Why do dancers get foot and ankle pain?
As a Chiropractor with a practice dedicated to dancers, I treat a lot of patients with ankle and foot pain. Below is an outline of various anatomy and how it potentially is involved in the pain you may be experiencing in dance class! For any questions, please reach out to me at hello@madetomove.ca or better yet, book an in-person appointment at www.madetomove.ca!
ANKLE
Did you know that your ankle is the least stable in terms of boney anatomy when it is pointed (plantarflexion)? Isn’t that amazing that a ballet dancer can put all of their body weight on their feet in this position?! If you have some restriction in your ankle joint (ankle mortise) you may be experiencing some pinching or even over working of surrounding musculature. Your ankle mortise is made up of your tibia, fibula, and talus!
Ankle mortise
CUBOID BONE
Did you know that you have a small bone called cuboid that can cause some major pain in the side of your foot? The only muscle that attaches to cuboid is tibialis posterior. Tibialis posterior is one the muscles in the ankle that stabilize and control it between inversion and eversion (like a stirrup). Cuboid syndrome occurs when there is irritation between the cuboid and the heel bone (calcaneus). This means treating this muscle often involves treating the muscular stirrup.
Cuboid
TIBIALIS POSTERIOR & FIBULARIS GROUP
As previously mentioned, I find this pairing of muscles very commonly involved in ankle pain. These muscles, as mentioned, stabilizes the ankle from rolling in or out. When dancing, we are not only forcing these muscles to work a little overtime due to the fact that we are dancing on a rise (on the balls of our feet), but also because our footwear is usually very minimal forcing our muscles to pick up the slack
GASTROC & SOLEUS
Did you know the calf is made up of quite a few muscles? The two most superficial muscle are gastrocnemius and soleus. These muscles have a lot in common, but also a lot of differences. Gastroc crosses the knee joint and the ankle mortise, meaning it flexes both joints. Soleus, on the other hand, only crosses the ankle joint so it is not involved in knee flexion. This affects how we train these muscles and how we stretch them. They both do attach into the Achilles tendon, meaning the can be involved in similar pain provokers. The other main factor to consider is what type of muscle tissue soleus is versus gastroc. Soleus is made of slow-twitch fibres, meaning it is great for endurance and acts as a work horse and postural muscle. Gastroc is fast twitch meaning it is great for power, but runs out of steam more quickly than soleus. By understanding both anatomy and histology we can pinpoint the issue you are experiencing and get you better more quickly!
ACHILLES TENDON
A frequent diagnosis in clinic can be a tendinopathy. Achilles tendinopathy means there is an issue in the tendon or the musculo-tendinous junction. The point at which the tendon transitions into muscle (tendon attaches muscle to bone) is a weak point, susceptible to injury. Any transition area in the body is always more prone to issue, but in the muscle and tendon, the transition point is the weakest, typically. When treating pediatrics, it is important to consider the differential of a growth plate fracture. This Salter-Harris type fracture covers any fracture, whether that be compression, separation or a break through the epiphysis, metaphysis or both. In children, the part of the bone where the Achilles tendon attaches to is not yet fused and thus is being avulsed. When this occurs it is described as Sever’s Disease and is most often ages 8-15.
Achille’s Tendon
PLANTAR FASCIA
Our plantar fascia attaches from the medial tubercle of your calcaneus (heel bone) and spreads out under the metatarsals. During the toe-off phase of gait, we rely on the passively stretched tissue in our feet as well as the intrinsic muscles. When our muscles are fatigued or over-worked, our passive tissue (fascia) gets stretched too much, too frequently. This can lead to plantar fasciitis and pain in the heel and under the arch of the foot.
ATFL
ATFL stands for anterior talo-fibular ligament and it stabilizes the ankle mortise on the anterolateral aspect. When we roll over the ankle in dance class, we stress this ligament, often leading to damage, inflammation, and then repair (scar tissue). This is the most common way to sprain your ankle and this is the ligament most often sprained. Chronic ankle sprains can lead to pain and decreased proprioception of the ankle joint (ability to tell where the joint is in space).
ATFL
SUBTALAR JOINT
Did you know there is a bone between your heel cone (calcaneus) and your ankle joint (mortise)? This bone that sits on top of calcaneus is talus. The joint between your talus and your calcaneus contributes primarily to ankle inversion and eversion. When your subtalar joint is not functioning as it should, there is often restriction in at least one direction as well as pain associated with walking.
Subtalar Joint
ANKLE SYNDESMOSIS
When we think of ankle sprain, we need to include high ankle sprains. There is a connective tissue (or syndesmosis) between your distal tibia and fibula. During some ankle sprains, you can irritate or damage this syndesmosis!
Syndesmosis
SESAMOID BONES
Did you know that you have two small bones underneath the ball of your foot (head of your first metatarsal bone)? These bones can become inflamed, typically from blunt trauma (hard and unsupported landings during grand allegro). This mechanism for pain should be considered when there is pain similar to plantar fasciitis.
DIGITAL PLANTAR NERVES
The nerves that run between the metatarsal bones and into the toes are your digital plantar nerves. A Morton’s Neuroma, also known as Morton’s Meralgia, this is another condition that presents as pain under the ball of the foot. In this condition, your plantar digital nerves become entrapped. This type of pain is typically more burning, numb, or pins and needles sensation.
Digital Plantar Nerves
METATARSOPHALANGEAL JOINT
Your MTP is the joint between your big toe and your tarsal bone. Pain can present here for many reason, one being gout. Although gout is a metabolic condition, it presents similar to arthritis most often in the first MTP joint. The irritation comes from crystal deposits within the joint space. The joint is very red, hot, swollen, and extremely painful to touch. Gout can present in other joints as well.
Metatarsophalangeal Joints (MTP)
If you are experiencing foot or ankle pain that is affecting your dance training or performances, please see a licensed healthcare provider with diagnosis in their scope of practice. If you are in the Greater Toronto Area, book in to see Dr. Gray at Made To Move!
