A Dancer’s Pain: Plantar Fasciitis and Foot Trauma

 

Periostitis is a bone bruise that occurs from direct trauma to the bone. Bone is covered with a material called periostium. After a trauma to the bone blood can fill into the space between the bone and its covering. The periostium is actually lifted off the bone. This is a painful condition that should be differentiated from a fracture. The pain comes from swelling to the surrounding soft tissue as bone has no nerve endings and can’t feel pain.

Pain will limit dance activities for up to 2 weeks. If the bone is fractured, it will extend the recovery process another 4 to 6 weeks, leaving the dancer sidelined and inactive. The most common areas for a dancer to have a bone bruise is the heel and the metatarsal heads. Immediate treatment will decrease healing time. Ice, compression and elevation should be initiated immediately. This will limit inflammation that’s causing pain. Padding around the area can also reduce discomfort. Proper compression bracing will protect the affected area, a limitation of activities and anti-inflammatory therapy are essential methods of treatment that will accelerate healing. Should periostitis go untreated it will cause pain for several months compared to healing in about 2 weeks.

The plantar fascia is a long ligament at the bottom of the foot that attaches from the heel to the metatarsal heads. It helps create the arch of the foot and acts as a support for the anatomical structures of the foot.

Plantar fasciitis is an inflammation of the fascia band, caused by an abnormal pull of the ligament, repetitive stress factors or overuse. The result is arch pain and or pain in the area of the heel where the ligament attaches to the calcaneus.

Two major causes of plantar fasciitis are biomechanics and trauma. Any traumatic event to the arch area of the foot can cause inflammation of the fascia band. The most common cause of this type of trauma for a dancer involves jumps. Propelling off the ball of the foot and landings causes an abnormal strain. An incorrect landing can cause excessive trauma.

Biomechanical conditions such as over pronation causes a stretch and lengthening of the foot. With repetitive occurrences, the plantar fascia ligament is stretched. As abnormal forces continue, the fascia band is strained and inflammation occurs. Dancers involved with running routines are more likely to experience this problem. In addition, pliés involve excessive stretch on the arch and incorrectly performing a plié will cause plantar fasciitis.

The immediate treatment is ice therapy, about 20 minutes of cold therapy every hour and limited activity during the first 48 hours of onset. Rest is vital during this time to limit the amount of swelling and prevent a long recovery time or the development of a chronic problem. A foot brace that incorporates elastic tension and compression will support the injured foot during recovery and encourage rapid resolution as the fascia ligament will remain static, not over stretched. Use the brace for several weeks and incorporate cold therapy should immediately before and after dancing for about 20 minutes. Anti-inflammatory medication and stretching exercise can also accelerate healing.

If a dancer suffers from repeated bouts of plantar fasciitis or develops a chronic condition continue using the foot brace throughout dance and daily activities. If the chronic plantar fasciitis is traumatic in nature, there is a good chance that the problem lies in the dancer’s technique. A good dance teacher should be able to find mistakes that are causing the abnormal forces to occur.

Two small bones called sesamoids are located under the head of the first metatarsal. They act as a fulcrum for the flexor hallucis longus tendon that passes through them to make it easier for the big toe to bend. Trauma to the ball of the foot will cause inflammation to the sesamoids, called sesamoiditis. A dancer with a high arch, or cavus foot type, is more susceptible as sesamoids are more prominent in a high arch foot. Those individuals affected by a cavus foot type should take extra precautions to protect the sesamoids. Performing incorrect turns or dancing on a surface that has no give are also contributing factors.

Inflammation of a sesamoid will interfere with normal walking; dancing will become almost impossible. Immediate treatment is ice, compression, and elevation. After 48 hours, heat can be used to promote healing by increasing the flow of fresh blood and nutrients to the injured area. Protective dispersion padding can be used with supportive bracing. Anti-inflammatory medication may be used to reduce pain and edema, treatment will last approximately 2 weeks.