Dance Life: Foot Problems and Inflammation

A bunion is a boney overgrowth on the head of the first metatarsal, a bump can be seen and felt. The bump of bone can be extremely painful, especially when wearing shoes. On the outside of the foot, at the head of the fifth metatarsal a tailor’s bunion or bunionette can form.

Inflammation from rubbing the bump causes bursitis. As the bunion progresses it’s common for the big toe to point inward. A bunion leads to arthritis of the involved joint which implies not only pain, but limited range of motion of that joint. Chronic pain is common as the condition worsens.

Bunion are primarily caused by improper biomechanics, pronation is the main culprit, causing excessive mobility of the first metatarsal. With extra movement along the metatarsal head rubbing occurs against the shoe and a muscular imbalance follows pulling the toe laterally. It’s critical to begin conservative treatment immediately, which could sidestep the need for surgery. External forces can increase the formation of the bunion so it’s necessary that shoes and stockings fit correctly.

When abnormal pronation is present, the use of biomechanical devices can correct muscular imbalances and stabilize the position of the bones and joints. Conservative treatment at an early stage is optimal as with chronic, painful bunions surgical correction is likely, and if the joint is involved, it will probably end a dancer’s career.

Bursitis is the inflammation of a bursa, a small sac in the fibrous tissue that contains fluid. Bursae are located at areas where there is much pressure or friction. They protect underlying tissue and allow free movement without straining or stretching the tissue and act as shock absorbers to many of the joints of the foot protecting the bones. They develop under corns, bunions, and other areas where bone pressure is excessive. A trauma or overuse of the affected part will cause the sac to become enlarged and inflamed. Additional fluid fills the sac as inflammation develops. Most commonly affected areas are behind and below the heel, under the first metatarsal head, in the bunion area, and in the toes.

Treatment includes resting and proper bracing and padding. Injection and physical therapy can help reduce swelling and breakdown the bursal sac, they also increase circulation to the area to speed healing. A biomechanical exam and gait analysis is necessary when the cause of the inflammation is related to faulty biomechanics. By stopping abnormal forces, the recurrence of the bursitis should be minimized. Surgery is necessary when the underlying cause is the anatomy of the bone structure. Reshaping the underlying bone can prevent the bursitis from occurring.

Callus and corns are the buildup of hard skin with an accumulation of keratin in the epidermis. They are the direct result of pressure, stress or friction, usually from abnormal foot mechanics. Both conditions are composed of the same material. Callus form in a flat, straight pattern similar to normal skin lines. Corns are conical or circular in formation. They can be pushed deeper into the skin and cause more pain. A soft corn is located in the interspace between the toes.

Some dancers form a normal amount of superficial callus as a direct response to the increased friction and pressure of dancing on the foot. This superficial callus does not require treatment and should not be removed. A shearing callus and any type of corn, however, can be very painful. They are abnormal formations that require treatment and should be removed for the dancers comfort. The pain can cause limping and compensation that causes secondary problems to develop.

Do not use a razor blade or scissor to cut the hard skin. A mistake can cause a very painful infection and loss of dance time. Self-treatment includes soaks, the use of a pumice stone or callus file and over-the-counter padding material.

A capsule is a ligamentous bag that surrounds a joint. It’s attached by its edge to the bones on either side. With excessive force, landings, or a trauma, the capsule can become inflamed, a condition known as capsulitis. The bag will fill with fluid and become very painful upon palpation or as the joint is put through range of motion. The harder the dancing surface, the greater the chance that capsulitis will affect an involved joint. The first metatarsal phalangeal joint is the most common site for capsulitis in the foot. This is where most weight bearing occurs, at toe-off, just before the toe leave the ground in the gait pattern. Properly protecting the joints of the foot and dancing on a surface with more give are preventative measures.

Capsulitis requires medical intervention, the area should be padded and bracing applied for protection. It’s important to limit joint motion to allow for healing. Physical therapy is effective at reducing the inflammation and injection therapy and NSAIDs can help ease pain and inflammation. For chronic sufferers of capsulitis, a biomechanical exam and gait analysis are necessary. If an underlying structural problem exists, it should be treated to prevent the excessive joint force. Normally, capsulitis responds to treatment in about two weeks, but dancing should be limited during the healing time.

Contusions are soft-tissue bruises, the bruise doesn’t affect underlying bone or create a break in the skin. Capillaries, small blood vessels, rupture after a compression or shock to the foot. Dancers most frequently bruise the ball of the foot or the ends of the toes from landing. When a person jumps, the force hitting the foot increases 4 times; therefore, 125 pound person lands with a force of 500 pounds. This makes it easy to under why contusions occur.

Immediate treatment for a contusion is ICE therapy; ice, compression, elevation, for the first 48 hours. Heat may be applied on the third day to improve healing. Dispersion padding protects the area as a hematoma, or blood clot, might form increasing pain dramatically. The use of heat will break up the clot and drive fresh blood and nutrients into the area. Loss of dance time is minimal, only a few days, but protecting the area will prevent reoccurrence.