Dancing is an exercise and an art, dancers are preforming artists especially ballet dancers. Apart from being resilient and perfect in their dance steps, ‘ballerinas’ are also expected to be aesthetically pleasing, flexible yet strong and fragile. Ballet dancing is so beautiful to watch as professional dancers showcase classic movement.
She dances on the tips of her toes in pointe shoes (full relevé), does acrobatic display and even hops across the floor. To get to this professional level where they exhibit beautiful and graceful dance moves, there is a lot of training, practice and stress on the feet, ankles and more.
There has been many researches and academic studies for 35 years and more to find out the pressure ballet dancers put on various parts of their feet as compared to normal people. Well, it was discovered that simply walking in pointe shoes doubles the peak pressures acting on the foot compared to barefoot.
The Journal of Dance Medicine and Science in 2012 carried out a study where pressure data were collected with a high-speed, high-scan pressure platform sampling at 100 Hz. Female dancers in training, approximately 13.5 years old, were the test subjects and measurements were made as the dancers rose from demi-plié to demi pointe (intermediate pressure conditions). The researchers measured pressure and force data for barefoot, soft shoes, demi-pointe shoes and pointe shoes and pressure was recorded for specific areas of the underfoot for each shoe condition. In pointe shoes, the peak pressure is over 3 times the mean barefoot pressure.
Selina Shah, medical director of dance medicine for the Center for Sports Medicine at St. Francis Memorial Hospital in San Francisco in 2010 conducted a study and in full pointe found that the average pressure on the toe box while on pointe is 220 psi or 1.5 MPa with the majority of the weight (pressure) concentrated on first toe. Even more dramatic results are a 60-kg (132-lb) ballerina landing on pointe from a height of one meter generates an impact force of approximately 4950 N or 700 psi. This may be the reason why ballerinas feel they are under a lot of pressure.
PROFESSIONAL BALLERINA FEET
Professional ballet dancers are known to be perfect in the dance steps including classical ballet dancing and dancing on pointe. To dance classical ballet, the feet must remain in a snug, canvas or leather slipper, this is so that the dancer can feel the floor while dancing. The more you progress in dancing, the more you spend 4-6 hours a day wearing pointe shoes which confine the feet and toes in a very small space. Even with the confinement, the dancer performs repetitive, challenging movements and executions which place load, torque, pressure and force on the feet.
Dancing on pointe requires that the foot and limb be flexed in a dorsal direction for very long period of time. It also demands placing enormous stress on the peroneus longus tendon and on the 2nd metatarsal specifically. This can cause lot of stress on the Achilles tendon complex especially during the relevés movement (a term used to refer to a dancer moving from the flat position of the foot on the floor, up ‘en pointe’ and back down).
So, apart from the rigorous movements and twists of their toes for prolonged period of time, professional ballet dancers also face tight fitting and non-supportive shoes. Male ballet dancers typically do not dance on pointe. They do more lifting and jumping
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BALLERINA FEET DAMAGE AND INJURIES
There are many injuries that are common to dancers performing intricate movements up and down on their toes throughout a huge range of motion over time.
Bunions may be hereditary some times but they can also be caused by constant pressure of the tight fitting toe shoe against their feet, and the increase stress on the medial column as a dancer attempts to achieve more ‘turn-out’ ( Foot dynamics ).The pressure caused by wearing tight fitting toe shoe will cause friction and worsen the bunion pain.
A bunion is a bony protrusion on the edge of the big toe joint. This protrusion forms when the big toe is forced to angle inwards towards the other toes. Bunion can be painful and cause swelling, sometimes there is no pain.
Sesamoids are very small bones found in the tendons, they are connected to the big toe and act as pulley. However, they can be fractured or strained by activities like excessive walking, jumping, dancing on hard surfaces, shock, and dancing on demi-pointe. Fracture or excessive strain can cause under the ball of the foot and sometimes on top, especially on demi-pointe.
Plantar fascia is the thick, rubber-band like fibrous tissue that originates at the heel and connects to the base of the toes. This band of tissue can be overuse especially if the arch is not supported by proper footwear. Dancers especially ballet dancers overuse the plantar fascia and this can cause pain and swelling at the inside base of the heel and arch area.
Hallux Limitus and Rigidus
This condition is common in people with bunions. Straining the big toe joint repeatedly can cause the big toe to be stiff and painful, this will make dancers with this condition to shift their weight to the outside of the foot during demi-pointe. The shock and forces from dancing can lead to inflammation of the big toe joint, and over time cause stiffness and a lack of range of motion.
This is caused by the nerves fibers between the metatarsals and toes, usually between the 2nd and 3rd toes but also between the 3rd and 4th toes are impinged. This can make the nerves around these toes to become swollen and permanently scarred. Neuromas can result to burning or tingling felt at the ball of the foot to the toes. However, the pain usually goes away when shoes are removed, suggesting the shoes are too narrow and excessively tight.
Achilles tendon is a fibrous cord on the leg that connects the back of your calf muscles to your heel bone, it also allows the dancer to rise onto pointe. When this cord is inflamed or irritated, it results to achilles tendonitis. Wrapping the ribbon too tightly around the ankle, not letting the heels between the relevés to be completely down, using drawstrings or elastic which is too tight around the heel can all lead to a dancer having achilles tendonitis. This can cause pain during relevé, soreness and swelling around the affected area.
The shaft of the 2nd metatarsal bone while on pointe can be stressed when the foot is maximally plantar-flexed, it contributes to the fracture. Fractures can happen to any bone but dancers especially ballerinas experience this stress fracture mostly on the 2nd metatarsal bone because of the physical demands of their dance. The fractured area may become swollen, tender and painful.
Blisters and Calluses
Wearing ill fitted pointe shoes, making certain moves and twists or even friction between the toes can cause blisters on the feet of ballet dancers. Small painful pocket of fluid are formed and these blisters should not be irritated so as not to become infected.
Black or Broken Nails
Most blisters can result to black nails. Repeated dance steps can make the toe nails to get broken.
Overworking and putting more pressure on the lateral side of the ankle for multiple hours per day may result to sprains on the ankle most times.
When the ball of the foot is overused, it can become inflammed. This inflammation is very painful. In dancers, balls of the feet are irritated due to the jumping movements involved with dancing. Also, dancers land on the balls of their feet and this balls of the feet absorb all the impact with little support from ballet shoes.
Dancer’s Heel or Posterior Impingement Syndrome
This is a condition wherein a bump or pinch is formed on the rear part of the foot, this is felt near the ankle or in the ankle itself ( Medical websites ). When the ankle is always facing a certain position, there can be wear-and-tear on the tissues cause on the dancer’s heel.
DEFORMED BALLERINA FEET
Ballet dancers feet can become deformed if the dancing is done for a very long period of time. This deformed feet also called “Ballet dancer feet” is common in professional ballerinas.
- Toes twist to one side.
- Feet lose shape.
- Toe nails become discolored, often black or dark.
- Toes twist to one side.
- Soles of their feet are hard, dry and become cracked.
- Feet become painful.
- Feet have blisters and hard calluses.
- Feet begin to bulge with bunions.
TREATMENT FOR BALLERINA FEET INJURIES
There are different treatment methods depending on the type of injury you have. Your podiatrist will carry out an x-ray to know the exact injury in order to give the best treatment.
Some treatment methods are:
1. Getting enough rest.
2. Using ice pack on the areas that are swollen, tender or painful.
3. Taking recommended anti-inflammatory medications can help reduce the inflammation and pain.
4. Surgery in cases like bunions although surgeries are recommended when the dancer is ready to retire or stop his or her dancing career.
5. Injections like cortisone can be used to treat neuromas.
6. Wearing orthotic devices can be used in treating injuries like plantar fasciitis.
7. While wearing high heels outside the studio may help alleviate the pain of achilles tendonitis.
8. Applying the injured area with anti inflammatory gel can relieve the pain.
9. Proper fitted ballet shoes is also very important in treating and even preventing some of these injuries.
Ballerina feet is for ballet dancing, the dance is beautiful to watch but next time, appreciate the dance steps, trainings and feet injuries the dancers go through to entertain you. Most dancers with any of these injuries do not take enough treatment as doing so will mean taking time off their career or even retiring. We strongly advised that proper care and treatment be taken to avoid further complications.