Dancing is a profession for some and a form of recreational exercise for many others. Although beautiful this strenuous art form places unusual demands on the body, particularly the feet.
A review of some common foot problems found in both recreational and professional dancers follows.
Hallux Rigidus or Hallux Limitus
This condition is characterized by pain and/or restriction of movement at the joints of the big toe.
To achieve full demipointe the metatarsal phalangeal joint must be able to make a 90 deg. angle. Dancers who start later in life may lack this much mobility.
A dancer without mobility who forces a high demipointe will cause the bones in the joint to impinge on each other. If this is done repeatedly, impingement spurs will develop leading to even further decreased motion in the joint, inflammation and eventual degeneration of the joint.
Compensations for lack of full mobility include sickling. This position will decrease impingement but it is not an esthetically acceptable line and puts the dancer at risk for ankle sprains.
An acceptable and safe compensation for this condition is a half-demipointe position. The dancer must learn to rise onto the ball of the foot without forcing the foot into full demipointe.
Treatment for hallux rigidus is rest and ice in the acute stages. Ice massage (rubbing an ice cube on the big toe joint for 5 minutes) will help to decrease the inflammation.
A toe spacer placed between the big toe and the second toe will help align the toes for optimal motion in the joint. Stretching of the foot can be done to help improve flexibility. The stretch into a demipointe position can be done in a non-weight bearing position, in a pain free range and should be held for 30 seconds.
The dancer should assess the available pain free range of the joint and learn to work within that range. Mobilization of the metatarsal phalangeal joint by an experienced physical therapist is also quite effective.
This condition is characterized by pain on the bottom of the foot near the heel. The possible causes and treatment are discussed thoroughly in another Physical Therapy Corner: Plantar Fasciitis. Special considerations for the cause of this condition in dancers include:
• Forcing a high demipointe.
• Achieving the turnout of the legs by rolling over the feet and letting the arches collapse.
• The "dancers run" which requires the dancer to run on the balls of the feet.
The dancer can treat this condition as described in Plantar Fasciitis. It is not usually possible to alter footwear for dancing. However, when not dancing, shoes with a good arch support and a stiff sole should be worn. The dancer should also evaluate their technique to correct over-turnout, forcing demipointe or running and jumping without letting the heel reach for the floor.
This condition is characterized by pain and tenderness along the ball of the foot. For dancers, this condition is commonly caused by instability in the joints of the smaller toes. Sprains and overstretched ligaments lead to laxity in these joints.
Typically overwork and years of forcing of extreme motion in the foot leads to laxity and subluxation of these joints.
Treatment for this condition includes strengthening the muscles that curl the toes under. This can be done with towel scrunches. General strengthening of the lower leg and ankle can also help increase stability of the toe joints.
A metatarsal pad can help prevent subluxations and may relieve pain.