• Dr. Gina Mendoza

Ballet: Beautiful to Watch, Hard on the Feet


It's the holiday season, and for many of us, that means a trip to the city to watch the local ballet company perform Nutcracker Suite.


The ballet dancers who perform in these productions are a breed apart. They aren't just dancers; they are athletes and artists working in a medium that demands aesthetic perfection. For the women, this usually means being slender to the point of looking fragile, yet being flexible and strong.


Classical ballet dancing places incredible demands on the feet and ankles. For women, master the art form requires the foot to remain in a snug leather or canvas slipper so that the dancer can feel the floor. As a female dancer progresses, she will spend up to six hours a day in pointe shoes which confine the feet in tiny space. On top of this, the dancer must perform repetitive, challenging motions and executions which place load, torque, and force on the feet.


Here's a list of the most common injuries that those ballerinas in the Nutcracker Suite have likely experienced (or will one day experience):


Sesamoiditis

The sesamoids are very small bones in the tendons connected to the big toe. They serve as a pulley and can be strained or even fractured. Bony feet, dancing on hard surfaces, excessive walking, jumping, and shock, and dancing on demi-pointe can lead to sesamoiditis. Pain is experienced under the ball of the foot and sometimes on top, especially on demi-pointe. Inflammation and pain may limit motion of this joint.


Hallux Limitus and Rigidus

Repeated strain on the big toe joint can result in stiffness of the big toe. Those who also present with bunions are more prone to hallux limitus. 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. Because of the pain and stiffness dancers will shift their weight to the outside of the foot during demi-pointe. In extreme cases surgery may be necessary.


Bunions

A bunion is a bony protrusion on the edge of the big toe joint which develops when the big toe is forced to angle inwards towards the other toes. It may produce pain and swelling. Some bunions are hereditary, however dancers often develop them due to the constant pressure of the tight fitting toe shoe against their feet, and the increased stress on the medial column as a dancer attempts to achieve more ‘turn-out’. The constant friction of a tight shoe can exacerbate bunion pain.


Neuromas

A neuroma feels like a burning or tingling that can shoot from the ball of the foot to the toes. Numbness and cramping may be present as well. It is caused by impingement of nerve fibers between the metatarsals and toes, usually between the 2nd and 3rd toes but also between the 3rd and 4th toes. The nerves may become swollen and permanently scarred.


Plantar Fasciitis

The plantar fascia is a dense band of fibrous tissue that originates at the heel and connects to the base of the toes. It stretches and contracts each time the foot is used, and is prone to overuse especially if the arch is not supported by proper footwear. Dancers experience pain and swelling at the inside base of the heel and arch area.


Stress Fractures

Dancers often experience stress fractures in the 2nd metatarsal. Tremendous stress is placed on the shaft of this bone while on pointe when the foot is maximally plantar-flexed. The area around the fracture may appear tender and later on the involved area may become very swollen. Dancers are especially prone to stress fractures not only because of the physical demands of ballet but also the quest for thinness.


Achilles Tendonitis

The Achilles tendon extends down the back of the leg to the heel and allows the dancer to rise onto pointe. Not lowering the heel completely down between relevés, ribbons that are wrapped too tightly around the ankle, and drawstrings or elastic fitted too tightly around the heel can all contribute to tendonitis. Symptoms include tightness, soreness, and swelling of the tendon, pain during relevé, and sometimes a slight stretching noise.


As you're enjoying the artistry of this year's production of Nutcracker Suite, why not take a moment to appreciate the sacrifices these dancers are making in pursuit of their art? If you're a dancer and you're experiencing any of these problems (or if your feet hurt for any reason) a visit to Mendoza Podiatry can put you on the path to better foot health. Just give us a call at 615.826.0941.

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