Athletes or Artists?
inside the shoe for long periods of time is also the
perfect etiology for plantar fasciitis. Dancers, more
so than other athletes, are usually unwilling to take
time off from their activity to let overuse injuries such
as plantar fasciitis heal. Pedorthic treatment for this
syndrome, and heel pain, is primarily to decrease
pronation and off-load pressure on the heel with
elevation. Due the variance in dance footwear, it is
more difficult to modify the dancer’s shoe in order
to facilitate treatment. An orthosis can be fabricated
with a horse-shoe concavity at the heel to specifically
relieve heel pain. A good longitudinal arch support
and a forefoot post will help control pronation on the
medial side. A cuboid lock (support pad) can prevent
the foot from sliding off the device laterally. The
firmer the shoe, the less stress will be placed on the
foot as it tries to flex. As a result, stress on the plantar
fascia is limited.
Posterior Impingement Syndrome of the Ankle:
Dancing often necessitates jumping. In posterior
impingement syndrome of the ankle, pain is felt at
the back of the ankle when the toe is pointed. This
is due to a piece of bone that occupies space behind
the ankle, leading to compression of the soft tissues.
As this condition is related to pointing the foot, any
additional pressure on the Achilles tendon will cause
pain. An Achilles notch at the back of the shoe or
cutting the backstay of shoe at the top line to relieve
pressure on the Achilles tendon insertion may help.
Any cut made at the back of the shoe may need to be
bar tack stitched to stop the cut from tearing too far
down the backstay.
Sesamoiditis:
Here’s a condition that has been long recognized in
dancers. So much so that an off loading pad in the
region of the two sesamoid bones that lie beneath
the head of the first metatarsal, is called a “Dancer’s
Pad.” Pain that develops in the sesamoids can be
caused by excessive pivoting or pounding on the first
metatarsal head or from poor technique when landing
from jumps. In athletic shoes used on hard court
surfaces, the incorporation of the “pivot spot” design
in the sole under the first metatarsal head has become
a standard feature. Most shoes used in dance, other
than for practice, will not allow this design feature
on the bottom of the sole. Most of the recognized
pedorthic modifications that help this condition, such
as a good toe rocker to reduce dorsiflexion and reduce
weight off the first MPJ, or a well cushioned midsole,
may not be possible in dance shoes. When the space
in the forepart of the shoe is limited, a thin silicone
or Poron® pad under the first metatarsal head will
help. Cutting the pad to off-load the sesamoids bones
specifically creates the “dancer’s pad.’
Shin Splints (Posterior tibial stress syndrome):
Dancers are vulnerable to shin splints as a result
of hyperpronation due to leaps and jumps on hard
surfaces, improper shock absorption or weakness of
the tibialis posterior muscle. Pain at the insertion
of the tibialis posterior usually indicates tendinitis
or inflammation of the tibialis posterior tendon. A
rearfoot varus wedge controls pronation and reduces
stress on the tendon and muscle. Running shoes
with an overpronation control device on the medial
aspect of the shoe would be good advice for everyday
wear to relieve pain. For dancers, in most cases, a
custom-made orthosis is the most effective method
of controlling excessive motion in the foot. Most
categories of dance shoes will accommodate at least
a ¾ length orthotic. In ballet shoes, a stiff shank and
arch support is all that can be offered conservatively
within the shoe. If a dancer already uses an orthotic,
they should always include the orthotic in any new
shoe fitting, as with any other type of shoe.
Sprained Ankle:
Recognized both in sport and dance (particularly
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