Saturday 19 April 2008
Friday 4 January 2008
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
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.
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.
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
-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
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
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