Key Biomechanical Insights For Treating Dance Injuries
- Volume 20 - Issue 6 - June 2007
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After completing my residency and an orthopedics fellowship at the New York College of Podiatric Medicine, I quickly became a medical advisor to world-class athletes. In the dawn of the sports medicine era back in 1980, I joined a multidisciplinary dance-health facility and saw up to 30 dancers a day. New York City was the dance capital of the world and some surveys reported that 80 percent of dancers sustain career-threatening foot/ankle injuries.
Unfortunately, my biomechanics training applied more to the average Joe but not the dancer. I found that the concepts from Root and others who were founding fathers of podiatric biomechanics did not apply to dancers, who spent little time engaging their subtalar joints in ground reaction. Dance involved a fixed set of extreme positions, an archetypal soup for overuse injury. It did not seem like there was an exact way to measure ankle ranges of motion. I was rattled by these challenges. Then a soft-spoken dancer from A Chorus Line walked into my office and my life changed.
“Doc, I have Achilles tendonitis because I cannot point my foot all the way, see?” Although he actually had a posterior impingement injury in his ankle, what sobered me was his expectation that I would see a pathological lack of ankle plantarflexion. I did not have a clue what he was indicating. Realizing this might be an epiphany, I exposed my unjustified reputation and said, “Danny, what are you looking at?” Through poorly veiled surprise, he pointed to the dorsal surface of his foot distal to the talar neck and compared it to the distal sagittal third of his tibia.
A light went on for me. I was looking at what a dancer looks at when critiquing ankle plantarflexion. It was easier to see and precisely measure than published orthopedic methods that compared the fibula to the fifth metatarsal but were oblivious to the influences of the interposed joints. All I needed was a pencil, a little hardware store circular level or eventually just my eyes, and I could precisely measure talar plantarflexion.
Concentrating on foot and ankle function during dance, I carefully observed classes and performances. In a few months, I was able to use simple, accurate, replicable techniques to measure ankle ranges. Then I related these requisite ranges of motion to the common set of hallmark dance injuries. I was able to establish a database, based upon the 1,500 professional dancers I had already seen by the late 1980s, in which excesses or inadequacies in ranges correlated strongly with particular injuries. I have used and lectured about this framework in my dance injury practice, sports medicine practice and general podiatric practice throughout my career.
That said, let us take a closer look at some evaluation techniques and clinical implications with dance-related injuries.
A Guide To Active Plantarflexion (APF) Of The Ankle
All dancers need at least a straight line of foot versus leg. This is required in ballet dancers to pointe, in modern dancers to work on the floor, and in modern and ballet dancers to relevé and tendu. Those who have less than 180 degrees may suffer posterior ankle impingement injuries or midtarsal floor bruises throughout their career.
When it comes to treating APF of the ankle that is inadequate, there are conservative and surgical treatments to address the problem.
A frank lack of plantarflexion in a non-dancer may signal a posterior ankle ossicle. Sliding in baseball or wearing high-heeled shoes can create posterior impingement injuries as can similar hyperplantarflexion trauma.