Wednesday, 2 January 2008

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


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.


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)


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.


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.


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.


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


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.


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.-


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.


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.


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.


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.


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 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.

No comments: