterior impingement of the os trigonum is common in dancers. In extreme plantarflexion, an os trigonum, a large posterior tubercle or less commonly, a large dorsal process of the os calcis, is compressed intermittently for periods of up to six hours a day from the dancer standing in the demi-pointe position. The dancer with symptomatic posterior impingement presents with posterior ankle pain aggravated by relevé and relieved somewhat by plantar grade stance.

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