Overuse injuries are more common than traumatic injuries, given the repetitive load requirements of dance coupled with the inability of the body’s tissues to withstand the demands that are imposed on them. The foot/ankle/lower leg area is vulnerable to a wide range of injuries, including stress fractures, tendon injuries, sprains, and strains.
Tendinopathy is commonly an overuse injury whereby the tendon becomes painful, stiff and swollen. The Achilles tendon and the Flexor Hallucis Longus tendon are two tendons that are commonly affected in dancers. Factors that contribute to the development of this condition include extrinsic factors such as flooring, changes in training schedule or poor technique. Intrinsic factors include tendon vascularity, gastrocnemius-soleus function and age/weight. Treatment includes rest, use of electro-physical agents such as low level laser therapy, activity modification, orthotic therapy and strengthening exercises.
Posterior Ankle Impingement
Posterior ankle impingement is a condition characterised by tissue damage at the back of the ankle joint due to compression of these tissues during maximal ankle plantarflexion. This condition is commonly associated with ballet dancers who require extreme range of motion in their ankle joint to achieve the en pointe position. The impingement may be associated with poor ankle joint mobility causing the tissues to become damaged when forcing the foot to an en pointe position. Soft tissue impingement can be caused by thickening or irritation of the FHL tendon, posterior joint capsule thickening or synovitis. In other cases a separate extra bone (os trigonum) may develop or extra bony growth on the talus may prevent the dancer from obtaining full ankle plantarflexion.
Initially conservative management should be the first line approach. This includes a period of rest and occasionally an immobilising boot be may be required. Physical therapy such as myofascial release, low level laser therapy, joint mobilisation and taping can help settle symptoms. Rehabilitation should address any biomechanical anomalies, muscular weaknesses or poor athletic technique that may be contributing to the development of the syndrome. In extreme cases or cases that do not respond to conservative care, a surgical opinion may be required.
Stress fractures are incomplete breaks of the bone. A stress fracture of the metatarsal typically occurs over time with excessive weight bearing activity such as running, sprinting, jumping or dancing. It is commonly associated with changes in the intensity of activity (i.e. sudden increase of activity) or changes in the training conditions (such as footwear, surfaces, etc.). It may also be caused traumatically such as a poor landing from a jump in dancers or landing from a height. Poor calf muscle strength can cause excessive forefoot loading and fatigue of these muscles in dancers may contribute to the development of this condition. It commonly affects the 2nd and 5th metatarsals.
The management of stress fractures requires a rest period from weight bearing aggravating activities for 6-8 weeks. In the initial phase of treatment an offloading walker is used for two to four weeks. Low level laser therapy may be useful in reducing pain, swelling and increase bony remodelling. Orthotic therapy may be required to help reduce abnormal load from poor foot mechanics. Exercises to improve the function of the intrinsic and extrinsic foot muscles may help to prevent recurrence.
How Your Podiatrist Can Help
Podiatrists are equipped to diagnose, treat, manage and prevent these injuries. We have the ability to refer for imaging if necessary, such as x-ray, ultrasound and other modalities if required. We also have a broad range of manual skills including, joint mobilisation, dry needling, myofascial release, strapping/taping along with rehabilitation and strengthening exercise prescription. We also offer the common podiatry modalities such as skin and nail debridement. The Perth Foot and Ankle Clinic offers Low Level Laser Therapy as an adjunctive therapy. This is a painless, effective and drug free treatment option that can be beneficial to the dancing population whereby other treatment options such as orthotics cannot be used.