Life of a Dancer: Knee Injuries and Nerve Pain

 

A dancer’s knee is second only to the foot in vulnerability. In ballet position, 180 degree turnout at the hip is required. Dancers who cannot reach 180 degrees will force their knees and ankles outward trying to create the appearance that the hip is rotated. The dancer will bend the knee to accomplish fifth position. This results instability and a strain on the ligaments of the knee. More importantly, the risk of injury increases substantially.

For example, the grand-plié puts extreme pressure on the knee. The dancer is bending the knee fully in the five positions of ballet. Pressure is exerted on the tibial collateral ligament and ligament and cartilage damage is likely. Moderation and proper technique is paramount, repetition leads to serious knee injuries. Avoid sitting in this position or risk injury.

The most common knee injury for a dancer is due from overuse syndrome called dancer’s knee or chondromalacia patella. It’s most commonly caused by excessive and abnormal pronation of the foot. Excessive foot movement causes twisting in the knee from minor rotational changes. The mobile and flexible foot type will develop anterior and medial knee pain. The dancer with a more rigid and inflexible foot will have limited range of motion and greater shock on impact and will develop lateral knee pain. Due to wider hips, women have more problems with dancer’s knee.

Treatment involves controlling abnormal biomechanics. Wearing orthotics while dancing and in regular footwear may help control the over pronation and reduce the abnormal force on the knee.

Morton’s foot, named after Dr. Dudley J. Morton, is considered one of the most prevalent causes of foot pain and foot problems in the world of sports medicine. A Morton’s foot is demonstrated by a short first metatarsal. The normal parabola of the metatarsal heads would have the first metatarsal as the longest and the length of the other metatarsals decreasing towards the outside of the foot. With a shorter first metatarsal excessive pronation occurs. The body’s weight distribution falls toward the inside of the foot causing the dancer’s balance to be outside of the normal lines of the body. Thus, causing added weight distribution into the arch area.

This causes excessive movement along the inner part of the foot, known as hyper-mobility of the first ray. The extra motion makes the dancer more prone to forming bunions and increase the work of the second metatarsal. As the longest metatarsal, it receives an increase in the stress through weight-bearing and liftoff during gait. The second metatarsal head usually hypertrophies and the shaft of the bone thickens. A painful lesion can occur on the bottom of the foot below the second metatarsal head. Further, displacement of the two tiny sesamoid bones located under the first metatarsal occurs.

A Morton’s foot is an anatomical condition. Some dancers with this foot type can have a normal dance career. If symptoms persist, a restriction of certain dance movements might be required. Performing relevés correctly can become very difficult as distribution of weight on the ball of the foot becomes necessary. Initial treatment involves the use of padding and bracing to give additional support to the first metatarsal and take pressure off the second metatarsal.

Nerve entrapments can occur in the soft tissue of the foot. Nerve compression is also an associated condition, occurring from repeated severe pressure across the nerve. Entrapments imply that the nerve is not moving freely and is trapped in one area, while compression means that something is pressing on the nerve. Direct trauma also damages the nerve against the bone and sometimes nerve problems are secondary to other conditions like heel spurs, exostosis and foot fractures.

Nerve entrapments and compression occur mostly in dancers where there is constant pressure in an area. Footwear that is consistently impinging on an area for an extended period can lead to this problem. Symptoms include pain, numbness, a tingling sensation and even muscle weakness. Thus making properly fitted shoe wear essential.

When the nerve entrapment or compression is caused by another condition, prompt treatment should alleviate the nerve problem. It’s vital to establish the primary cause to correctly treat symptoms. Sponge rubber can be used to alleviate direct pressure from the affected area. Conservative therapy includes injections and physical therapy in an attempt to break up scar tissue or inflammation that might be causing the problem.

Neuritis is an inflammation of a nerve, usually the nerve’s covering, or sheath, is affected. Neuritis develops as a consequence of long-acting pressure and irritation of the nerve. Pain from neuritis is normally continuous.

Neuralgia is nerve pain without any change in the structure of the nerve. Neuralgia is caused by direct trauma, foreign bodies, scars, diseased bone or an inflammation of the nerve, like neuritis. As there are many causes of neuralgia, proper diagnosis of the primary condition is critical in determining what’s causing the pain.

Neuritis and neuralgia require medical treatment by a professional. A dancer with nerve-like symptoms such as electric shock, loss of sensation, tingling, shooting pain, and paralysis should contact a physician immediately.

A neuroma is a benign tumor and an overgrowth of nervous tissue usually caused by excessive pressure and irritation. The repetitive force to the covering of the nerve causes a mass of new nerve growth to form. The most common area to form neuromas in the foot are between the toes, called interspaces. There are four interspaces on each foot. Pressure between the heads of the adjacent metatarsals cause the formation of neuromas. A dancer will form a neuroma between the third and fourth metatarsal in the third interspace.

Pain is severe as the neuroma gets larger and can be described as electrical shocks with shooting pain. Tingling and occasional loss of sensation sometimes occur. Symptoms worsen when wearing shoes or with any confinement of the foot.

When diagnosed early neuromas will respond well to conservative treatment. Wider shoes take pressure off metatarsals and a felt plug can be placed under the head of an adjacent metatarsal to take pressure off the nerve. Because nerve tissue is removed during surgery permanent loss of sensation in the interspace and into the toes is possible. Early conservative treatment is the better alternative with virtually no loss of dance time.