Dancers Foot & Ankle Injuries

For dancers who want to learn more about foot and ankle injury prevention and treatment, you can view our video about a dancer who was treated by the physicians at Midwest Orthopaedics at Rush (MOR) and landed on her feet.

The dancer is even more prone to foot and ankle injuries, thanks to the twists, turns and points the dancer's feet must endure during practices and performances. In addition, the dancer is under pressure to stay thin. Eating too few nutrients exacerbates the dancer's injuries by weakening bones and muscles, yet the dancer needs to keep them strong to perform.

There are more dancers than ever before and many competitive dancers who practice every day. This has led to an increase in dance-related injuries. According to a 2013 study by the Nationwide Children's Hospital, they were up 37 percent from 1991 to 2007.

The foot and ankle team at Midwest Orthopaedics at Rush, Dr. George B. Holmes Jr., Dr. Johnny Lin, and Dr. Simon Lee, routinely see and treat patients suffering from these common dance problems.

The physician examines the patient, and if necessary, orders an X-ray, computerized tomography (CT) scan or magnetic resonance imaging (MRI).

Non-surgical Treatment Options

  • Taking pain relievers such as non-steroid anti-inflammatory drugs (NSAIDs)
  • Wearing an immobilizing boot
  • Applying the acronym athletes know well — RICE (rest, ice, compression, elevation)

Following are a few of the more common foot and ankle problems that the physicians at Midwest Orthopaedics at Rush treat, however dancers may experience additional problems not discussed in this brief overview.

Achilles Tendonitis or Injury
The long tendon on the back of the leg, the Achilles, takes repeated abuse in many activities. Eventually, it may become inflamed, inflexible and causes nagging pain in the heel and lower calf. Dancing "through the pain" can cause the tendon to tear, which makes it subject to rupture. When it ruptures, the pain is so sharp in the back of the leg that it feels like being kicked.

Ankle Sprain
"It's not broken" gives little solace to the dancer who suffers "only a sprain" because the pain keeps her grounded until it heals. Dancers are typical victims of sprains because of the movements involved in dancing, such as rapid directional changes, twists and turns, jumps and landing. The bad news: The dancer must follow doctor's orders until it heals. The good news: Treatment is almost always non-surgical. Remember that if a sprain does not improve, it may be something worse. 

Shin Splints
Pain and swelling in the front or inside of the shin can mean a shin splint, which means the lining of the bone tore away from the bone. It heals with time, but the dancer must take it easy and follow the physician's advice while the shin heals.

Chronic "shin splints" that do not improve with rest and time may be a sign of a stress fracture or a condition where pressure builds inside the muscles called chronic exertional compartment syndrome. Seek evaluation if the condition does not improve.

Stress Fracture
Repeated use of the foot and leg can cause a stress fracture, which is a tiny break of the bone. The pain ranges from dull to intense, but can be relentless. A stress fracture is more likely in northern climates where insufficient sunlight exposure leads to Vitamin D deficiency, which leads to weakened bones. It may also be associated with a recent change in exercise routine, increased intensity, or switching activities. The stress fracture in the foot or lower leg is a common injury for dancers who run or jump.

Dancer's Fracture
Physicians see a break of the long bone on the outside of the foot so often among dancers, they call it the "Dancer's Fracture." Typically, it occurs after the dancer performs a jump. The pain is immediate and the dancer is out of commission during treatment.

Dancer's Heel
When the back of the ballet dancer's ankle can take no more wear-and-tear, a bump forms. Then pain prevents the dancer from performing a pointe. Technically, this is called Posterior Impingement Syndrome because it affects the posterior (rear) of the ankle. Anterior Impingement Syndrome affects the anterior (front) and can result from repeated plies.

Hammertoe
Misalignment of the foot can cause a hammertoe, so-named because another toe (usually the second one) bends toward the big toe and looks like a hammer head. Untreated, it becomes fixed in that position and the dancer cannot wear shoes without painful friction. Some people can thank unlucky genes for their hammertoe, but it may also develop in dancers as a result of tearing of the ligaments on the bottom of the toes.

Heel Spur
Sometimes a dancer develops a heel spur, which is an abnormal growth on the bottom of the heel bone. It does not necessarily cause pain. A dancer with flat feet or high arches is especially prone to a heel spur. Although the pain can sideline a dancer, a heel spur sounds worse than it is, and rarely requires surgery.

Ingrown Toenail
Although the ingrown toenail causes many a locker-room joke, it is painful enough to cut a dancer from the routine. The skin grows over the toenail, usually because the toenail is not cut straight across. Untreated, the ingrown toenail can lead to an infection.

Neuroma
Pain in the forefoot and numbness in the toes can indicate a neuroma, which is a condition of the nerves. One or more nerves is pinched, and burning pain and inflammation follow. Untreated, it can lead to even more pain. Treatment temporarily sidelines the dancer but stops the pain from creating bigger problems.

Plantar Fasciitis
The dancer who overuses the foot can stress the fascia, which connects the heel to the toes. It triggers pain on the bottom of the foot, especially first thing in the morning. Dancing for long periods of time or dancing on hard surfaces can make it worse. The key is to identify it before nerve pain develops because nerve pain requires more aggressive treatment.

Sesamoiditis/Turf Toe Injuries
Pain underneath the big toe, especially when barefoot, can indicate sesamoiditis, which is inflammation of the two small sesamoid bones in the forefoot. The patient tells the physician, "It feels like I'm walking on a rock." People with high arches are prone to this because their feet do not absorb shock well. Bottom line: It hurts like heck, but can be fixed. High energy and high impact dance styles, such as hip hop, may cause injury to these bones or the ligaments and tendons that run under the big toe. This is referred to as a turf toe injury, so called because it is much more common on artificial turf. This requires early and aggressive treatment but most likely without surgery.

Metatarsalgia
Pain on the ball of the foot can mean metatarsalgia, named for the five metatarsal bones. Dancers share this problem with athletes in other high-impact sports, where the ball of the foot bears the brunt of the pushing-off phase of an activity. Treatment is typically non-surgical.