Twinkle Toes: Dance Fractures and Foot Conditions

A dislocation occurs when bones separate at a joint, but don’t fracture. Any joint in the foot can dislocate, but the most common for a dancer is a dislocation of one of the toe joints. Any dislocation will cause significant pain and swelling.

Begin ICE therapy immediately; applied a cold gel pack to the area, compress the involved joint and elevate. Immediate medical attention is required to put bones back into position. This can be done manually, sometimes with anesthesia and sometimes surgically. Once the bones are back into their normal alignment, pain and swelling at the joint may still be present. Trauma to the joint causes capsulitis. Anti-inflammatory medication, anesthetics, physical therapy, and bracing for immobilization help ease pain and discomfort. The severity and layoff from dancing is dependent upon the specific injury and bones involved.

An exostosis is an overgrowth of bone in an area due to continuous pressure. A bone spur develops in response to friction. The long growth causes pain when compressed again another bone or shoe. The continued pressure causes bursitis to form in the soft tissue, the exostosis, and the skin. When the bony growth is under a toenail it is called a subungual exostosis. Arthritis and other conditions can cause spurs to occur anywhere in the foot. The most common place for a dancer to develop an exostosis is in the toes. Corns in the toes are often caused by exostosis.

Conservative treatment includes padding around the bony growth to reduce friction. Physical therapy and NSAIDs can decrease the pain from inflammation, avoid pressure across the exostosis to reduce symptoms. Wearing proper fitting footwear is essential.

Surgical correction may be necessary to remove the bony growth, thus returning the natural shape of the bone. People suffering from chronic exostosis should consider surgery as it’s the best way to control the problem longterm. In most case, the procedure is performed in office as it’s an ambulatory surgery. Only 3 to 4 weeks of dance time is lost.

Fissures are cracks that occur in the skin and are especially prevalent in the heel area. Usually, caused by excessive dryness. Dancers face the problem of developing cracks at the heads of the metatarsals, frequently associated with barefoot dancing. The ball of the foot acts as a pivot and is subjected to great forces and friction with the dance floor. When the skin cracks, it can cause a tremendous pain and loss of dance time.

The best prevention for fissures is to keep the feet moist, except before dancing. This use of frequent moisturizing cream and skin lubricants can maintain the skins natural moisture barrier and repair developing skin breaks. When a crack develops, keep it clean and use antiseptics. For serious, deep skin cracks, an antibiotic ointment may be applied with a bandage to cover the area. Dance can be resumed when the area is free from pain. Chronic sufferers can use moleskin or tape over the affected area to reduce friction and decrease the chance of recurrence. Application of zinc oxide or a moisturizer high in vitamins and antioxidants will protect the affected area before applying a protective bandage over the cracked skin leading to faster resolution.

A fracture is a bone break. A bone can chip, splinter, compress, break into many pieces, or compound, stick out of the skin. The type of fracture will depend upon the activity at the time of the injury and the position of body weight. The extent of the injury and amount of downtime from dancing is dependent upon the type of fracture and which bone(s) are involved.

ICE therapy should be started immediately; apply a cold gel pack or bag of ice to the area of injury, use compression and keep the injury elevated. Many dancers injure their feet and deny the seriousness of the incidence. Any injury causing, swelling, tenderness or an inability to bear weight should be treated immediately.

If a bone is displaced, it could require a reduction, or setting, possibly performed surgically. The bone must be immobilized for proper healing. Depending on the bone involved, healing can take 1 to 2 months. The immobilized bone should be allowed to rest without continuous force, thus no dancing until the injury is properly healing. The only exceptions to this rule are some of the bones in the toes or the sesamoids under the first metatarsal. Post-op physical therapy will speed healing, but regardless, traumatic arthritis can develop following a fracture and limit joint movement, creating pain.

A ganglion is an enlargement of a tendon sheath, a covering of a tendon, or joint sac that fills with fluid. Trauma to the sheath or sac causes the ganglion to form. A ganglion is a type of cyst, a sac that forms under the skin containing fluid or soft material. Irritation to an area can cause a cyst to form. The ganglion is usually slow growing, soft and moves freely. Pain occurs when pressure is exerted over the mass. The most common spot for a ganglion to form is above the extensor tendons on the dorsum of the foot. Pressure from a shoe across this area should be avoided.

Treatment includes padding around the ganglion to avoid direct pressure. Corticosteroid injections can help breakdown the walls of the ganglion and promote reabsorption of the fluid. Aspiration with a needle to drain the cyst may be needed, tight compression bandaging is then applied.

A hammer toe is a condition in which the toe bends into a shape similar to the end of a hammer. The top or end of the toe receives excessive pressure because of this abnormal shape. The pressure causes the toe to become swollen, red, blistered, and forms hard skin or a corn.

Hammering of a toe is typically caused by a muscular imbalance due to bone structure and the positioning of the tendons. When the tendons pull they create an uneven pull on the bone. With time, the bone position changes. This is a hereditary tendency that cannot be controlled. The other leading cause of hammer toes is an outside force. A toe bends if the shoe is too tight and constant force against the toes eventually causes a hammer toe.

Biomechanical devices, like foot braces and orthotics help muscular imbalances and poor bony anatomy. Surgery should only be considered for chronic, painful and developing conditions.