A Guide To Diagnosing And Treating Common Dance Injuries

Lisa M. Schoene, DPM, ATC, FACFAS

   The anterior tibial tendon or extensor hallucis longus tendons can become inflamed, which may result from the dancer trying to improve the pointed foot’s appearance with overzealous stretching methods or devices. This practice may also injure ligaments surrounding the tarsal or tarsometatarsal joints. Long-term instability can occur due to the continued pointed position already stressing those tissues. One should educate the dancer on how to stretch properly and strengthen the foot’s intrinsic and extrinsic musculature.

When There Are Medial Foot And Ankle Injuries

Medial ankle and foot injuries may include posterior tibial tendon injury, flexor hallucis longus tendon injury and medial ligament injury.

   Out of all medial side injuries, the flexor hallucis longus injury is by far the most common. Its etiology starts with poor foot alignment and strength of the foot and hip musculature. Due to the fact that this tendon is so long, it has a delicate lever system that is prone to injury. If there is weak hip musculature, such as in the gluteus medius, it will predispose the dancer to internal leg rotation and excessive pronation of the foot.

   When this is combined with the tendency to overpronate either due to faulty technique or genetics, there will be a major eccentric strain on the medial ankle tendons, especially the flexor hallucis longus. This injury can be lengthy and requires good radiographic testing, preferably diagnostic ultrasound. Treating any of the medial tendons should always include foot and hip strengthening, balance and biomechanical control with shoegear and possible orthoses.

How To Handle Lateral Foot And Ankle Issues In Dancers

Lateral ankle and foot issues may include cuboid subluxation issues, lateral ankle sprains, sinus tarsi issues, and peroneal tendon and retinaculum issues.

   The cuboid bone can be a source of lateral foot pain. These cases commonly involve a rotational strain to the bone, either following a lateral ankle sprain or peroneus longus weakness, strain or injury. If the bone becomes subluxed slightly from its resting position, it will cause sharp, exquisite pain that may feel like a fracture. Without concurrent soft tissue injury, simple manipulations and cuboid padding are the treatments of choice.

   Lateral ankle sprains are common and one should treat these swiftly and aggressively. Weightbearing “walking boots” are preferred as they provide continuous acute care and some offloading while keeping the foot at a 90 degree closed pack position, which is best for the ligamentous structures to heal. The dancer relies on the feedback and stability from the lateral ankle ligaments so when one of these ligaments is compromised, it may cause instability and further injury. Overuse peroneal tendon or retinaculum stresses can occur as well, and not uncommonly as sequelae of the ankle sprain. Aggressive strengthening and proprioception work is advised for lateral ankle injuries in order to prevent future compensatory patterns and new injuries.

Keys To Making The Proper Diagnosis

As a podiatric physician, it is crucial to understand that the foot can affect the knee, hip, core musculature and spine. Unless a dermatology condition is the chief complaint, it is important to evaluate the whole lower extremity.

   The dancer should be in tights or shorts for the best visualization while testing. Evaluate flexibility and strength for symmetry, and do a complete biomechanical exam to detect any intrinsic biomechanical factors. Address and correct any deviations visible in the exams. Dancers can benefit from foot orthotics in their street shoes if they have abnormal pronation. Some dancers may walk externally rotated due to habits they develop in class. Encourage dancers to walk with a normal angle of gait in order to offload the hip rotators.

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