Dance Til You Drop: Shinsplints and Skin Rashes

Shinsplints are an overuse compartment syndrome. An overuse injury is when the muscles in an area are overused and fatigued. In shinsplints, the leg muscles become overused. The leg muscles are pulled away from their attachments into the tibia. Fatigue can also play a factor, causing pain in the muscle compartment itself.

Shinsplints can affect multiple areas different of the leg. Anterior shinsplints create pain on the lateral side of the leg. The anterior muscles raise the foot into dorsiflexion and excessive pulling leads to pain. Medial shinsplints cause pain on the inside portion of the tibia. Posterior shinsplints cause pain in the back of the leg, where the muscles travel down the back of the leg into the inside of the arch. Pronation causes the arch to flatten, putting a strain and a pull on these muscles, that pull extends into the muscle in the back of the leg. Pronation can also cause anterior shinsplints, where the anterior muscles work unconsciously to stabilize the foot, trying to keep the foot in the correct anatomical position. The extra workload causes fatigue of the muscle group and instead of propelling off the toes, the pronated foot is raised by the leg muscles.

Shinsplints are also caused by an imbalance between the anterior and posterior leg muscles. Most dancers develop very powerful posterior muscles in the leg. The anterior muscles work much harder because of the strength of the calf muscles, these muscles work in tandem. When the posterior group tightens, the anterior group must stretch. An imbalance of strength or flexibility between these muscles causes fatigue from overuse.

The dance surface is also a factor, the harder the floor the more force exerted into the leg. The anterior muscles can tighten up to splint the foot in anticipation of trauma of running or jumping on hard surfaces. Try dancing on a softer surface to mitigate this unbalance and potential injury.

Shinsplints for a dancer can also be directly related to the position of the heel. Shinsplints can result if the heel doesn’t make contact with the ground when landing. A proper landing from a jump should distribute weight from the toes to the forefoot, mid-foot and finally into the rear-foot. The heel should be on the ground supporting bodyweight. A lack of heel contact causes the force to stay in the forefoot, meaning that the only stability that remains are the leg muscles. Eventually, they will tighten with overwork causing fatigue.

A double-heel strike is another potential cause of shinsplints. The heel reaches the ground then lifts slightly for balance after the landing, creating a double-heel strike. The leg muscles work even harder for stability when this happens. Treatment and prevention start with determining the route cause of shinsplints. If technique is involved, with landings for example, better training and technique is necessary to avoid injury. If anatomical structure is involved, a foot brace or appliance may be helpful with correcting the problems and resolving pain. By eliminating unnecessary forces and excessive movement in the foot there will be less strain on the leg muscles.

Immediate pain, requires RICE  therapy; rest, ice, compression and elevation. Ice or cold gel pack can be immediately applied before and after dancing for about 20 minutes, and then again before bed. Dance can continue if there is no pain, but once pain is felt dancing should be stopped. Chronic shinsplints can lead to stress fractures so it’s important to stretch and maintain flexibility. Stretch the leg sufficiently and effectively to reduce extra pressure on the muscles. Try not to over-strengthen the anterior or posterior leg muscles. Each individual needs specific stretching and strengthening exercises depending on their own needs. Gradually build strength, coordination and endurance of the leg muscles in an even manner.

Many skin rashes affect a dancer’s foot, inflammatory conditions of the skin termed dermatitis and rashes caused by fungus or yeast are the two most common. Dermatitis is a superficial skin inflammation characterized by scaling, swelling, redness, itching, blistering and crusting. Another term for dermatitis is eczema.

Dermatitis is caused by contact with an external skin irritant. Contact dermatitis can be from a chemical reaction to any stimuli, but the most common comes from either foot gear like stockings and shoes worn for dance. Some dancer’s also have allergies to rosin or talc and react to medication, cream, moisturizer or other products they apply to their feet. As a result, dermatitis can occur from an allergic disorder. Dancers with hay fever or asthma are more prone to this reaction. They tend to break out in the soles of their feet and palms of their hands. The lesions can be itchy and annoying. Psoriasis and other dermatologic conditions can also be present.

The treatment for dermatitis involves determining the causative factor and removing the irritant. Topical anti-inflammatory medication is often prescribed. Usually, the dancer will respond to treatment in a few days and symptoms subside. Dancing can continue as tolerated. The use of soap on the area while bathing should be minimized as there are potentially harmful chemicals that may impact the healing process. Sometimes an oral medication is needed to stop the itching.

The second category of skin rashes is caused by organism like fungi and yeast. They are microscopic plantlike organisms that cause skin infections. The foot is a wonderful host for these organisms; dark, warm and moist.

The symptoms produced are similar to dermatitis; inflammation, redness, itching, blistering, oozing and maceration. The maceration is usually between the toes and painful fissures develop. The fungus can also lodge in the toenails. The nails get thick, discolor yellow or brown, and debris forms under the nail. Treatment includes anti-fungal topical agents, but the best treatment plan coincides with prevention as good hygiene is fundamental. Bathing the feet daily, keeping the feet dry and wearing proper footwear is critical. Dry the feet, especially between the toes and use foot powder as recommended. Changing shoes and socks regularly will decrease the chance for an occurrence. Use natural fibers like cotton and wool as they are absorbent.