Dancing with Pain: Ankle Sprains and Stress Fractures

A sprain is an injury to a ligament which consists of non-elastic tissue connecting bone to bone, adding stability. Ligaments form joints of the body and excessive pulling or pressure on a joint area will lead to a sprain.

Sprains are classified into three grades. Grade 1 is a primary sprain in which there’s no tear in the ligament, mild tenderness with some swelling will occur, but the affected joint suffers no instability. A secondary sprain is a partial or incomplete tear of the ligament. There is moderate instability of the joint as well as pain and edema, discoloring of black and blue, and difficulty weight-bearing. Grade 3 is a complete tear of the ligament, pain is severe and the joint is unstable. Hemorrhage into the area is present and weight-bearing is impossible.

Most sprains occur at the ankle. The majority of sprains at the ankle are inversion sprains where the foot rolls inward. They are most common for the cavus, or high arch, and normal foot type. Eversion sprains where the foot rolls outward are more common for the pronated foot.

Sprains at the ankle can be caused by numerous factors. Certain foot types are more prone to ankle sprains. The dance surface plays a critical roll as an inclined or graded stage will add pressure on the ankle. Specific dance movements also place uneven pressure on certain areas. Constant changes in direction or non-natural movement also increase the chance for sprains to occur. Poorly fitted or improper footwear is also plays major role.

Dancers are also affect by their own body structure. Forces can be exerted repetitively into an area because of the bony alignment. A muscular imbalance also can contribute to additional ligament stress and ligamentous laxity with extensive ranges of motion adds to instability. Treatment is dependent upon the extent of damage. Follow the RICE guidelines immediately after sustain a sprain, rest and immobilization are essential ingredients for proper healing and a speedy recovery.

Grade 1 sprains require bracing like an ankle brace. Healing occurs in about 5 to 7 day and the dancer will be able to return to full activity. Grade 2 sprains may require require a soft cast for immobilization or a more robust ankle brace to be worn for about 4 weeks. Dancing should be avoided and can only resume under the guidance of a physician. Grade 3 sprains require casting and complete immobilization. Healing will take approximately 8 weeks and surgical repair may be necessary depending on the extent of the injury.

A stress fracture occurs from fatigue of the bone. Constant repetition of force on a bone will cause it to break. A microscopic fracture with only a mild crack will develop as the force continues. The crack deepens and the fracture will become more extensive. Overuse of one area can lead to necessary force to cause a stress fracture. It’s also called a march fracture from the repetitive force of marching.

Dancers most frequently develop a stress fracture of the second metatarsal, but stress fractures can occur at any metatarsal or other bone of the foot or leg. Swelling and tenderness on palpation and extreme pain are signs of this condition. Stress fractures can be confused with capsulitis, bursitis, or tendonitis. Accurate diagnosis is essential because each treatment plan is different. Treatment involves immobilization usually with a soft cast. Rest is critical as with most injuries and dancing is forbidden. Weight-bearing in general should be limited and non-weight bearing exercise and stretching can be performed during the layoff which will last approximately 4 weeks. Once healed, a gradual return to full dancing is recommended. Once the causative factor is identified it should be avoided in the future or the condition will likely reoccur.