Injuries: Foot Pain

(Please remember: Pain is your friend. It is signalling that there is a problem to be addressed. Do not ignore it. Seek professional advice.)

I woke up early with a post in my head…felt the need to write about feet. No, no…no foot fetish here. On the contrary…I actually have a very pronounced distaste for feet, toes in particular. Quickest way to get me off the couch is to touch me with your toes or, worse yet, put your feet in my lap for rubbing. AIN’T happening!!! Poke me with your toes and you might lose one.

But, feet are necessary, aren’t they? I have had my fair share of foot trouble, most of it when I was a modern dancer in college. Why? Because I did not understand hip rotation correctly which meant I was hyper-pronating my feet. There was also the added stress on my feet of dancing bare-foot…up until college I wore tight ballet shoes, jazz shoes or tennis shoes (pom-pon girl!). My poor feet were in shock when I took up modern dance in college!

Anyway, foot pain can be debilitating for a dancer for obvious reasons. There can of course be as many reasons for pain as there are dancers, but in my experience, a huge contributing factor to foot pain for so many dancers is hyper- or over-pronation.

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Sometimes over-pronation is simply caused by the fact that you have flat feet meaning the arch of your foot is very low or non-existent. If you were born with flat feet, this may not be painful for you. If flat feet are a new occurrence, it probably is. Either way, the sheer fact that the arch is collapsed allows the foot to over-pronate.

Over-pronation in dancers and athletes is usually caused by faulty biomechanics of the leg as a whole. Being evaluated by a doctor or sports therapist will help identify the problem so it can be addressed.

Here are some common foot problems.

1) Plantar Fasciitis: This is pain felt under the foot at the heel, in the arch, and/or all the places in between. The pain is caused initially by inflammation and swelling of the plantar fascia, and can worsen as tears and bone spurs develop.

“The plantar fascia is a ligament attached to the heel bone (calcaneus) that divides and fans out to attach at the base of the toes (metatarsals). Layers of muscles, tendons, nerves, and blood vessels run over the bottom of the foot. The plantar fascia covers these layers and acts as a bowstring on the bottom of the foot, helping the bones of the foot maintain the arch. A fat pad covers the plantar fascia beneath the heel bone; this pad cushions the heel as it takes the force of each footstep.”WebMD

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Plantar fasciitis can not only put you on the sidelines of dance, it can make the rest of your locomoting life miserable as well. See your doctor for diagnosis and help with the pain. Show your doctor what you do…if there are alignment issues, specifically with the leg and foot when turned out, get thee to a sports therapist or trainer so someone can help you learn to use your outward rotation correctly. More hip rotation info here: Hips & Turning Out

Treatment: R.I.C.E.R. This is rest (R), ice(I), compression(C), elevation(E), and getting that referral (R) for the necessary medical treatment. This is ALL so important. In my book, REST (meaning, NO DANCING!) is most important whether we like it or not. ICE alleviates pain as well as inflammation. COMPRESSION (ace bandage or taping) and ELEVATION (above the hip joint) both help to alleviate inflammation as fluids are directed out of the affected area. Anti-inflammatory over-the-counter medications like Ibuprofen (Tylenol is not an anti-inflammatory medication even though it is a pain killer) help this process as it alleviates the swelling as well as the pain. And then, to stop the pain train, REFER this problem to an expert: an orthopedic doctor, a sports medicine doctor, a sports therapist. There must be an analysis of any misalignment and pronation, and then professional direction for correction through re-training, strengthening, stretching, taping, adding orthotics if needed, etc.

2) Heel pain in children: This pain might be in the same place as plantar fasciitis, but can be caused by apophysitis instead of irritation of the fascia. Apophysitis is an irritation/swelling of bone growth plates that have not fused yet. Examples of apophysitis are calcaneal (heel, Sever’s Disease), tibial (shin, Osgood-Schlatter Disease), and iliac (hip).

Treatment: Go to the doctor. More info here: FootPhysicians.com.

3) Achilles tendonitis: This is pain felt at the back of the heel and/or from the heel up the back of the ankle. The pain is caused by the inflammation and swelling of the irritated achilles tendon. This tendon attaches the 2 calf muscles, the gastrocnemius and the soleus, to the back of the calcaneus (the heel bone).

Tendonitis is, for the most part, an over-use syndrome. Implications for treatment? Stop using it!! Treatment: R.I.C.E.R. (see above)

In my experience with dancers, tendonitis can be the result of trying to point the foot using the ankle only. It is important to understand that a pointed foot is accomplished by movement in 3-4 areas, not just one. 1st you move your ankle, then the bones in the tarsus (the area in front of the ankle), then the metatarsals (the long foot bones), then lastly the phalanges (toes). Learning how to use and articulate the intrinsic muscles in your feet can help alleviate the pain of tendonitis because you are no longer trying to use only your ankle. Trying to get more point out of your foot by pulling hard on your heel bone is a common cause of this problem in dancers. For more info, see On your toes.

4) Big toe joint pain, Bunions: This was my bugaboo. Started within months of going to college and starting modern dance. What changed? I was not wearing shoes which meant that there was no outside help for my over-pronation. As my feet spread, no longer being contained by tight dance shoes or supported by the arch in my athletic shoes, my over-pronation became worse which put tremendous pressure on my big toe joints. Taping my arch up helped. Powerful anti-inflammatory drugs helped. Cortisone shots helped (though they also made the joints crunchy). But all I really needed was to learn how to rotate my hips correctly which happened as soon as I went to grad school. It was that simple.

Now, of course in my undergraduate journey, I was told that I had bunions. “Bunions are often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. With a bunion, the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment, producing the bunion’s ‘bump.'” Foot Physicians

One zealous doctor wanted to operate, to break my feet to straighten things out. Only problem was that I might not really dance again. I opted to deal with the pain a bit longer! So glad I did, because I did not have bunions, just faulty leg and foot mechanics.

If you are diagnosed with bunions, get thee to a sports doctor who specialises in runners to get help. The best would be a doc who specialises in dancers, but these are few and far between.

5) Sesamoiditis: This is pain caused again my inflammation and swelling, this time of the tendon that encases the sesamoid bones at the base of your big toe. These little bones develop in the tendon under the big toe to act as shock absorbers. I would imagine that sesamoiditis is fairly common in Irish dance because the technique requires jumping and landing on the ball of the foot.

Treatment: as soon as you feel any bruising on the ball of the foot, stop dancing and ice it! If you take care of it, it does not have to be a huge problem. But, obviously, if the pain continues or is severe, go to the doctor. When I had this, my PT made a pad from thick moleskin to cover the ball of my foot, but there was a hole cut in it over the area of the sesamoid inflammation. This prevented me from putting weight on that area. We put a similar pad without the hole on my other foot so that my alignment was not affected. I wore dance shoes in all of my modern classes until it was healed.

For more on the sesamoids, go here: Sesamoid injuries.

6) Ankle sprains, strains, and breaks of all kinds: Go to the doctor.

More: Foot and ankle information

Click for more kinesiology info: Dance Kinesiology

To start educating yourself, try here.

4 Comments (+add yours?)

  1. Anonymous
    Sep 25, 2007 @ 08:28:00

    just thought i would leave a comment i found your blog earlier in the summer months, i just love it,i love the dressmaking advice (i agree its not that easy to make a professional looking dress, it takes time and practise.) but my favourite at the moment is the anatomy stuff.how you find the time amazes me and how generous you are to share your knowledge. thank you

  2. Anonymous
    Sep 26, 2007 @ 10:47:00

    Great post! Another common problem for Irish dancers is Morton’s Nueroma from our tight shoes. Any input on that and how to prevent/manage it?

  3. Caroline
    Sep 26, 2007 @ 12:56:00

    Great info again Ann! I have to admit that I have had all these problems above, except the bunions. It is sad but true. The only thing I missed here, which I am currently experiencing is pain on the (in)side of the foot. Not really in the arch but more to the inside. Yes I am sure it is overuse, and I have a collapsed forefoot (which I am treated for)…but this is something new to me šŸ™‚

  4. Trackback: Dance Kinesiology posts « Taoknitter

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