Common dance injuries explained: From hallux rigidus to trigger toe

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Dancing is a wonderfully enjoyable hobby with fantastic benefits for fitness and flexibility. Injuries are wide-ranging and in this blog, find out what they are and how they’re caused.
Foot, shoulder, ankle, knee – read on to find out about each of them.

Dancer’s Fracture
This fracture often occurs from landing from a jump on a turned-in foot.

The sesamoid bones in the foot provide a support surface while the dancer is on demi-pointe. With overuse of this position the tendon that runs between these bones can become inflamed, causing a tendonitis known as sesamoiditis.

Hallux Valgus and Bunion
This injury typically has a gradual onset and is more common in individuals with flat feet, or a tendency to roll the foot in during a turnout position.
Pain will be felt with pressure to the affected area. Ill-fitting shoes are another common cause.

Hallux Rigidus
This condition is characterised by pain and/or restriction of movement at the joints of the big toe. To achieve full demi-pointe the joint of the foot to the big toe needs to bend to 90 degrees. If a dancer does not have this natural flexibility, then the stress will lead to inflammation and ultimately degeneration of the joint.

Plantar Fascilitis
This overuse injury affects the tough tissue in the sole of the foot. Inflammation of this band occurs with prolonged weight-bearing and pain often increases towards the end of a day of dancing. Dancers with tight calf muscles or Achilles tendon are more likely to suffer as are those who dance on a hard, non-sprung surface.

Often caused by instability of the toe joints, this problem gives pain and tenderness in the ball of the foot. The instability in dancers is often caused by repeatedly forcing the foot into extreme ranges of motion which stretches structures including tendons and ligaments. This increased laxity leads to joint instability which in turn, leads to pain as fatigue sets in.

Lateral Ankle Sprain
This most common ankle injury in dancers occurs when the ligaments on the outside of the ankle are torn as a result of the ankle rolling outwards under pressure. The sprains are typically acute in nature, occurring after a landing jump goes wrong.

Achilles Tendonitis
This is the largest tendon in the body and the most commonly ruptured in dancers. The Achilles tendon at the back of the ankle takes enormous stresses with the constant pointing of the foot. It is important for dancers to stretch the calf muscle effectively and avoid dancing on a hard, non-sprung surface.

Trigger Toe
A common injury in female classical ballet dancers. The inflammation of the flexor hallucis longus tendon on the inside of the ankle will affect a dancer’s ability to en-pointe.

Posterior Impingement Syndrome or ‘Dancer’s Heel’
This condition involves compression of soft tissues at the back of the ankle. Stretching the calf and Achilles tendon will relieve the stress. Pain is often brought on by pointing the toe or coming into relevé.

Anterior Impingement SyndromeCompression at the front of the ankle caused by bony formation from the overuse of pliés. Swelling is often noted and pain with deep pliés. Appropriate strengthening and stretching is important in rehabilitation.

Shin Splints
An overuse injury causing pain in the front of the lower leg this pain is often caused by repetitive jumping or running. With repetitive loading, the muscles fatigue and these tired muscles then place more stress or load onto the bone. Stress fractures may occur if shin splints are not treated early and if not may develop into bone fractures. Spending too long in pointe or demi-pointe will increase the pressure and stress to the front of the shin. Dancing on hard surfaces also increases the risk of trauma.

Anterior Knee Pain and Chondromalacia Patellae and Patella Dislocation

Anterior knee pain is caused by a weakness in the quadriceps muscle group at the front of the thigh. Weakness, or in fact tightness, of this muscle group places stress on the knee cap and pulls it out of its natural groove in which it glides. This is more common in adolescents for a number of reasons. One reason is a common sudden increase in training intensity and another is a growth spurt causing the bone to grow before the muscle and therefore stretching the muscle causing it to weaken.

Behind the knee cap is a lining of cartilage which allows smooth gliding. If due to the abnormal pulling of the quadriceps muscle the cartilage becomes worn, a condition called Chondromalacia Patellae occurs – pain and inflammation are the result. This pain is often caused over a period of time and is made worse by activities that involve repeated bending of the knee including prolonged sitting. Dancers will often notice pain during a session, especially with jumps and grande plié. If the kneecap slips out of the groove temporarily then this is known as subluxation. If the kneecap does not return after it slips ou,t it is known as dislocation. A dislocation is often due to direct trauma. Both will need extensive thigh strengthening and avoidance of overuse during class.

Hyperextension of the Knee
If the knee is straightened too much so that it bends backward, an increased stress is placed through the joint. The ability to do this is often linked with a laxity of the ligaments and is not usually isolated to one joint. The hyperextension of the knee is said to improve the aesthetic of the leg with a pointed foot and therefore is often encouraged. Joint hypermobility or ligamentous laxity however should be taken seriously.  You can read more about the condition in our blog on hypermobility.

If you’re unfortunate enough to find yourself injured, book an appointment with one of our physios who can help you on the road to recovery quickly and most importantly, safely. Better still, don’t wait until something happens, visit us for advice on correct stretching, training and injury prevention so you need never stop enjoying your dancing.