A Guide To Diagnosing And Treating Common Dance Injuries

Lisa M. Schoene, DPM, ATC, FACFAS

   When these intrinsic and extrinsic factors intersect, they will be the recipe for injury. Although there are some factors in the extrinsic category that dancers may not have complete control of, they can modify many of the intrinsic factors. It is the job of the physician and physical therapist to educate all dancers, especially the youngest ones, so they can learn to manage their bodies more effectively.

An Overview Of Common Dermatological Issues For Dancers

Dermatological issues may appear minor in comparison to musculoskeletal issues but calluses and corns can be painful and debilitating to the dancer. Pressure can create a blister, corn or even a small ulcer on toes and joints. Wearing the pointe shoe or other tight dance shoes can be excruciating but the dancer is obliged to remain on stage, smiling and dancing. Floor burns, blisters or splinters can occur if dancing or walking around the studio barefoot.

   Proper foot hygiene is important for the dancer. Regularly trimming nails and calluses will keep them from causing more pressures. Nail injuries are the norm due to the various techniques and shoe gear. Many dancers have dystrophic nail plates or develop infected nail grooves. Trimming and filing down nail thickness can help with excessive pressures in the dance shoes. Dancers can quickly and easily treat nail issues with great relief and minimal effort and downtime.

Addressing Posterior Ankle Issues

Eighty-five percent of all dancers will have a musculoskeletal injury during their career with over 50 percent of these injuries occurring in the foot or ankle.2 Typically, the majority of all lower extremity injuries will be overuse in nature although the ankle sprain is one of the most common traumatic dance injuries.

   Posterior ankle issues may include os trigonum impingement syndrome; an irregular posterior process of the talus causing impingement; posterior synovitis of the ankle and/or subtalar joint capsule; Achilles tendonitis and/or retrocalcaneal bursitis.

   Although the Achilles and bursa issues are less common, they can still occur in the dancer. They may be precipitated by a change in shoe gear, choreography with more jumping or varied footwork, or deeper plié type movements, which will really challenge the tendon and bursa. Similar to treatment for our typical patients, the use of a higher heel can help alleviate pain and adding a small lift for dance shoes may be beneficial as well.

   Other conditions on the posterior side will induce pain when the dancer is in the en pointe position (plantarflexed). The tissues can get impinged and cause trouble with any of the posterior structures. True synovitis and thickening of the posterior capsules of the ankle and/or subtalar joints are very common. From the constant and extreme deep stretching of the posterior tissues, an unusual thickening of the posterior capsular tissues may occur. The joint fluid becomes inflamed and the excessive tissues can protrude slightly. This causes the joints to not articulate properly, leading the dancer to report having a “jammed” and/or “full” feeling in the posterior ankle. She may also say that it feels like the ankle needs to be “popped” or adjusted.

   Os trigonum impingement has similar symptoms. If one decides that os trigonum impingement is the only issue occurring and conservative therapy fails, excision may be the best option but the clinician should time this appropriately in such a way as to minimize downtime for class schedules, rehearsals or performances.

Getting To The Bottom Of Anterior Ankle And Foot Dilemmas

Anterior ankle and foot issues may include anterior ankle joint impingement syndrome; anterior ankle bone spurs; tibial stress fracture; or anterior tendon and ligament pathology.
These injuries are painful when the dancer is in plié positions (dorsiflexed). The anterior ankle capsule can show signs of synovitis similar to the posterior conditions and this may occur concurrently. The dancer may develop a small lipping or spurring in the anterior ankle. This more typically occurs in a mature or retired dancer.

   A less common injury is the tibial stress fracture, which may be ongoing and undertreated for too long. This injury can lead to the dreaded “black line” so an involved fracture and a lengthy treatment course may ensue.

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