Dancing puts a lot of demands on the musculoskeletal system, and is especially tough on the legs and feet. Research shows that 67-95% of all professional dancers are injured at some point in their career, and 34-62% of those are lower extremity injuries. Because of the extreme positions that a dancer is often in, the foot is particularly vulnerable to issues.
Internal and External Factors
There are both internal and external factors that lead to acute and overuse injuries of the foot. Internal factors include:
- Inadequate strength and flexibility
- Hormonal imbalances
- Nutritional deficiencies
- Biomechanics and alignment, especially in “first position”
External factors include:
- Insufficient warm up
- Suboptimal environments, such as unresilient flooring or a cold rehearsal room
- Poorly fitting dance shoes
- Overload in training, ie repetitive jumping for long periods of time without a break
- The difficulty of the choreography
- The style of dance- ballet is particularly stressful to a dancer’s foot due to the extreme positions they often need to take, including turnout, demi releve, plié and being on pointe, which requires a dancer to support her entire body weight on their ankle and first and second toes.
The majority of foot injuries reported in dancers are overuse injuries, which is no surprise considering that a professional or full-time student dancer spends at least 35 hours per week in rehearsals. One such injury is flexor hallicus longus (FHL) tendonitis, often referred to as dancer’s tendinitis. The flexor hallicus longus tendon crosses the metatarsophalangeal joints, which are essentially the joints connecting your toes to your feet. In dancers, these muscles three times harder than those that only cross the ankle joint. Repetitive changes in foot position can lead to inflammation, and nodules and tears can also develop.
Symptoms of FHL tendonitis may involve ankle pain while jumping and/or on pointe, pain when moving the big toe, and locking of the big toe. Treatments can include:
- Taking a temporary break from pointe work
- Anti-inflammatory medications
- Joint mobilizations
- Re-educating a dancer’s technique: demi pointe/on pointe and releve
- Soft tissue management of scarring and adhesions
- Stretching if great toe becomes locked
Due to the dynamic biomechanical forces that their art form requires, dancers have specific difficulties and are prone to certain injuries. Knowledge of the basics of dance and thorough examination skills of the entire kinetic chain are essential in the diagnosis and treatment of the dancer. At the same time, injury prevention and therapeutic intervention should be encouraged within dance schools and companies to reduce the impact of these injuries. Both prevention and treatment are essential to allowing dancers to reach their full potential and enjoy long, successful careers.
- Harkness Center for Dance Injuries: Common Dance Injuries. Accessed on March 23, 2015. https://www.med.nyu.edu/hjd/harkness/patients/common-dance-injuries/footankle.
- Kadel, N. Foot and Ankle Injuries in Dance. Physical Medicine and Rehabilitation Clinics of North America. 2006
- Macintyre, J. Joy, E. Foot and Ankle Injuries in Dance. Clinics in Sports Medicine. 2000.
- Mcbryde, A. Rodriguz R. Et al. Dance Injuries. Sports Medicine Update from the Newsletter of the American Orthopaedic Society of Sports Medicine. 2007.
- Prisk, V. O’Loughlin, P. Et al. Forefoot Injuries in Dancers. Clinics in Sports Medicine. 2008.
- Turnout for Dancers Hip Anatomy and Factors Affecting Turnout. Accessed on March 23, 2015. https://c.ymcdn.com/sites/www.iadms.org/resource/resmgr/imported/info/turnout_for_dancers_anatomy.pdf
- Weber, B. Dance Medicine of the Foot and Ankle: A Review. Clinical Podiatry Medical Surgery. 2011.
Jamie Lamb is a doctor of physical therapy with Hospital for Special Surgery Rehabilitation. She has been dancing for about 20 years, and before starting her career as a physical therapist she danced for 15-20 hours per week with a pre-professional ballet company on Long Island. Jamie also interned in dance medicine with the Rochester City Ballet, and still takes classes regularly.