Wednesday, 2 January 2008

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

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