Wednesday 2 January 2008

Looking after your feet

Some tips on how to look after the Dancers feet.

The foot is the most important part of the body for the Dancer. You can spend whatever you want on your outfit but unless you have the right shoes, you may have problems when dancing. While I am writing an extensive series on how to prevent injury and give you information on parts of your feet and lower body area, which you can build into a library, here are some day-to-day suggestions to make your dancing life a happy one. Always see a doctor when you have pain.

The toes:

Do not knuckle your toes under to ‘pop’ them. Like cracking, your knuckles of the hand this will dry out the joints and open you up for arthritis.
Cut your nails straight across the nail and do not curve inwards as this may cause ingrown toenails. Never pick your nails and always use a toenail clipper, bigger than a nail clipper, or get someone to cut across with sharp scissors. Buff the edges lightly to take and sharpness off the nail.

Wash in between your toes always, as this is an area that can build heat and cause fungal growth such as athlete’s foot. If you get this condition, use a cream or spray after washing and wash and apply two or three times a day. Also, spray inside your shoes, outdoor, slippers and dancing shoes.

Watch for any redness on the toe joints and report this immediately to your parents and arrange to see a podiatrist or foot specialist in case it is the start of a problem.

Try to wear socks without seams as these can rub on your toes, cause friction and give blisters.

Massage your toes before and after dancing to release any tension. Use a light massage oil or baby lotion. Only a little. If you can’t do it yourself, get some one to gently press their hands around one foot near the ankle and press slightly while pulling their hands towards your toes. Gently press with the thumb into the metatarsal area, the ball of the foot, and massage for a minute or two. Massage each toe at each joint. Remove any excess oil, there should not be any if you use the
right amount, and try to relax the muscles in your feet.

The mid section:

The arch is a very important part of your foot. Do not tie your laces tight around your arch, as it will cause damage to your arch. I designed a new way to tie your laces to stop pressure on the arch and the Achilles tendon, so please try to use that method.
Damage on the top of the foot caused by lacing is also serious as it is a tender area. Muscle, blood vessels and tendon damage can occur here.
Massage this area after every class to release the tension. Concentrate on your muscles in the foot and relax them. This will also require you to relax the leg muscles as well incidentally.

The Heel:

Plantar injuries may occur from a number of reasons. Use a pad to relieve pressure on Plantar Fasciitis, and other pain.
Watch for soreness under the heel, on the heel bone at the back and on the tendon that comes out of the bone up into the leg.
Do not tie around the heel area where it can press into the Achilles tendon. This will inflame the tendon and put it at risk.
General care.

Always warm up before a class and also concentrate some of that warm up on the feet and ankles. Cool down after class, very important, as this is when damage can also occur. Warm up before and during competitions if you are waiting about. Very important. Always cool down after dancing. This is much the same as a warm up as it loosens the muscles and joints. Your teacher will advise you. I cannot emphasise how important this really is to all dancers.


About the author:
Craig Coussins started training as a dancer in his mother’s school in the West of Scotland well over 55 years ago. He started fitting and designing shoes made by the UK’s oldest dance shoemakers, ‘Gamba’ in London 30 years ago. The man that trained him to be a fitter, John Brenna, made the shoes for Anna Pavlova who lived near the Gamba factory in London. Craig went on to become the senior fitter and designer for Gamba responsible for the correct fitting of over 167 professional Ballet companies worldwide. During this time, he wrote what was to become the internationally accepted fitting manual for pointe and ballet shoes. Craig has designed many award winning sports and dance shoes over the past 20 years (). He retired in 1995 to develop shoes closer to his Celtic roots. A passionate fan of Dance, and one of the worlds leading authorities in the prevention of injury in dance. After a period in 2000 of getting better from a serious illness, Craig returned to the dance shoe world in late 2003.to take over the reins of Hullachan Brand Name and bring safe dancing to the world

Glossary of Injury Treatmnets

Treatments- this section is being added to:



Ace bandage (or athletic tape) Ankle supports:

For binding sprained ankles. You will need to be shown how this is done by a doctor or physio. It is important to know this as a dance you are the same as a sports competitor and as such, this knowledge becomes part of your equipment for competing. Use ankle support bandages or pre made ankle supports when you have a problem but be aware that over-use of these when unnecessary will cause the ankle to become dependent on these and therefore weak.

Analgesic Cream:

(Before using these, read the section on Analgesic drugs and inflammation in the next chapter.)

There are many around in North America and Europe. I have listed some of these here. It is worth getting one or two as part of your ‘Dancers first aid kit’. There will be other brands in Europe and ‘Down Under’.

Biofreeze®: is a gel and works by providing a cooling sensation to the area applied which decreases the pain and increases the blood flow. The increased circulation to the injured tissues promotes healing and relaxation of stiff, sore muscles. The effect of Biofreeze lasts for several hours.

http://www.kasenterprises.com/

Tiger Balm: Used for centuries this is a general analgesic, pain reducing rub. I can recommend it from first hand experience. A versatile external medication, Tiger Balm provides effective relief for most symptoms of muscle strains and sprains. Smells a bit mentholy but is good never the less. I used this after a fairly serious car smash that caused me a great deal of bruising and sprain injury over my body. After teh hospital they said that I should take pain kilelrs and things will get better. I used Tiger Balm and found it both comforting and it seemed to redcue the pain overall. Maybe it was me but It has been used for mnay byears in China for this kind of injury and it is very successful there. The car was written off but I got better.

Bengay©: provides temporary relief of minor aches and pains of muscles and joints associated with simple backache, arthritis, strains, bruises, and sprains.

Aspercreme: Analgesic Rub is an odour-free crème and lotion for temporary relief of minor muscle aches and pains.

Glucosamine Gel: Glucosamine is widely associated with joint health & is now available in a clear dermatologically tested topical formulation. Non-sticky and non-greasy, Glucosamine Gel is easy to apply, & massage may soothe aches & pains. For adults & children over 12

Ralgex Cream: Ralgex Cream provides fast & effective warming relief from muscular pain & stiffness, sprains,

Radian B Ibuprofen Gel: Anti-inflammatory that relieves pain & inflammation from Backache, Muscular pains, Sprains, Strains, Sports Injuries.

Nurofen Gel:

A topical analgesic and ant-inflammatory gel to relieve pain & inflammation in conditions such as backache, muscular pains, sprains, strains, etc. Contains Ibuprofen 5%.

Mentholatum Ibuprofen Gel:

A topical analgesic and ant-inflammatory gel to relieve pain & inflammation in conditions such as muscular pains, sprains, strains, etc. Contains Ibuprofen 5%.

Deep Freeze Gel:

Fast acting pain relieving gel .Deep Freeze Cold Gel is a pain relieving Cold Gel. Its cooling, penetrating action goes deep down to relieve the aches & pains of overworked muscles, tendons & joints.

Deep Heat Rub:

Warming muscle rub for relief of muscle aches and Pains. Contains Eucalyptus oil, which is proven to reduce muscle pain.

Anti-Perspirant:

In answer to sweaty feet. I will cover this in more detail later but to avoid sweaty feet you can apply an antiperspirant before you dance. Washing the feet before, during (long competition days if possible) and after dancing will also reduce the need for using an antiperspirant. It should not be used all the time tough as overuse can itself cause pore blockage. Change your socks often and always wash these as soon as you get home. There are many brands of antiperspirant deodorant available over the counter in all countries. Read the label first to make sure that you get what you need. Absorbent solutions such as Drysol contain aluminium chloride can be found in many deodorants. This will help to decrease sweating when used on a regular basis.

In the old days, simple cornstarch was the answer for sweaty feet.

Antibiotic Cream;

Antibiotic creams can reduce bacteria. This means that such a cream can help reduce the incidence of badly smelling feet. Should only be prescribed by a podiatrist or doctor. Antibiotic creams are sometimes used in the treatment and recovery of badly calloused heels.

Analgesics and Anti Inflammatory Drugs-can do more harm than good sometimes:

After treatment for an injury, you may wish to take a painkiller or, if attending a doctor were prescribed simple painkillers such as aspirin, paracetamol etc. the trouble is that some dancers take these as a general precaution or indeed, when ever they feel like it and when they have to dance. At no time should any of these drugs be taken simply to allow you to dance in class or a competition. If you are injured you stop dancing. That is all. Get better. The drugs can damage your liver, stomach lining and have long-term side effects. It should be realised that if you take drugs to reduce inflammation you can open up your body to serious infection. Now make a decision based on that fact. Stronger drugs such as Ibuprofen, Brufen, Naprocin etc, are all designed to reduce the inflammation. The trouble is, and what many dancers fail to understand, is that the inflammation is part of the healing process. All, injury produces inflammation. This is an extremely beneficial response to an injury. It is the natural response that the body has developed to deal with trauma. Without an inflammatory response, there can be a high degree of serious infection throughout the area. The body has trouble controlling infection and as some of these infections can be lethal, it is vital that you realise that inflammation is a good thing and not a bad thing. I will go into this aspect of natural body responses later in the Glossary. However, inflammation and swelling are also distinct conditions that often work together. The swelling can cause pain within the inflammation. It’s a very interesting subject for dancers and the more you know about it the more you will understand what is and what is not relevant to your injury.

Osgood-Schlatters Disease or 'Growing Pains'

The most common knee pain for adolescents between 11 and 14.

In response to the excellent observation regarding tendon damage in young people this can be a number of things. Growing Pains, Osgood's Schlatters Disease or Shin Splints. I have extracted some helpful articles from the Internet that will be of interest. They are essentially American articles .

Osgood-Schlatter Disease Kevan E. Ketterling, M.D.

Osgood-Schlatter disease is indeed an impressive sounding ailment. The name brings to mind exotic illness and many patients tend to confuse it with Hodgkin's disease, a form of cancer. In reality, Osgood-Schlatter disease is a very common and benign variety of overuse injury that occurs in knees of adolescents. It is related to growth of the bones and thus occurs only in athletes who have not yet finished growing.

Osgood-Schlatter disease refers to pain, swelling and inflammation about the tibial tubercle. This is the bump on the front of the shin bone (or tibia) where the kneecap tendon (or patellar tendon) attaches. Force from the strong muscles in the front of the thigh is transmitted through this attachment to straighten the knee. The tibial tubercle is also the site of a growth plate. This is an area of cartilage where bone growth occurs. The growth plate cartilage is weaker than the underlying bone and the tendon attached to it.

When the forces across the knee are greater eater than the muscles can accommodate, the growth plate is pulled away from the underlying bone. This results in the pain, swelling and inflammation which characterize the disease. Activity exacerbates the pain, particularly running, kneeling, squatting and jumping. Often pain occurs in both knees. As with other overuse type injuries, symptoms are more common at the beginning of a new season, or after a sudden increase in training intensity.

Osgood-Schlatter disease most commonly occurs between the ages o f 11 and 15, and is more common in boys. This is a time of rapid bone growth, which may contribute to the problem. The bones grow so fast that the muscles and tendons are unable to keep up. This leads to a lack of flexibility and strength, which increases stress on the tibial tubercle.

When an athlete presents with Osgood-Schlatter disease, x-rays are usually necessary to rule out more serious problems such as tumors or infection. Additionally, x-rays may show small extra pieces of bone forming in the patellar tendon where the growth plate cartilage has been pulled away from the underlying bone.

Treatment begins with a short period of rest and methods to reduce the inflammation, such as ice and inflammatory medications. A rehab exercise program is then beg un, emphasizing flexibility and strength, particularly in the quadriceps muscles. A brace which decreases the force on the tibial tubercle is often useful to keep the athlete competing. The goal of treatment is control of the symptoms until growth is finished since once the growth plate has fused to the underlying bone, the problem resolves.

Emphasizing pre-season conditioning can help to prevent development of Osgood-Schlatter disease. Incorporating stretching to increase flexibility into the work-out routine is also important. Lastly, it is important to recognize that in adolescent athletes organized team sports may be only a portion of their overall activity. Gym class, sandlot sports, and even play activities may contribute to overuse injury. 1997-99 Fox Valley Orthopaedic, all rights reserved.

Shin-splints isn't a specific diagnosis,"

reports Dr. Robert Gambrell of the Medical College of Georgia Center for Sports Medicine "It really means that your shins hurt and you don't want to move them. " Shin-splints generally involve pain in the front or inside part of the lower leg. This pain frequently results from tendonitis, the inflammation of the muscles where they attach to the bone," said Dr. Gambrell.

Growing Pains are Real and Common Among Children

By Dr. David Zuckerman

Growing pains. An old wife's tale? Well, yes and no.


Adolescents do experience accelerated growth spurts. And the foot, ankle, and leg pains that young boys - and increasingly girls - report are associated with growth plate centres. Thin, flat, crescent - shaped growth centres separate bone and cartilage in younger children. As a child nears puberty, these growth centres close and ossify, the process by which cartilage becomes bone.

Between the ages of 8 and 12, when boys and girls become more active in sports, or dance, a child may complain of pain or parents may notice limping. While these complaints are historically more common among boys, as more and more girls join in hockey, soccer and other team sports, they, too, suffer growth centre pain. The most common growth centre complaint I treat is severe pain behind the heel, which stems from overusing the foot and ankle in hard training. The fibres of the Achilles tendon pull on the heel's growth plate and create inflammation within the heel bone.

Growth centre pain is even more common among children who have flat feet, toe-in or have other foot problems. For these youngsters, an orthotic, a splint or soft cast is usually enough to properly position and strengthen feet an d ankles, and prevent future pain and injury. With prompt treatment, growth centre pain persists only a few days or weeks and surgery is rarely needed. Untreated, growth centre injury can require long term treatment.

Such an injury can even result in fracture or dislocation of the growth plate, chronic pain, muscle imbalance, reduced range of motion, shortened limbs or permanent joint deformity. In extreme cases, a total joint replacement may be necessary.

When I suspect a youngster's pain is growth plate related, I x-ray the area to rule out fractures or dislocation of the growth plate, which is held together only by cartilage. I examine the child's practice and game schedules, and I often find the youngster is playing sports year-round, practicing daily, warming up with wind sprints and skipping proper cool-down exercise. Kids will resist interrupting their game and practice schedule, even for a short time. But sometimes the podiatrist must immobilize the injured growth centre in a soft removable cast o r splint for a brief period. Then, more often than not, he or she, can prescribe an orthotic for the shoes that allows the child to play, without re-injury.

Usually, when growth centre pain occurs, modifying activity is enough to remedy the problem. Above all, parents and coaches must never allow a youngster to play through injury or pain. The writer is a surgeon podiatrist who practices in Woodbury, NJ.



This is a reprint from the Pulse Section of the Courier Post.

Growing Pains In Children by Bruce A. Epstein, M.D. - 6/8/92

Growing pains are a family common occurrence in a paediatric population. These discomforts are all too familiar to the concerned mother or father who has awoke in the middle of the night to the sound of a crying child. Rushing to the bedside, the parent finds the child holding their leg in obvious pain.

Remarkably, a gentle massage, some hugs, and a few words of reassurance are all that is needed to soothe the pain. The recovery is usually complete by dawn, and the parents are frequently astounded by the sight of their healthy child bouncing out the door at full speed, pain free .

Fitting Shoes to the young Dancer
by Craig Coussins of http://www.hullachan.com/
YOU ONLY HAVE ONE PAIR OF FEET SO WHY RISK DAMAGING THEM?

Although the foot is such a wonderful piece of natural mechanization we are sometimes apt to forget that it can easily be damaged through incorrect shoe fitting. This can include normal day shoes as well as ballet and other dance shoes.

If we look at three distinct types of dancing , Highland, Irish and Ballet Pointe, all require different physical abilities and use opposing tendons and muscles .The Highland Dancer works on the ball of the foot resulting in a wider width across this area. They can also develop a shorter Achilles Tendon . Great stress is put on to the heads of the metatarsals and the impact can be measured at around three to four times the dancers weight hitting at that point of impact.

The Irish Dancer uses the higher area of the foot including rising up. The action is a more forward travelling movement with impact on the ball of the foot as mentioned in the Highland Dancer. Less pressure is put on the heel.

The Ballet Dancer on Pointe needs muscle extension and strength in the ankle with less emphasis on the metatarsal heads. The weight of the body is supported with the sides of the shoe and not the great toe as some budding ballerinas mothers seem to believe. Not having support on the sides of the shoes can damage the young foot or deform it. The muscle group under the sole is important to allow correct relevè or rising up onto the ball of the foot or base of toes and stress from impact is normally associated I want to discuss the problems to which the Irish dancer is open.

The general observations cover soft shoes for Highland and Irish Dance and hard shoes or Jig shoes for Irish Dance. It is useful to read the results of my day to day work.

Bunions: Deviated toe joints, rolling feet and knock knees.
The most common problem is the bunion and the deviated big toe joint. Bunions. Remember that these are confused with the deviated toe joints, either the outer or inner toe, and inflammation resulting from abrasion or pressure. The solution is to see first of all if the young dancer is rolling in. The great toe will be compensating by twisting to the outside of the foot bringing the great toe joint into play. The area on the surface of the joint will be sore and probably inflamed. This could be inflammation of the Bursa, the small pocket of fluid around the joint but mainly it is the painful callosity on the foot overlaying a projecting bone. The rest of the condition is known as 'halux valgus' or deviated toe joint. The dancer usually needs the toes to be straightened and separated or strapped into the normal line. This can be done if the shape of the foot is spotted at an early stage as young dancers can start this rolling in at age two or three. The teacher can help by checking the foot and making the necessary corrective exercises or send the child to an experienced fitter for further help and advice. It is a good idea to phone the fitter prior to the child's visit if you are particularly concerned about something. I would recommend that you keep a list of child or adult specialist orthopaedic doctors who can improve the condition.

To conclude, the way to avoid bunions is to fit the shoe closely to the foot and make sure that the width is supporting the sides of the foot and that the sides are slightly tight.

Finding solutions:
The dancer sometimes tries to get a larger or wider shoe to allow no pressure and this will result in no support at the sides of the shoe making the foot slip down with the great toe following its line and forcing the joint even further out of alignment exacerbating the original condition. The fact is that a narrower shoe can greatly help the dancer as long as the foot has been strapped into its original line. However depending on how far the condition has developed this may not be possible. I would always work the dancers foot by hand to see how much movement was available and start remedial discussions from there.

The simple fact remains that despite the research made over the last ten years by specialists, some teachers still make young dancers wear the brand of shoe that they as dancers wore when it is quite clear that the foot shapes are so varied and different it is nonsense to assume every foot will fit into the same brand or style of shoe. Especially now that, as a dance shoes designer, I have designed so many new styles, innovations and types of dance shoe to meet the ever growing demands of the art. It is indeed fortunate for many young dancers that their teachers prefer Hullachan as the brand for their students.

If this were the case with the running shoe industry they would be on a losing streak and I am sure that the outdoor shoe manufacturers would never recommend one style of shoe and one shape for every child's foot and that's without taking into consideration the feelings of both child and parent.

To recap the problem we face as teacher, parent, dancer, shoemaker and fitter:
The Arch:

None of these points refer to the dancer as to whether or not they dance, but will help in the fitting.

There are three main shapes of arch, low, medium and high.
Three toe shapes:
The dancer with the low arch may be unable to achieve a satisfactory arch and could have trouble standing on toe or high and even on the ball of the foot. The dancer with the high arch invariably has weak ankles and without proper tuition is unable to support themselves properly as they are simply not pulling up. Using a stiff outer sole will not help.

Exercise to build up strength in the arch will help and wearing the Hullachan will allow better control. If you have no arch wearing the Hullachan will not give you one but if you have any kind of arch shape, the Hullachan will show what you have unlike many other brands. The dancer with the high arch will usually have weak ankles and that will cause her to twist or not get full strength while on half or full toe. This is a problem while learning until the teacher has taught her how to build up her strength and help her to develop the thigh muscles instead of just calf and ankles. As there is no support in the soft toe shoe or pump it is important that good muscle co-ordination is being developed through exercise and centre floor dance technique.

The Toe shapes of dancers:
Three basic shapes of toe perimeter shape will usually determine how a dancer will develop foot strength. This is not how the dancer will develop as a dancer but will indicate possible issues they will need to be aware of with their toe joints and possibly lower limb problems later on. It is worth noting that i the ballet world a dancer is not allowed on pointes or block toe shoes until around three to four years of strengthening development or the toe joints will be seriously damaged and the the knees could also be seriously at great risk. After these training years, the young dancer graduates into pointe shoes which are designed in the shape of an ice cream cone with a squared off toe with the front cone in a stiff shaping, to take some of the weight of the dancer while on their toes.


The Toe Shapes:

The Peasant Foot: The strong foot-This refers to the square foot where the first, second and sometimes third toes are almost the same length. This is a strong foot shape and there is good balance between the first two toes.
The fitting here is usually medium or wide.

The Greek Foot; A long slim foot shape.
This is where we have the longer big or great toe. This is longer than the other four toes.
This could present some problems for some dancers because the toe joint of the great toe is taking all the weight if the dancer is told to go onto their toes. Essentially this means that this dancer will have to work a lot on strengthening their toe joints, arches, ankles and knees to take the weight of their bodies if they choose to go on toes at a later stage.
The fitting here is usually narrow or medium.

The Egyptian Foot: This means either a pointed shape foot.
This is usually where the second toe is longer than the great toe. Now this is only a problem if the shoe is too wide at the toe. The foot makes a natural pointed shape and if the shoe is too wide then there will be space on either side of the toes. However making the shoe too short will pressure the second toe and cause the base of the second toe joint to possibly compress into the the foot and create arthritis later on. Great care needs to be taken ion the fitting of the Egyptian foot.
The fitting here is usually extra narrow or narrow.

General fitting:
Many children today have larger feet than the last generation but not so much fatter feet rather longer slimmer feet. Different areas of the country have predominately different shapes of foot to the other. We have a number of fitting techniques to adapt each shoe to each shape of foot and these alterations are done at the time of fitting. Teachers can also make sure that they check the condition of the young foot and mention any problems quickly to the parent. Often these issues can be observed in how a dancer does a step and whether or not they are able to manage a particular step. Walking on the inside or outside of the feet , Rolling in, sway back legs. knock knees are a quick indications. Other observations are sore backs, sore knees, sore arches. However in very young dancers, the joints are still soft and as you can read from the anatomy section, these joints may not become fully developed until early teens.

An experienced fitter will always point out any problems [or possible problems] to the parent or dancer and this information should be passed on to the teacher for further help. Barrry Kaufax, of Barrys in Scotsdale Arizona and one of Americas leading dance shoe fitters once told me this analogy: It really is vital that the fitter, the dancer and the teacher should work together like a three legged stool. If one leg of that three legged stool stool is not working with the other then something will fall and that is, of course, the dancer. So yes, we all have a responsibility to the trust the young person places in us to do the right thing by them.

Problems when fitting:

The Ingrown toenail:

Starting at any age this condition can result from shoes that are fitted too tight or too short including soft toe ballet, Pointe shoes, Highland or Irish Shoes. The solution to avoid problem conditions is clearly stated in previous paragraphs.
the solution to the condition is to cut the toe nails across the width and not to cut into the sides of the nail or shape the nail into a curve.

Avoiding narrow shoes may be a solution to ingrown Toenails but do not arbitrarily state this as the child may actually benefit from a narrow fitting depending on the where the problem toe is. The great toe is normally the problem one and the condition can be on either side of that toe. You sometimes find the toe is twisted or tight against the next toe and pressure is forcing the skin over the nail. A Podiatrist or chiropodist will give you help in curing the effect but try and avoid the case.

Rolling in or out can also be a cause.

Hammer Toes:

Shoes that are too big when fitted to the child at a young age when the parent wants room for growth and the little foot tries to grip onto the sole of the shoe leading to another condition such as hammer toes as well as ingrown toenails. Another cause is simply tights or socks that are pulled up too tightly and make the toes bend down.

Hand me downs? Second hand Shoes?::
Usually big sisters shoes have been handed down and are still too big. This can also be where a second hand shoe has been bought and previously worn by a completely different shaped foot. So I would never advocate the use of second hand shoes. Why take the risk?

Soft Corns:
In between the toes soft helomas or corns can develop on the dancers foot. Extremely painful this condition can be caused by incorrect shoes as opposed to badly fitting shoes. Warm moist conditions created by Irish or Highland shoes with plastic linings, plastic or P.V.C. insoles etc]. Hullachan do not use plastic materials to line their shoes. These corns must be professionally looked at and the shoes that create the conditions that lead to butyric acid formation through excess perspiration must be avoided. After all you have 125,000 sweat glands in your foot and it is important that the foot breathes properly. We stopped selling plastic or P.V.C. lined shoes years ago because of the damage they can cause and all our Hullachan products are made with natural materials. The special pad actually breathes and allows air to duct.

Hard Corns:
Common among dancers that had their shoes fitted incorrectly usually form on the knuckles of the second third and fourth toes. We can talk about this effect and the causes for a long time but the salient causes go back to two major situations we discussed in the other articles on my website www.hullachan.com.The first is when you ask a dancer to point their toes, unless you actually check them they invariably point their big toe and curl their other toes.

As a fitter I see this with the young Highland and, sometimes, Irish Dancer.

When the foot is young the cartilage has not hardened and the young foot can stay in this shape. The problem of course is that the foot is not being stretched and the development of the arch will never be easy but the knuckles of the foot are raised to the top of the shoe and through abrasion and pressure a callosity will grow on the head of the joint and a corn could form. The point about the shoe being too big for the young foot and a hammer toe condition developing can also apply to this problem. The other cause is when a shoe is too big or too wide and the dancer slides down into the crown of the shoe and finishes up being supported not by the sides of the shoe but by her bent toe joints in the tip of the shoe. More common than you would believe this is caused by the shop that sells only a few assorted sizes of shoe and tries to sell what they, the shop, have rather than what the dancer should have. Unfortunately there are a few bad fitters still around and you, as teachers, parents and dancers must determine the professionalism of the shop you are recommending your students to.

We all know that the job of teaching doesn't finish when the pupil leaves the class and as the young dancer looks to you for advice in dance they also rely on you to advise them as to the correct shoe and the correct fitter.

Achilles Tendonitis:
Achilles Tendonitis can be caused by a number of problems and most of these are easily solved. The first is where the drawstring has been pulled too tight and is digging into the back of the ankle creating pressure on the sheath of the tendon and causing inflammation. One of the results of this is the so called heel bump and the problem of that is the dancer can never get a shoe to fit comfortably either for dance or for street wear.

Another cause is faulty technique in landing and taking off when performing a jetè or jump. In both cases this may be the result of the shoe being too big and the drawstring being pulled too tight to compensate. This also goes back to the dancer who has developed the width of the met heads through Highland or because of a bunion or deviated toe joint. In all these cases the heel will not widen to match the width at the front of the foot. This causes the heel of the shoe to be too loose. In this case we can in some cases alter the heel shape to make the shoe a little firmer.

I would like to help with any questions that you may wish to ask about shoes, fitting or problems so please send your comments or questions, anonymously if you wish and I will be delighted to assist teachers and parents.

Teachers are welcome to use, copy or distribute these articles on condition that all articles are marked copyright © Craig Coussins-www.hullachanpro.com, and that reprinting and distribution is not for profit. All other articles must be marked with the authors name and copyright. These articles are for the benefit of our kids health and similar information should be made available to increase our knowledge of these matters.
Craig.

Interesting link to a toe care range of protectors: http://www.foothealthcare.com/acatalog/Big_Toe_Seperators.html

IMPORTANT NOTE TO ALL ARTICLES:
Doctors, Podiatrist and Medical Advice: Anything you have read here refers to my own experience and it is important that if you have any issues you must take the dancer to a specialist in any event. The notes here are to give you some general information. The Doctor and specialist can often help alleviate the condition but as as fitters, teachers, parents and dancers, we need to try and work out the cause if the cause has come about from the dance or shoe.

The Heel

The Heel - Information for the Dancer.
-Craig Coussins-(Hullachan Pro)

Pain: The basic cause can be overuse in dancer’s cases but despite that, you really should have a clearer understanding of the various conditions that affect the heel and ankle.

The ankle supports the entire weight of the body and because of this the joints, muscles and tendons are very susceptible to injury in this area. The heel comes down at extremely high speeds and the fascia or base interconnective tissue including muscle and tendon area under the foot that runs from the toes through the arch and onto the heel bone, can cause extreme pain if it is damaged or torn.

The heel.

Around the heel are a number of fatty layers that soften or cushion the impact of walking, dancing or running. This fatty tissue can also de-fat if too much callus is left to develop and then the heel can become tender. Callus formation can be reduced by correct footwear that protects your heel area and treatment of callus can be done with self-care using proprietary lotions, visiting a podiatrist or chiropodist and, initially, cushioning for relief of pain

We discussed briefly that the plantar fascia under the foot can tear away some bone at the heel causing what is known as a ‘Heel Spur’. Sharp pain, stiffness of the ankle area or foot, which is sometimes worse in the morning when the sufferer gets out of bed, someone with this heel pain can limp about for a few minutes or longer before the pain declines. In some cases, mainly with adults, the pain does not get better. Initially some inflammation may occur which can be painful. In the case of children, some pain may develop with growing bones and again cushioning can help. The treatment for this is dependant on the pain. Indeed some heel spurs have no painful episodes but many do, and if the pain is bad, then surgical treatment may be necessary.

Other causes of heel pain: Pains in this area may suggest a more serious condition so it is important to get medical or specialist advice. These conditions include impact damage, arthritis, and misshapen heel bone formation, heel neuromas’ that are benign tumours of the nerves around the heel, gout, psoriasis, fat tissue damage or abnormality, overweight, splinters and warts. Flat feet. In use or exercise, excess pronation of the foot, this includes rotating the heel in an outward direction and an inward rotation of the ankle. Good fitting and supportive dance shoes are essential.

Avoidance and Treatment

Avoidance of most strain will include warming up correctly and cooling down. You can stretch your feet with heel raising exercises for example. This is s series of warm ups for your feet that will strengthen and stretch the muscles correctly. These should take around 10 to 15 minutes before and after a class. These can also be done outside class to strengthen your lower legs about four or five times a week.

Before a warm up- Using a wall for support, raise the heels of the floor putting all the weight onto the front of the foot, the ball of the feet and the toe area. Relax and slowly lower the heel back onto the floor. By repeating this simple exercise 14 to 18 times before, warming up you will reduce the possibility if straining the foot muscles.

Sitting on a chair, hold your feet in the air and try and draw the letters of the alphabet with your big toe.
Use your hand to gently bend your toes up to the maximum without hurting or overdoing it, hold this for a count of 100 and release. Do this once with each foot.
Using a tennis ball or one of the new tennis ball size massage rubber balls, place that under the arch of your foot. Do not press too hard and roll the ball all over the sole of foot for about three or four minutes each.
Do not stretch any area of the plantar section, the sole of the foot when the heel is already sore, as this will lead to greater pain.

Self care of the heel area. Your doctor may prescribe, or you may be offered in a class or at a competition such medicines as ibuprofen, aspirin, or other anti-inflammatories to reduce the inflammation and pain. Please follow the exact dosage and make sure that you do not have any allergic reaction to these medicines if offered in class or at a competition. Discontinue if there are any such allergic reactions such as sweats, sore stomach or breathing difficulties. If you are asthmatic, you probably already know what you can and cannot take anyway. Read the instructions on any packet as these will tell you what allergic reactions may occur and under no circumstances take any medicines from friends as what works for one person may seriously injure another.

The R.I.C.E. method. Is an acronym for rest, ice, compression, elevation. Used for sprains, strains and many general twists and forced damage but in this case also optional for heel pain.

Rest: Do not dance or exercise if you are suffering from painful conditions such as heel pain, muscle strain and even tendon inflammation. Exercise slowly if possible to keep the body from stiffening up.

Ice: This technique is fine for everyone except those suffering from bad circulation or Diabetes. Soak the heel in iced water or surround with ice packs or a couple of packs of frozen peas loosened off before applying as these will cool down the inflammation for about 15 to 30 minutes. Otherwise, fill a washing up plastic container with cold water just to cover the heel area. Add ice cubes over a period of 30 to 40 minutes, just a few at a time to slow down the blood flow and acclimatise the heel to the cold water. Do this three times a day. Some activity may be possible and indeed some authorities and I agree with this in the main, suggest that you should make the body work as much as is possible and no more though. If you do this however, use the Ice water immediately after any such activity though.

Compression: in cases of more severe pain, a podiatrist or specialist may tape up the painful or injured area.

Elevation: Lifting the foot while sitting will help reduce swelling in cases of sprain but may also relieve the sufferer of heel pain as well. Many dancers find that elevating the heel inside the shoe helps and by cushioning the heel, relief can be obtained. Higher backs on the hard shoes can help and in the case of hard shoes, it is important for these to have stiffer heel sections. Boys reel shoes need to have stiffened heels for extra support.



Questions:

I keep getting blisters on my heel and sometimes on my toes. What is causing this and what can I do about it?

The first thing that comes to mind as a shoe designer is that when your shoes were fitted they were either too wide for you or too big. The friction of shoes sliding on your feet will cause overheating and subsequent blister formation. The second thing you need to make sure of is that the inside of the shoe is not causing the problem. Inside the hard shoe at the heel, area is a material that should be slip proof. If it is not then the shoe will slide up and down on your feet. It’s an easy test when you get your shoes fitted. Rise onto the ball of your feet and the shoe should stay on the heel. If you feel it slipping then it is either too big or the material being used is not slip proof. The central seam of the soft shoe can cause blisters on your toes. Even from a hard shoe where the toe puff, or stiffened area at the toe over your own toes, has a distinct ridge and it catching your toes when you dance. Feel that with your fingers before fitting. Spenco and other manufacturers make special blister plasters that cover the tender area. If you are prone to blisters, you need to keep your feet clean and dry between dances and classes. Change your socks or tights during a competition or dance.

Further research:

http://www.hullachanpro.com/achilles.htm

http://www.coretherapy.com/health_news/articles_lower_leg_injuries_in_dancers.html
http://hsc.csu.edu.au/dance/core/performance/dance_technique/prevent_injury/achilles_tendonitis.html
http://www.drnick.com/sports_med/dance_medicine/dancemedicine.asp
http://www.wheelessonline.com/ortho/achilles_tendinitis_in_ballet_dancers
http://www.shape.bc.ca/resources/pdf/MSIDanceInjuries.pdf
http://www.danceart.com/Mechanix/preventinjury.htm

Treatment:
http://www.200.com/tendonitis.htm
http://www.coretherapy.com/health_news/articles_lower_leg_injuries_in_dancers.html


General Information:

I have done research for you and you will find suitable articles here:
General Info on Retro Calcaneus Heel Pain: http://straws.com/a_retroc.htm
Retro Calc Bursa: http://www.shands.org/health/information/article/001073.htm
Surgery of RC Bursitis:
http://www.podiatry.curtin.edu.au/encyclopedia/bursa/
Heel Bone Spur: http://www.merck.com/mrkshared/mmanual/section5/chapter60/60c.jsp

General issues with Heel and Achilles injury or Trauma:
http://www.aafp.org/afp/20020501/1805.html

Intro to The Achilles Tendon

Achilles Tendonitis,

The most common tendon injury amongst dancers. The tendon is easily strained and repeated damage causes inflammation of the tendon. The difficulty is that the Achilles tendon affects almost all the foot movements of the dancer and it then becomes hard to stop or reduce further irritation or damage after the tendon becomes inflamed. . Treatment includes rest and raising the heel with a small pad such as the Heel Pop sold by Hullachan. The thicker heel padding in the new Hullachan Jig Shoes acts as a preventative. This shortens the tendon and alleviates some of the pressure. Strapping of the tendon area must be done if you need to continue to dance. This strapping allows the dancer to work but stops the tendon from over stretching in use.

History and the name:

When I speak to dancers that have serious injury, it is usually the Achilles tendon around the back of the heel that seems to be the most common of these. Around 18% of dancers get this painful condition at the back of their heels. It was called the Achilles tendon from the Greek legend of Achilles.

I know we are talking about this part of the body but I thought you would like to hear the background to this myth. It was not always Achilles’ heel that was his weak point.

Thetis was Achilles mother. She wanted him to be immortal so holding him by the heel; she dipped him into the river that runs into the underworld, The Styx. The legend goes; she held him down once and forgot to immerse him a second time holding the other heel so the magical waters of the Styx did not cover the heel. That part then stayed vulnerable and not immortal. Since the 15th century, from writers on medicine such as Ambroise Pare and others, the term, Achilles Heel, referred to a weak point, not only physically, but also mentally.

Writer, Michael Macrone, in his excellent book called, It’s Greek to Me, (Harper Collins, New York, 1991) explained that Achilles did not always have a vulnerable heel. Certainly, he had a weak spot, but according to the original story about Achilles, Homer, in the Iliad, said it was his pride. Later versions indicate his weakness was his love for the Trojan princess Polyxena. In his Metamorphoses, Ovid suggested that Achilles had a vulnerable spot on his body; but the Roman poet, Statius (c. A.D. 45-96), was the first to imply in a poem that it was his heel.

Back to the actual problem.

What is the Achilles Tendon?


The Achilles is connected to one of the strongest groups of muscles in the leg. Huge pressures build up in this area and athletes are very prone to damage in this area. The tendon we are discussing is attached to three muscles. The tendon itself is the end part of that muscle group. These are the gastrocnemius, (gast) which has two ends and the soleus muscles.

The problem is that the gast muscle crosses over three main joints. The knee, the ankle and the subtalar joint. Please let me explain a little anatomy as this really does affect you when you do Irish Dance. The foot is divided into three sections. The forefoot, the back, or hind foot and the mid foot. The back foot is the anklebone or talar joint, and the calcaneus or heel bone. The subtalar (or subtalus) joint is formed by these two main bones and why it is important for you as an Irish dancer is that it is responsible for its amazing flexibility. When you do a rocking side-to-side movement with your ankles, it is the subtalar joint that allows this.

The major part of the Achilles is in the lower part of the leg near the foot and attached to the heel bone or calcaneus. See the drawing.

Unlike other most other tendons, the Achilles is not inside a sheath and does not have a rich blood supply of its own.

Symptoms.

A sharp pain; painful heel up the back of the leg when you start to dance. The pain can subside during dancing and then return before you finish. This is the problem. You are lulled into a sense of false security. Just grin and bear it; work through the pain; deal with it?, I don’t think so!

Causes.

Achilles tendonitis can be caused by a number of factors. These can include simply ignoring any pain at the back of the leg of heel, extra classes preparing for a Championship or show, such as dancing twice a week and suddenly practicing five times a week. Breaking in a new shoe that is far too stiff, and not warming up, or cooling down properly. Fortunately, you are a body and not a machine, however, machines break and so can bodies. Be sensible and warm up correctly.

Shoe pressure at the back of the foot, tying laces around the mid foot which stops the full functionality of the foot joints, getting kicked or damaging the tendon at the heel or just above the heel area.



I was asked about this in November 2005 and the question was that 18% of ballet dancers will suffer an achilles injury at some stage in their dance life. This was my answer:

It depends on the dance discipline. In Highland Dance, around 35% of dancers will get some form of tendonitis injury and Achilles is one of the more common ones. In ballet the damage can be caused by faulty landing and twisting but the cause of achilles in dance is nearly always caused by the tapes or laces being tied too tightly around the ankle, causing compression of the sheath and subsequent damage. In Highland and Irish Dance, the damage is further caused by tying around the arch that can reduce blood flow to the extremities of the foot. The tying around the ankle is secondary here but in tandem with the arch constriction then that sets the dancer up for an Achilles or tendonitis injury. In Irish Dance, there is likelihood of around 30 to 40% chance for an Achilles or arch tendon damage if the dancer ties their laces around the arch.

This was well researched by both me and many leading dance injury specialists including work done by the famous Justin Howse who wrote the book, Dance Technique and Injury Prevention with his associate, Shirley Hancock back in 1988. Mr Howse was the senior consultant and orthopaedic surgeon to the Royal Ballet Schools, The Royal Academy of Dance and the Remedial Dance Clinic, London. Ms. Hancock was the senior physiotherapist to the to the Royal Ballet Schools, The Royal Academy of Dance and the Remedial Dance Clinic, London. I have consulted with them over the years when I was the fitter for over 150 Ballet companies all over the world. My own research in the 35 years of fitting to improve my range of Ballet shoes and to try and reduce injury which is rampant in Ballet, resulted in the creation of the Hullachan range of shoes. None of the ballet shoe manufacturers I spoke to was, at that time, willing to invest in that research to reduce injury and so I started my own company making Highland and Irish Dance shoes. Why? Well I am part Scottish and Irish and I invested everything I had to make that dream happen-at least for Irish and Scottish dancers.

Treatment for Achilles Tendonitis.

R.I.C.E. treatment is, Rest, Ice, Compression and Elevation, so please get that into play immediately to reduce the problem and do it at least three times a day over three or four days.. See a doctor as soon as you can. If your Achilles is getting less painful still continue treatment of R.I.C.E. for the next two to four weeks or until it is healed.

Reduce practice of course to about half of that you normally do. Avoid too much stretching. However saying that use correct stretching and if you do get an attack of Achilles tendonitis from your dancing, do not stretch too enthusiastically, but continue to stretch gently or if attending a doctor, follow their advice. Avoid stair, wall, incline and towel stretches. Try not contract the muscles in the initial period of pain.

If this does not show positive results, use a firm heel support or lift of no more than a quarter inch or half a centimetre. Do not use flat shoes in day-to-day use such as trainers. The idea is to relieve the pressure on the tendon so that it does not stretch too much. A good preventative part of your general warm up should be gentle calf stretches.

Do not use overly cushioned insoles in Jig Shoes or in Pumps that are too soft. Some materials feel great to start with but then collapse and become hard.

I should point out that when I designed the Hullachan Jig Shoe I inserted a special medically approved thin heel cushion covered by a firmer insole. This was not too thick and had the benefit of helping prevent heel strike as well as stopping too much depression following an Achilles tendon problem. Too much cushioning is very bad, as, after contact with the floor, the heel of the foot will sink down lower as the shoe absorbs the shock. That will then further stretch the tendon as the body moves over the foot. Too thick a heel cushion such as a rubber-cushioned insole can have the opposite effect of the preventative measures I incorporated into the Hullachan Jig Shoe. Avoid all trainers when practising if you get Achilles tendonitis.

Other problems in this area.

Heel bump may be diagnosed as Haglund’s Deformity. It can possibly indicate that the tendon is pulling away from the heel bone, or that a bony growth is caused by pressure at the back of the heel. Ascertain if there is any pain while you are barefoot and while you are wearing a shoe. The Achilles Tendon problem will be painful while you are barefoot. Haglund’s is painful while wearing a shoe but, normally, not barefoot. Heel bump, while in some cases, not too serious or indeed even painful can cause shoe fitting problems and this could mean you buying a shoe that is not the right overall fit. Width is probably the answer here. I have an answer for this but will discuss this later on.

Achilles Tendonitis Bursa,

Is where the tendon overstretches, and causes an inflammation of the bursa, or pocket of fluid that allows movement at the joint where the tendon joins the heel bone or calcaneus. Please note that this bursa can also become inflamed if pressured by your dance shoes and creates a similar condition that feels like Achilles tendonitis. The new Hullachan regular pump and Gel Toe has looked at this problem and inserted elasticised side panels to stop the heel being pressured.

Achilles Tendon 2-Growth Pains

A common pain is the severe pain behind the heel, which stems from overusing the foot and ankle in hard competitive preparation. The fibres of the Achilles tendon pull on the growth plate of the heel and create inflammation within the heel bone.

However, growth centre pain which can include Achilles Tendonitis is even more common among children who have flat feet, toe-in or have other foot problems. For these youngsters, an orthotic, a splint or soft cast is usually enough to properly position, strengthens feet and ankles, and prevents future pain and injury in their walking shoes. We can apply a suitable soft orthotic in their Hullachan Pros as well.


With prompt treatment, growth centre pain persists only a few days or weeks and usually without the need for any surgery. However untreated, growth centre injury can require long term treatment.

The notable features of growing pains includes:

1. Intensity - Usually mild, sometimes a few children complain of a lot of pain that makes them cry. The pain can be short or it can last for over an hour.

2. Frequency - Intermittent, Some children get the pains every day or at night, others once a week or so, and some get them every so often. The pains tend to occur after a child has had sports at school or attends a dance class.
When Normally, late afternoon or evening before going to bed. Occasionally the pain will make a child wake up at night.

5. Where - In the muscles but not in the ankles or knee joints. Many children report that the pain is in front of their thighs, in the calves, or behind the knee. Joints can be affected by other more serious diseases and appear swollen, red, tender, and warm. The Osgood Schlatters joint looks normal.

Other symptoms - restlessness, but usually no tenderness, redness, swelling. or fever.

Paediatricians find one symptom useful in making a diagnosis of Osgood Schlatters and that is how the child responds to being handled while in pain. Children who have pain from a serious medical disease do not like to be touched because any movement tends to increase the pain. Children with "growing pains" respond quite differently; in liking to have their legs massaged. That makes them feel better and they like to be held and cuddled.

The child's physician should be notified if any of the following occur with your child's pain: Regular pain, swelling, or redness in the joint or lower limb area, fever, limping, unusual rashes, loss of appetite, weakness, lethargy, or uncharacteristic behaviour. These signs generally do not accompany Osgood Schlatters and may be an indication of a more serious disorder.


Growing pains may seem harmless enough from an adults perspective or even a teachers perspective, but to a child, they are very distressing. Since the child seems better and is free of pain in the morning, parents sometimes suspect that the child is faking the symptom. This is generally not the case ---the pain is quite real and it is at these times that they need their parents reassurance and support more than ever! If you do not believe me, just ask your own parents! I did and it was explained to me that I too suffered this condition. Both my children have been through it as well.

These recommendations must not be relied upon as medical advice and it is not intended to replace the advice of your child's doctor.



Further research:

http://www.hullachanpro.com/achilles.htm

http://www.coretherapy.com/health_news/articles_lower_leg_injuries_in_dancers.html
http://hsc.csu.edu.au/dance/core/performance/dance_technique/prevent_injury/achilles_tendonitis.html
http://www.drnick.com/sports_med/dance_medicine/dancemedicine.asp
http://www.wheelessonline.com/ortho/achilles_tendinitis_in_ballet_dancers
http://www.shape.bc.ca/resources/pdf/MSIDanceInjuries.pdf
http://www.danceart.com/Mechanix/preventinjury.htm

Treatment:
http://www.200.com/tendonitis.htm
http://www.coretherapy.com/health_news/articles_lower_leg_injuries_in_dancers.html


General Information:

I have done research for you and you will find suitable articles here:
General Info on Retro Calcaneus Heel Pain: http://straws.com/a_retroc.htm
Retro Calc Bursa: http://www.shands.org/health/information/article/001073.htm
Surgery of RC Bursitis:
http://www.podiatry.curtin.edu.au/encyclopedia/bursa/
Heel Bone Spur: http://www.merck.com/mrkshared/mmanual/section5/chapter60/60c.jsp

General issues with Heel and Achilles injury or Trauma:
http://www.aafp.org/afp/20020501/1805.html

Common Injuries and discomforts

Common Injuries and discomforts.

Wearing the wrong shoes can be a common reason for injury. One old issue in the Ballet world was where shoes stretched and slipped around the foot. The dancer, thinking that their shoes were on their feet in a certain way then landed incorrectly and could cause serious Achilles damage. In some cases the Achilles tendon snapped and that was the end of the dancers career.
We notice recently that some makers are trying to copy our unique Hullachan Shoes and while these shoes may look like the Hullachan they can pose serious problems for the dancer. Our shoes are designed to fit the foot properly, fit tightly into the arch, give support and stretch around the heel after a couple of wears. The sides, toe and cut of the shoes are all designed to form around your foot. These fake Hullachans do not do this and just copy the look of the Hullachan but without the function. The heels might look better than the genuine Hullachan perhaps but the Hullachan heel is carefully designed to stretch out and around the heel of the foot and then grip the heel correctly. These other heels will look good until they stretch and then the dancers has slipping heels or heels that will stretch and fall off.

Reading my articles will illustrate my dedication to the dancers safety and it appals me that these fake Hullachans may fool dancers into believing that they are buying safe shoes. Does it make any sense that I would make mistakes in my designs and hurt dancers?

There are a number of injuries, which can give Dancers some problems. What I wanted to look at was the most common of these, discuss the symptoms and look at ways in which treatment can help. Treatment is not always medical and an ounce of prevention is worth a ton of cure.

The information written in these articles should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician will need to be consulted with for diagnosis and treatment of any and all medical conditions. These articles are for general information only.

The foot has 19 muscles, 28 bones including the two main sesamoid bones (there are actually four sesamoid bones), 30 different Joints, 31 Tendons, 107 Ligaments, and for what it's worth 125,000 Sweat Glands.
Over 300 Ailments can affect the foot.
A dancer hits the floor at three times their own body weight when they simply walk and even more when they jump.
The most common complaints for dancers are Bunions, Ingrown Toenails, swollen Tendons and Shin Splints. You can add Knee problems and a dozen other 'less popular' but equally painful problems.
Many Dancers suffer from Arthritis after leaving Dance and back trouble plagues others.


What I will do is explain some of these to you .
These are listed in no particular order but some are interrelated. Each section is divided onto four parts.
What is it?; An explanation of what it is we are discussing.
Effect or what is does to you;
Cause or what causes the problem.
Avoidance or what to do to avoid getting it;
Treatment, an explanation of general treatments for the problem.

Common Foot and Ankle problems
Affecting the:

Toes, Nails, Metatarsals-Ball of the foot, Heels, Tendons; Achilles, Arch, Knees and Ankles.
1. The toes:
a) Corns/Soft Corns/ Callus- Partly covering the arch /
b) Bunion/ or Hallux/Halux Valgus/Halux/or Hallux/ Rigidus/ Bunionette/ Tailors Bunion
c) Morton's Neuroma /Hammertoes/ Claw toe/ Ingrown Toenail / Arthritis/.
The Mid Section of the foot:
a) Tendon Problems/blood vessels,
b) muscle strain/ Arthritis/
c) the arch/
3. The heel:
a) Tendon Problems/ Achilles Tendon Problems/
b) Ankle Sprain/Ankle Sprain/Instability of ankle/Tibial Tendonitis/Rupture/
c) Arthritis/ Plantar Fasciitis -Heel Spur)


Knee pains;
including Osgood’s Schlatters disease/ growing pains
Other ailments:
Sesamoiditis, curved or sickle feet, muscle strain/feet/leg/thigh and
lower back

The toes:

Corns. Hard and Soft Corns


What are they?
Corns can develop on any dancer if the shoe is not supportive or the leather is rubbing against the top of the toes. Corns are one of the foots easiest signals that something is wrong but also where it is wrong. There are two types of corn, heloma durums (hard corns) and heloma molles. The dancer who abuses their feet will cause the stressful situations that are usually hard corns, and it can be very painful

Effect:

The corn will appear on the point of the foots knuckles and along the flat area between the knuckles. The corn is one way in which the foot tries to protect against this abuse by building a small section of layer of skin to act as some kind of padding over the stressed areas where there is a lot of pressure on that part of the foot. Most toes curl downward instead of being flat. Fitting curled toes into shoes that are too tight toe is a principle cause of hard corns. The toes remain curled inside the shoe. In addition the tip of the curled toe is forces into the toe of the shoe and can not stretch.

Cause:

Bending your toes and pressing them onto tight shoes with no support can cause hard corns. In addition, this can also affect the shape of the toes as well and while toes are naturally slightly bent, curling your toes are setting you up for corns. Unfortunately, it can happen on very young dancers’ feet as well and this can be signalled as by the dancer knuckling under when rising on their toes in soft shoes. The toes collapse as there is of course, no strength in the toes themselves; the knuckles now come into contact with the floor with leather between the toes and the floor. In some cases, a central seam could also cause painful reaction in the same area.
So its formed through the shoes being too tight. It can, however, be formed by an underlying deformity of the bone area.
The pain of a corn or a collection of corns can be very serious for the dancer. Less so in young dancers but if not treated will go on to cause considerable pain as the dancer gets older.

Soft Corns-(Heloma molles)

Effect:

Corns will invariably stop you from performing at your best as the corns limit the action of the dancers technique because of the pain.
Reduction of general mobility in all areas, walking, running as well as dancing.

Cause:

These usually occur in the area of the foot where one of the three bones that form the toe, are too wide in the fourth and fifth toe area. Normal toe bones have a shape where they are narrower in the middle and wider at the joint. Soft corns can occur where the wider part is a little too wide and meets the next toe which in turn can cause friction. This problem is made worse when the shoe is fitted too tightly. Conversely, dancers with normal shaped toe bones can also develop soft corns. Especially common in dancers who wear the hard shoe as this elevates the foot and causes the weight to shift over the front of the foot which shift the body's weight forcing the toes into the front of the shoe. Another reason why you need arch support on a hard shoe no matter how flexible or stiff.

Avoidance:

At all times you will need to be fitted by a qualified fitter that actually knows what they are talking about. The problem as I see it is where the seller is not a fitter and is just selling you a pair of shoes. In day shoes or dance shoes, this is important. Any decent fitter will have all this knowledge available on call and if you know more about your feet than they do, then surely this is to your advantage?

If you are having trouble with corns you should wear shoes that fit and are not too tight. If possible, to both avoid getting corns and prevent pain if you already have them, do not use socks with seams as seams can cause the friction that in turn can cause corns. There are many socks on the market now that do not have seams. Wear thicker socks when wearing outdoor shoes or trainers but make sure these shoes are large enough to take the socks as well but not so large as to cause other problems such as hammer or claw toes.

Treatment for Hard Corns

These can be treated in a few ways. One is to wear wider shoes that do not compress the feet and keep your toes straight when you point your feet during the fitting. (Curling the toes to make a point is not correct technique and will cause you a lot of problems)
The second way is to have a Podiatrist of foot specialist to make you an orthotic, I shoe insert to straighten your toes if the toes are still flexible as in young dancers. There are also small soft toe pads that you can buy cheaply to alleviate the bent toe problem but only with your doctors advice.
Another way is to do something about the bones of the toes themselves. If the toes are not flexible and pretty much formed into the bent shape, your podiatrist may suggest a small operation to try and release the soft tissue to allow the bones to straighten out. This can only be done after a thorough examination.
The other treatment is to have them shaved down, cut off or treated with a solution that burns the corn off. These solutions are applied with either a corn acid liquid or a corn plaster. However, this does not actually sort the problem if there is an underlying issue and the corn will soon return in that case.
other option is have them cut or burned off with a topical acid solution or Treatment for Soft Corns

I said that the usual causes for soft corns stem from the wider area of bone in the joints of the toes. Using a wider shoe may well help initially but will not treat the problem. Soft corns are treatable in a surgery or podiatrist office.
A small incision is made under local anaesthetic and the specialist inserts a tiny grinder that takes the aggravating piece of the wider bone down to a normal size. Its only a small cut and closed with one or two stitches. Its very quick and there is a very short recovery but the benefit is immediate relief from the pain.

Calluses

What are they?
The callus is a thickening of the skin in the pressure area and is a natural defence of the body against friction. In normal cases a callus can protect the underlying skin and internal areas. Its fine on a gardener but not so good if you are a dancer

Effect

Callus formation can really be a problem on dancers feet. Hard skin will occur on the ball of the foot over the metatarsal heads, (the ends of the toes, the long inner bones, in the ball of the foot area). They can form on the outside of the great or big toe, on the underside of the great toe and in the heel area. If the callus becomes too thick it will press the soft skin inside the foot and start to cause extreme discomfort.

Cause:

Areas of the foot that have a lot of pressure or rubbing from badly fitting shoes can develop callus formation. However it is usually a biomechanical problem, balance and the way you walk, that can cause the problem. This will cause pressure between the surface skin, the inner softer skin and the bone structure. It can also mean that the foot is unstable and the foot is being moved to one or other sides of the weak area. Irish Dancers with low arches and flat feet can experience this problem because the arch is low the foot becomes unstable. The shape of your arch can cause instability in feet such as dancers with high arches are prone to having weak ankles, which can cause them to go over on their toes
Callus formation on the ball of the foot area can indicate the metatarsal heads are low which in turn can cause pressure in that area. This can, in most cases, be over the first metatarsal head or the one connected to the great toe or fifth metatarsal head, the small or pinkie toe. What happens is that the metatarsal head is unstable and moves upwards as it is unable to support the foot. This causes the second metatarsal head to take the weight which in turn causes great pressure on this area and so a callus will start to form in order to protect the bone.
In some cases a callus can form over the entire area of the ball of the foot as well as on the sides of the great toe.-

Avoidance

In many cases the callus is caused by the faulty biomechanics of the dancer. You will need to tie this section in with the treatment section under the circumstances. Don’t wear shoes that are too tight or if they compress the toes inwards as this will cause pressure. Be careful if you have a long great toe as this will set you up for possible problems as the great toe is not strong and when long it is unable to take the weight of the foot in some instances.

Treatment

We need to look at the three arch shapes to understand the problems of both callus and bunion formation. There are three shapes of arch. The High arch, the medium arch and the low arch, more commonly refereed to as a flat foot. (This is not always the case as a low arch can still have some shape.)

This is now part of what we call understanding the biomechanics of the foot. In a high arch the foot does not become flatter when in use and the result is that the ball of the foot and the heel take the pressure. This is quite bad as the pressure can develop in the other parts of the body and the knee, hip and lower back can, in time, be affected. The technical term for this shape is Pes Cavus. This is really an overly high arch and the normal high arch is simply referred to as a cavus shape foot. In this case the weight falls on the ball of the foot and on the heel causing callus formation.

To treat this condition a podiatrist or specialist will supply an orthotic, a foot support, that will work to make the foot even with the floor. This can be either a flexible orthotic for dance shoes or a stiffer one for hard shoes. The orthotic will then support the weight of the body and even out the weight accordingly. In severe cases the specialist may make this orthotic with extra padding to avoid all contact with the floor.

The low arch or flat foot is also called fallen arches, pronation of feet, pes planus or pes planovalgus. If the arch becomes too flat the weight is placed on the inside of the foot. As the flat foot is unstable this can cause the foot to misalign in part of the bone structure. Flat feet are a common condition. In small children the longitudinal arch is not developed and they may well have flat feet. Childs feet that lean, or pronate inward at the ankle bones toward the center line indicate flat feet. Through the early years the arch will develop and by age 12 or 13 the arch shape should be normal. Some dancers have what looks like flat feet when they stand on the flat of their feet but when they lift their feet they appear to have an arch. The callus development can occur on the inside edge of the foot, along the entire metatarsal head area and the heel and foot under the edge of the heel. The orthotic may then be one with an arch of the height your specialist decides to distribute weight of the dancer latterly and move the weight to the middle of the heel area.
Please note that stiff or painful flat feet may be associated with another problem and you will need to consult your specialist or local physician.

The Bunion:
Bunion/ or Hallux Valgus/ /or Hallux/ Rigidus/ Bunionette/ Tailors Bunion/
What is a Bunion?
Those Dancers who have had them know how painful they can be but do you know exactly what they are?
The obvious sign is that the toe bends out at the joint and the joint is inflamed.
We are looking at two problems here in fact. This is not a Bunion. This is a Deviated Toe Joint known as Hallux Valgus. The Bunion is the painful callosity overlaying the projecting bone.
It also may be caused by the inflammation of a Bursa which is a pocket of fluid enclosed in fibrous tissue present in various parts of the body exposed to friction. The inflamed condition is known as Bursitis.

Cause

Affecting girls more than boys, the Bunion is confused with the Deviated Great Toe Joint. Between the first and second shafts of the Metatarsus is the 'Main or great Toe Joint'.
Girls sometimes have a tendency to roll in due to a variety of factors.
The first is that girls have wider hips than boys and this shape narrows at the knee caps. This can lead on down to the foot which rolls in to give balance.
Another reason is that strong shaping , such as , 'Knock Knees' can also do the same thing. Boys can also have this condition that may cause the foot to roll in.
Although not truly hereditary, it is generally accepted that children whose Mother or Grandmother had Bunions, may be more prone to have them.
In the first case of Hallux Valgus we have to examine that the shoe has been fitted correctly. This condition does not appear overnight.

Avoidance:

If you bend your toes this may make you think that you are pointing their toes. When you curl your toes you quickly weaken the foot and put unnecessary strain on the big toe which is weak anyway. You will never learn to point your foot correctly if you curl your toes.
When you straighten your toes, and I mean all of them, it tightens up all the muscles and tendons in the foot which then strengthens the whole foot and creates a much better arch.
When you straighten all your toes you develop the important muscles under the foot which will then be perfectly placed to develop the structure of the arch.
When you curl your smaller toes you release these muscles on that side of the foot which then puts all the strain on the big toe. This could cause the condition known as Bunions. Continuous bending will cause Helomas or Corns, on the knuckles of the first, second and possibly third toe in a normal arch and on the second and fourth toes of the higher arch shape.

Treatment:

It can be treated by straightening the toe joint and strapping which in the young foot is preferable as the cartilage forming the bones does not set until the 15th to 18th year. Cartilage is the solid resilient cellular tissue which covers articulating surfaces of bone and is found at some joints, later on, notably, the knee. Most bones are formed from cartilage in early life.
To recognise if there is a problem look at the toe joint of the Great Toe and see if the toe is bent in towards the outside of the foot.
Look at the joint and see if there is any inflammation at that joint. At the same time look at the outside of the foot at the little toe as a Bunion can form there. This is known as a Tailors Bunion. Tailors used to sit in a cross legged position while sewing and this Bunion was a common ailment for them.

A good Podiatrist or orthopaedic specialist will advise correct procedure to help the young dancer.
When your teacher asks you to point your foot, please make sure you are now aware of what will happen if you do not!
My motto is treat the cause rather than the effect.

General information on going to a Doctor or specialist such as a Podiatrist.
Treatment: This will involve seeing a Podiatrist or foot specialist who will advise you. There are some pharmacy available lotions for treatment but I advise seeing a specialist because of the possibility of an underlying bone deformity. This will give you some idea of what a specialist may do and these apply to all the areas of foot pain that we are talking about.
· Background of the problem:
The specialist will ask you where the pain is and what it is
you do- E.G.. Dance. You should have a reasonable answer prepared
to allow the specialist to make a diagnosis or decision as to
what is wrong. As a dancer, you may already know that there is
one technique you already do that causes the pain and you
should explain this to the specialist so that they have a
better idea of what may have caused the problem.
1. Examination
The first thing your doctor will do is get some important
information about the condition. These questions may take the
following form;
2. Where does it hurt?
3. How long has it been there?
4. I understand that you are an dancer so
5. Was there an injury during one of your classes or competitions?
6. Can you show me the kind of shoes you wore when this started to give you a problem?
This is usually followed by a thorough examination of your feet,

legs, the biomechanics of your body, how you walk, and the size
of your shoes.

Further examination can include X-rays or scans.
X-rays
· X-rays show the specialist the bones of your foot. The ankle may also me x-rayed as will the lower leg in some cases depending on the diagnosis. X- rays can also determine if there are any fractures, bone deformities and even arthritis problems for fractures and arthritic conditions which affect the bones.
Magnetic Resonance Scan or MRI Scan
· The MRI Scan uses magnetic waves to take pictures in such a way that when the film is processed it takes the form of slices through the foot. You just hear a noise as the scan operates and noting is done in any painful way to your foot. Its just the images that look like slices and not your foot. In today’s treatment diagnosis the MRI is incredibly effective at telling the specialist about the areas being scanned. Unlike X-rays, the MRI can look at the bones but also the soft tissues of the foot and ankle - the tendons, ligaments, and the surface of cartilage areas.
Computerized Axial Tomography or Cat Scan
· The CAT scan machine is, basically, an X-ray tube that rotates in a circle around the patient taking pictures as it rotates. A computer reconstructs the multiple X-ray images. These are in axial slice images sort of like the way a loaf of bread is sliced. Each slice of bread can be examined separately. The Scan may be done twice. First before and secondly after intravenous liquid to show up enhanced differences of the structures which improves interpretation of the images. Nowadays it can be quickly by a computer to give a three dimensional picture of the scanned area.
Further Tests
· Laboratory tests can include blood tests in order to help determine if other health problems are contributing to your foot problem - such as diabetes, infection or arthritis.
·Blood tests allow the doctor to see if there any any other contributing factors. However these must be the right blood tests and some test will not cover everything..

Doctor and specialist
Please refer to Doctor, podiatrist or specialist for medical treatment in all cases. This information source from Craig Coussins is to give you some facts so that you are aware of what may be the problem.

The Ankle

Ankles:

The major joint that can affect dancers of all disciplines. While I will cover sprains and strains later on in the glossary, I will make some pointers about the ankle.

Dancers need to exercise this important joint. This will strengthen the tendons and muscles around the ankle and reduce the possibility of inadvertent strain. Simple accidents can damage the ankle if you are a dancer. Some things to avoid: When stepping of Kerbs, pavements or sidewalks always be aware where your foot is. Kerbs are common causes of sprained ankles. Never go straight into dance until you have warmed up. Being cold will strain the muscles. Ask your teacher to work out exercises for strengthening ankles. If you are girl dancer, include never wearing high heels, as you can ‘come off’ these.

Proper stretching and warm-up exercises should be done before and after dance practice. It is essential that you warm up before competition and during the long periods between dancing which will help considerably to prevent ‘overuse’ injuries to the hips, knees and ankles. It is so apparent that injury happens when a dancer is waiting, waiting, waiting and then suddenly gets up to dance. You are cold. That is exactly when injury happens. A static stretch held for 10 seconds can help avoid overstretching injury.

Cool down, like another warm up is very important after class or competition in order to loosen these muscles and tendons. You may be too tight in these areas and will need to loosen them off, hence the ‘cool down’. Warm-up and cool-down exercises should take 5-10 minutes and should be done in a pattern of stretch/hold/relax. Do not snap, bounce or over pull these muscles when warming up. When your muscles, tendons, and joints, are properly warmed up, the strain on muscles, is then reduced. Knees should always be loose during warm-up.

Here are some basic exercises that are used on most Sports warm ups. I was a National Sports Coach in my own sports discipline for a number of years and I found these to be very useful.

In any case, an ounce of prevention is worth a pound of cure. Do regular exercises to stretch and strengthen your ankles.

Achilles tendon stretch:

Face a wall with your hands just touching the wall. Lean forward and support your body with your hands flat on the wall. Move one foot forward and one foot back a bit. Keep the heel of the back foot flat on the floor. Stretch forward until you feel the stretch in the back of the knee. Hold for 10 seconds. Relax the back of the rear knee and bend it toward the wall until you feel the stretch in the lower leg. That should feel stretched near the heel. Hold for 10 seconds. Repeat five times when first starting and work that stretch up to 10 times as you become better.

Achilles tendon and ankle stretch:

Start in a kneeling position. Lift one knee so the toes are even with the knee of the other leg. Lift the heel of the bent leg until it is elevated about a half-inch. While you lower the heel, lean forward on your thigh. Hold 10 to 20 seconds. Repeat five to 10 times.

I like this one for dancers. When I was training as a dancer in my youth I used it many times and it is a lot of fun. It is now a standard excerice in most dance schools.

Knowing your ABC’s
Stretch.


Start by sitting on the floor (or sit in a hard chair). Take your shoes off. Moving only your ankle, draw the entire alphabet on the floor. This is only done one time.

Ankle bend:

Using the back of a chair for a support, place your feet shoulder-wide apart. Hold onto the back of the chair. Slowly bend and rotate your knees side ways and down until you are standing on the side of your ankle. Hold for 10 seconds. Slowly rotate your knees in the other direction, which should mean that you are now standing on the other side of your ankle. Repeat 10 to 20 times.

Ankle rotations:

Start by sitting on the floor (or sit in a hard chair). Remove your shoes. Moving only your ankle, draw circles. Repeat 10 to 20 times. This is also a great exercise to use when flying.

Ankle and calf stretch:

Sit back on a hard seat with your back against a wall or the back of a chair. Keep your feet flat on the floor. Make sure that your heels are flat on the floor. Now lean forward keeping your back straight. To increase the stretch slightly-and only when you feel confident, push your knees down. Hold for a count of 40. Repeat this stretch five to 10 times.

Achilles tendon-Back of Ankle:

Start by kneeling down on the floor with your back straight. Move one foot forward and breathe in at the same time. Keep the foot flat with the bottom of the foot facing up. Lean forward and breathe out. Hold the stretch for a few seconds and then relax. You should feel the stretch in the top of the foot. Repeat these five times when first starting then 10 times as you improve.

Ankle Sprains:

Twisting or landing incorrectly from a jump onto an ankle can forcibly invert the joint and damage ligaments. This will cause a sprain. Immediate treatment using the RICE formula, (Rest, Ice, Compression and Elevation) to reduce swelling is important to quick healing. Any such injury that does not show an improvement in three days should be checked by a podiatric specialist or your doctor.

The Arch

The Arch;

There are three main shapes of arch, low, medium and high.

The dancer with the low arch may be unable to achieve a satisfactory arch and could have trouble standing on point and even demi point. The dancer with the high arch invariably has weak ankles and without proper tuition may unable to support thenselves properly as they may simply not be pulling up. Using a stiff outer sole will not help.

Exercise to build up strength in the arch will help and wearing the Hullachan will allow better control. If you have no arch wearing the Hullachan will not give you one but if you have any kind of arch shape, the Hullachan will show what you have unlike other brands.

The dancer with the high arch will usually have weak ankles and that will cause her to twist or not get full strength while on half or full toe. This is a problem while learning until the teacher has taught her how to build up her strength and help her to develop the thigh muscles instead of just calf and ankles.

Using a shoe with a flat arch could cause the shoe to slip around the foot. Please note that only Hullachan makes a true arched shoe which actually fits into the arch of the foot. Our unique design will work with all arch shapes. However, our design is being copied by some unscrupulous makers who try to pass of fake Hullachans but none of these makers understand how we create the special shape that defines and supports your arch. Fake Hullachans do not have the Hullachan label on the shoe.

The arch is a very important part of your foot. Do not tie your laces tight around your arch, as it will cause damage to your arch. I designed a new way to tie your laces to stop pressure on the arch and the Achilles tendon, so please try to use that method.

Damage on the top of the foot caused by lacing is also serious as it is a tender area. Muscle, blood vessels and tendon damage can occur here.
Massage this area after every class to release the tension. Concentrate on your muscles in the foot and relax them. This will also require you to relax the leg muscles as well incidentally.

Hullachan Jig shoes have flexible Suede Soles. All Jig shoes have our special memory flex arch with gives correct arch support to reduce arch injury

Introduction to dancers Anatomy for teachers and dancers

A TEACHERS AND DANCERS GUIDE FROM CRAIG COUSSINS
Forward: Due to the complex nature of this subject I thought it would be beneficial to cover the salient points of how anatomy can assist a teacher during a class by recognizing the more common problems of the young dancer.

Intro to Anatomy for the Teacher and Dancer
The Knee
Knock knees
Osgood-Schlatter disease or Growing Pains
Shin-splints
Achilles Tendon 2
The Knee and Bending
Bow Legs
Sway Back Knees.



Intro to Anatomy for the Teacher and Dancer
When a teacher looks at a dancer, they see a blank canvas onto which they can apply the experience of their years as a teacher. Perhaps this young dancer will become World Champion or a Principle Dancer in a company. Maybe they will go on to teach other young hopefuls in turn but one thing is for sure though and it is this. If the dancer does not do exactly what the teacher says they will not learn enough to succeed on the narrow path to becoming a professional dancer or teacher.

What we have to assume is that the teacher is aware of three things and is able to apply all three in equal measure and at the right time.

The first is an all-encompassing knowledge of Dance techniques.
An ability to motivate and make the dancer succeed at class work.
A complete understanding of dance anatomy and physiology.

The Teacher can not do the first without knowledge of the third in case they damage the dancers anatomical structure. A young dancer is growing and can be damaged by faulty technique in teaching.

The second is dangerous unless the teacher is aware of stresses on the young dancer, both mental and physical. Individual dancers can have problems executing certain movements and in pushing themselves or by getting pushed may actually cause anatomical trauma or damage.

The third relies on the teachers willingness to explore this area of study in order to improve their own teaching ability. All young trainee teachers should study anatomy and specifically dance anatomy at an early stage in their schooling to protect their charges. Respectable already look at this aspect of teaching on a regular basis through regular articles like this one continue to ensure the high standard of qualified teachers.
What I will look at is some of the basic names of anatomical parts but without mentioning everything in detail. This will cover the teachers interest in body anatomy and problems.

THE KNEE
Starting at the lower part of the femur, the knee joint is one of the most difficult of joints to heal if damaged. Most of you will know that a sprained ankle can heal relatively quickly but a sprained knee can take up to three times as long and indeed may never recover fully. I will go into the reasons for this later but suffice to say the knee is very delicate and is one of the most complicated joints in the body.

Comprising of two CONDYLES at the front, they become a smooth surface that fits into the PATELLA that allows articulation.
At the rear of the PATELLA, the CONDYLES create a depression that is the back of the knee. This is called the INTERCONDYLOID FOSSA.

On either side is a projection called the EPICONDYLE or this is easily felt.
The top area of the TIBIA fits into the femur that allows the knee to articulate and these forms the KNEE JOINT itself. Although it essentially makes a straight up and down action possible, slight rotation is also possible when the knee is bent.The head of the FIBULA can be felt on the outer side of the TIBIA, just below.

The PATELLA is not part of the knee joint although it is called the KNEECAP. This is because the PATELLA is attached to the TIBIA below by ligament tissue and is attached at the top by the QUADRATES FEMORIS MUSCLE on the front of the thigh. The QUAD straightens the Knee Joint.

In between the PATELLA and the FEMUR is a sac of fluid called a BURSA that protects the two bones against friction.A smaller BURSA protects the front of the Knee and yet another lies below the PATELLA.

On the upper part of the TIBIA lies the half moon shaped SEMI LUNAR CARTILAGE.
The complicated arrangement of the LIGAMENTS in the Knee holds the bones together in a horizontal and vertical fashion. Problems of the knee are as follows: Too much kneeling can cause inflammation of the main bursa. If a dancer comes down hard on the knee, either badly or constantly, e.g. rehearsal, the swollen bursa may start to leak causing extreme pain and stiffness. Damage to the smaller bursa will be a lot more serious.
Normal bending and stretching the Knee will cause little or no problems for the average dancer, as the ligaments are tight, protecting the knee joint. However, in a partial bending or flexed position the ligaments are looser across the knee joint which in turn destabilizes the joint allowing more movement than the joint can safely take. What happens in a simple movement, such as a transfer of weight from one leg to the other? It puts a strain on the medial ligament and while the muscles that surround the knee can take this strain, any sudden twist can cause too strong a pull. The ligament then stretches or drags the cartilage, which in turn can dislocate or move. Movements that can cause this include any slight rotation of the performed with a relaxed knee and can start the problem that will move the cartilage eventually.

Any movement that increases rotation of the knee must finish each rotation by straightening the knee joint using strong extension as a counter active movement.

Treatment is difficult but not impossible but can leave the knee permanently weak and therefore liable to reoccurrence of trauma or injury.

PULLING UP

The knee locks when fully straight but just before it locks; a small muscle on the inside of the thigh locks the joint with a small rotation inward and unlocks with a small rotation outward. Your instruction to your student to pull up their thighs actually means that they should lock their knee joint. This in turn gives the knee a smooth appearance instead of a knobbly look.The problem arises when the child is a little too enthusiastic and the patella is pulled up. This can cause, either the ligament attaching the patella to the tibia or the tendon of the muscles at the front and at the back of the knee, to stretch. This will result in pain above or below the knee. Rest and treatment is advised for two or three days and you must watch that the child does not jerk or pull the knee while at exercise.

Although I have explained that pulling up is in fact a locking action, this is different from a knee that actually locks or indeed a knee that gives excessively easily. The causes are possibly a patella slipping or cartilage being pinched but the knee may recover temporarily. The dancer must get to the doctor or specialist to ensure that there is no inflammation under the patella or other condition that may re-occur if not attended to. If inflammation is discovered it could lead to a complete stop to dancing. Overuse of a weak joint or a joint inclined to this condition could bring this about.

At this point, I will look at the dislocation of the patella. This happens mainly to female dancers. The usual thing is that they feel is a partial dislocation as it goes out then clicks back in. If the kneecap actually goes right out of place, one should first look at whether the quadriceps muscle is out of condition or not strong, enough or perhaps the dancer has poor leg alignment.

Whatever the answer is it usually happens to girls because of the wider hip placement gives an increased angle of quadriceps pull on the tendon. It may be caused by another dancer accidentally kicking the dancer in question when the dancer is relaxed and this will make the patella slide over and lodge in the lateral aspect of the knee. Not turning the knee out and over the foot the foot on the first step of a jumping action from one leg can force the patella to be pulled latterly. The dancer is unable to move his or her leg in a semi flexed position. If it happens, then Ice therapy, cast or rigid bandage should be used with a two or three week layoff.
Knees that are well aligned tend to give little if any trouble. It is when the student has knock-knees and those with sway back legs. Also look out for dancers with short hamstring muscles; identified by being unable to straighten their knee joint without some effort.

KNOCK KNEES
Knock knees are loose at the joint and this will make the dancer unstable and may affect the muscles, ligaments and structure on both sides of the knee. I mentioned in my last article that some dancers unfortunately turn out from the knee instead of the hip and it is this condition that allows them to do this quite simply. The tibia is slightly turned out and it is this that allows them the necessary movement to turn out from the knee. The results are strain on the foot and the knee with secondary strain on the upper outside thigh and eventually the hip and lower back. Talking about Knock-Knees leads me to discuss this condition in relation to Irish and Highland. Knock-Knees are the result of an exaggerated slope inward from the width of the pelvis or from a very small angle at the upper part of the femur. Girls are more prone to the pelvic situation where they have wider hips than boys and therefore have a greater slope inward.

To test for knock-knees ask the pupil to stand facing away from you with their knees together and feet slightly turned out. If there is a gap at the heels greater than one and a half inches then the pupil will have great difficulty studying for advanced work for the reasons I will give later. The resultant stance will invariably also show that the dancer rolls in, as this is normal in Knock-Knee condition. This test is made with the smallest amount of turnout, as the inner condyles of the femur will prevent the heels from coming together. The condyles are quite large at a young age, and get progressively smaller as the child grows and with a large turnout may give a false impression as to the amount of Knock-Knee condition.

Although not a curable condition, there are specific anatomical examples that you should know about. This may help in slight improvement.

Very young children may grow out of this condition due to the flexibility of the skeleton and the unequal development of the two femoral condyles. The child can appear knock-knee at three or four then completely recover by five or six. As the child gets older and the bones get progressively harder, the condition becomes irreversible. Rolling in or out are conditions that can be helped if caught at a young enough age. Trying to change the line of the foot at a later age will put stress on other areas of the feet, legs, knees or hips.

The neat strong type of child can work through this condition with a degree of Knock-Knee up to two inches. In a thin or tall child, there may well be some looseness at the knee joint that will identify later trouble.

Speed will be affected, as it will be difficult to acquire it, as will be good elevation and good elevation work. The push up from the floor is not taken in a straight line from foot to hip as determined but through an angle at the knee joint that will of course put strain on the feet and the knees. On the other hand, dancers with a stiff knee as opposed to a loose knee will experience strains of the ligaments, cartilage problems and possible inflammations.

The child will give you indication if you encourage them to mention if they are experiencing any slight pain or discomfort while performing new or repeated exercise. Far from encouraging them to complain, it brings them closer to the teacher that can solve these problems by perhaps correcting a movement they are doing incorrectly.

Osgood-Schlatters disease or Growing Pains

Let us look at the child who complains about pain on the inner or the outer part of the knee. From age 12 to 14, the child can suffer Osgood's-Schlatters, commonly called growing pains. The inner side can also be ligament strain or cartilage displacement. If you first have a look at the exercises, and specifically any kind of knee bending action, you may find that this movement is being done incorrectly. Osgood-Schlatter disease is a very common variety of overuse injuries that occurs in knees of young people between the ages of 11 and 14. It is related to growth of the bones and occurs in dancers or sports persons who have not yet finished growing.

The symptoms are pain, swelling and inflammation about the tibial tubercle. This is the bump on the front of the shinbone (or tibia) where the kneecap tendon (or patellar tendon) is attached. If the muscles at the front of the thigh are forced the pain will be transmitted through the thigh or into the inside of the knee. It will then be painful to straighten the knee. The tibial tubercle is also the site of a growth plate. This is an area of cartilage where bone growth occurs. The growth plate cartilage is weaker than the underlying bone and the tendon attached to it. Invariably we are looking at incidences where the bones are growing faster than the tendons and causing stress in these areas.

When the forces across the knee are greater than the muscles can accommodate, the growth plate is pulled away from the underlying bone. This results in the pain, swelling and inflammation that is indicative of the disease. Activity such as dance exacerbates the pain. Often pain occurs in both knees. As with other overuse type injuries, symptoms are more common after the summer or winter break, or after a sudden increase in competition preparation.
While Osgood Schlatters is more common in boys we see it more in girls as we see more girls in dance than boys. The age is important, as this is a time of fast bone growth, which is the common cause. In addition, the foot, ankle, and leg pains are associated with growth plate centres. The period of problems arise between 11 and 14 years.

The thin, flat, crescent - shaped growth centres separate bone and cartilage in younger children. As a child nears puberty, these growth centres close and ossify the process by which cartilage becomes bone as it develops from the centre of the bone itself. It is softer at the ends when the child is young and continues to harden as the child matures. Indeed the bones sometimes continue to grow until the age of 20 but usually fully ossify or harden around age 16 to 18. As I said the bones grow so much faster than the muscles and tendons and these are unable to match that growth. This means less flexibility and strength, which in turn increases stress on the tibial tubercle. Adolescents do experience accelerated growth spurts.Between the ages of 8 and 12, dancers become more competitive, these children may complain of pain or parents may notice limping.

I suggest that before a new class season starts conditioning can help to prevent development of Osgood-Schlatters disease. Incorporating stretching to increase flexibility into the workout routine is also important and it is very important to stretch to cool down after a class. It is not only dance that makes the condition worse it can also be P. E, Gym class etc, football, other sports etc that contribute to the condition. An overall approach must be considered from the parental side in this case as well as the dance teacher.

Shin-splints could be considered:
Shin-splints usually involve pain in the front or inside part of the lower leg. This pain frequently results from tendonitis or the inflammation of the muscles where they attach to the bone.
When a dancer has Osgood-Schlatters disease, x-rays are necessary to make sure that they do have more serious problems such as tumours or possible infections. X-rays may show small extra pieces of bone forming in the patellar tendon where the growth plate cartilage has been pulled away from the underlying bone.

Treatment begins with a short period of rest and methods to reduce the inflammation, such as ice and inflammatory medications. Exercise programs are begun, emphasizing flexibility and strength, particularly in the quadriceps muscles. A brace may be advised which decreases the force on the tibial tubercle and is often used to keep the dancer competing. The general reason for this treatment is to control the symptoms until the growth is finished. Once the growth plate has fused to the underlying bone, the problem resolves.
Lacing the Hullachan properly will help redcue this tendonites.
Achilles Tendon
2-Growth Pains

A common pain is the severe pain behind the heel, which stems from overusing the foot and ankle in hard competitive preparation. The fibres of the Achilles tendon pull on the growth plate of the heel and create inflammation within the heel bone.

However, growth centre pain which can include Achilles Tendonitis is even more common among children who have flat feet, toe-in or have other foot problems. For these youngsters, an orthotic, a splint or soft cast is usually enough to properly position, strengthens feet and ankles, and prevents future pain and injury in their walking shoes. We can apply suitable soft orthotics in their Hullachan Pros as well.

With prompt treatment, growth centre pain persists only a few days or weeks and usually without the need for any surgery. However untreated, growth centre injury can require long term treatment.

The notable features of growing pains includes:
1. Intensity - Usually mild, sometimes a few children complain of a lot of pain that makes them cry. The pain can be short or it can last for over an hour.
2. Frequency - Intermittent, Some children get the pains every day or at night, others once a week or so, and some get them every so often. The pains tend to occur after a child has had sports at school or attends a dance class.When Normally, late afternoon or evening before going to bed. Occasionally the pain will make a child wake up at night.
5. Where - In the muscles but not in the ankles or knee joints. Many children report that the pain is in front of their thighs, in the calves, or behind the knee. Joints can be affected by other more serious diseases and appear swollen, red, tender, and warm. The Osgood Schlatters joint looks normal.

Other symptoms - restlessness, but usually no tenderness, redness, swelling. or fever.
Paediatricians find one symptom useful in making a diagnosis of Osgood Schlatters and that is how the child responds to being handled while in pain. Children who have pain from a serious medical disease do not like to be touched because any movement tends to increase the pain. Children with "growing pains" respond quite differently; in liking to have their legs massaged. That makes them feel better and they like to be held and cuddled.
The child's physician should be notified if any of the following occur with your child's pain: Regular pain, swelling, or redness in the joint or lower limb area, fever, limping, unusual rashes, loss of appetite, weakness, lethargy, or uncharacteristic behaviour. These signs generally do not accompany Osgood Schlatters and may be an indication of a more serious disorder.
Growing pains may seem harmless enough from an adults perspective or even a teachers perspective, but to a child, they are very distressing. Since the child seems better and is free of pain in the morning, parents sometimes suspect that the child is faking the symptom. This is generally not the case ---the pain is quite real and it is at these times that they need their parents reassurance and support more than ever! If you do not believe me, just ask your own parents! I did and it was explained to me that I too suffered this condition. Both my children have been through it as well.
These recommendations must not be relied upon as medical advice and it is not intended to replace the advice of your child's doctor.

The Knee and Bending the knee in class.
Knee bends and lunges are hard on the knee especially when returning upwards. Leaning or falling forward puts great strain on the inside of the knee joints and this strain can increase substantially if their is any relaxation or sitting when at the lowest point of the movement. Bad positioning can put strain on the feet and knees and eventually give serious ligament problems.

The problem arises when the teacher advocates the practice of a deep plies or knee bend. This can stretch the ligaments, the Internal Cruciate Ligaments that can develop a weak knee.
Less experienced dancers may bounce when going down into Grand Plies or a deep knee bend when warming up because they do not have sufficient muscle control. This may open the knee joint suddenly and tear the ligaments supporting the structure. Although all plies must be done with perfectly aligned thighs, ankles and feet, this is occasionally not checked in detail. Some dancers rise from Grand Plies or a deep knee bend straight into turn or spinning movement. While acceptable in experienced dancers it is folly to suppose that all dancers can do this as they must have complete physical control of the knee joint. If executed with the weight on the inner side of the thigh resulting in strain on the inner ligament, the medial ligament.

The deep knee bend should start, as far as the younger pupil is concerned, with the feet turned out and slightly apart. This is easier to correct and less complicated as far as the dancers muscle and joints are concerned.

In this position, also called the second position in Ballet, the stretch on the inner thigh, muscle is more immediate than in first position which is where the legs are together with the feet turned out and the back of the heels touching each other.. It stretches the large blood vessels that run down the inner leg and thereby increasing circulation faster than if the knee bend or plies had been executed in first.

The knee bend also known as the Plies (plee-ay) assists the dancer in warming up. It is important to determine the depth of the deep knee bend (grand plies) and even whether it is entirely necessary at the beginning of a class. I would prefer the dancer to be well warmed up before doing a deep knee bend. This is done through looking at the strength of the spine, the flexibility of the hip joint, the elasticity of the muscles on the inner side of the thigh and the length of the Achilles tendon. When you execute plies or knee bends in second position this gradually loosens the hip joints so that the knees are pressed out fully. The movement taken until the thighs is parallel to the floor with the back straight and the knees over the centre of the feet. Yes, of course this takes a few months of practice to get it perfect but it should be practiced only as far as the dancer is able.

In relation to Highland and Irish dancers who may have short tendons; the grand plies or deep knee bend may be a limited action by default. The tendon, attached to the calf muscle may prevent the Highland or Irish dancer from a degree of flexibility in the ankle joint and if pushed, could result in tearing.

In fact, faulty plies may well be the cause of slipping cartilage later.. Always make sure that the bending action is correctly performed with the knees over the centre of the foot and not twisted in or out. The back straight and the shoulders straight. A teacher will know the proper technique.

Never allow a pupil to sit in the plies or knee bend as this will result in stress on the joint, ligaments and muscles. Although ligaments can be stretched due to the support of the surrounding muscles, sitting in the plies then make the same ligaments take the weight of the body without muscle protection and this will then weaken the knees.
No professional school would immediately start a class of with full knee bend. They would work from partial knee bend to develop the warm up as this gradually allows the Knee Joint to function without sudden stress.
Follow plies or knee bends with quick single leg exercises to allow good blood flow through to the toes.

Bow Legs
The other problems with knees can be Bow Legs.
Although two kinds exist, one happens mainly with boys where the femur is normal but the tibia curves outward. The main type happens in both sexes where the bow is from the thigh. This is caused when the femoral curve happens on the side of the leg rather than on the front. The resultant space between the knees is caused when the condyles face slightly inwards instead of to the front.

Bow Legs interfere with the correct placement of the hip and the condition, although it can be slightly improved upon, will always be there. Boys can however achieve a slightly better elevation but girls are more variable as it depends on the position of the feet as they are affected by the position of the legs.
To conclude: although I have said correction of these problems is extremely difficult if not impossible, you should be aware of specialist doctors advice. In the early stages Orthotics may help to extend tight musculature or weak musculature to be strengthened but it is important that wrong exercises are not done that may accentuate to alignment of the leg.


Sway Back Knees.
These may be the result of very young dancers having Bow Legs and pressing their knees back stretching the ligaments at the rear of the knee and leaving the front very flat. The dancer being asked to pull up their thighs and instead have pressed the knees back without being corrected may also cause it.
I think that this will probably cover the salient points although I should mention that it really only skims the surface. At least these points affect your job as a teacher and I strongly suggest that the study of this information can only lead to even better teaching.