In my 27 years as a Podiatrist I am still occasionally shocked by a pair of feet! Usually it is a homeless foot or, more often than not, the foot of a ballet dancer! When you think of a Ballet dancer, I am sure you think of a serene face, elegant feet dancing in pink satin shoes, a pretty tu tu with hand stitched lace and the perfect hair bun with a silver diamond-encrusted Tiara. However, if you go south to the feet, you will see an entirely different picture. Before I discuss some of the common foot conditions which ballerinas live with, let’s take a look at the structure of the foot. It is a very complex structure; it has 26 bones (28, including 2 Sesamoid bones), 33 joints, 107 ligaments, 19 muscles and tendons. The 52 bones in your feet make up about 25 per cent of all the bones in your body, so you can see how dancers and athletes experience problems.
Look at the diagram below, showing the bones of the feet. Now Imagine them being cramped into ballet slippers!!
Ballet dancers exert a lot of pressure and wear and tear on their feet. The feet must be particularly strong and flexible, ballet shoes are not, by most standards, highly supportive. Because ballet shoes do not provide the foot protection that say, athletic shoes provide, many foot problems occur. Some common foot conditions experienced by dancers include trauma to the skin (e.g. blisters, corns and callouses), stress fractures, plantar fasciitis, ingrowing toe nails, bunions, tendonitis and heel pain.
Foot injuries are for most common amongst experienced ballet dancers, as it is quite common to find them practising up to six hours a day in shoes that are quite small and close-fitting. In addition, the experienced ballet dancer will perform many repetitive movements, many of which place a considerable force on the feet.
Sesamoiditis is a common injury among ballet dancers. The sesamoids are two small bones that are located in the tendons beneath the big toe area. The repetitive motions performed by ballet dancers can put extreme pressure on the sesamoids, causing sesamoiditis. The pain experienced with sesamoiditis is focused on the ball of the foot, especially when the dancer is on demi-pointe.
Hallux Valgus (Bunions) are also common among ballet dancers and usually occur when the big toe is forced inwards towards the other toes. Bunions can produce pain and swelling, thereby making dancing difficult. Pointe ballet is even harder and more strenuous on the feet, as it places a great deal of stress on the tends in the feet and ankles, and causes the toes of the foot to push toward the floor every time the ballet dancer moves to the en pointe position.
The best way to visualise what ballerinas may experience, is by imagining pointing your toes and then standing on them. Now walk about and jump occasionally. Do this for 10 years and you will receive a cornucopia of foot anomalies, from neuro-vascular corns to ingrowing toe nails, not to mention horrendous blisters. The main problem with corns (excess hard skin in one focal area) is that they can appear in the most awkward places to reach, such as in the web commonly in between the fourth and fifth toe. Because the corn is in such a tight space, it is very awkward to get a scalpel blade and difficult to achieve the correct angle required to ‘enucleate’ the hard corn. There is another underlying issue here. Dancers tend to have macerated skin, especially between the toes. (Prolonged exposure to moisture can cause skin to soften and break down). A pair of feet has approximately 250,000 sweat glands. Each day, a dancer’s feet will excrete almost a pint of moisture. So, when treating a corn there may be layer of water-logged skin to sometimes break through before arriving at the offending monster, the dreaded corn.
Heel-pain is another problem ballerina’s experience from landing after jumps. Ingrowing toe nails are also common form wearing tight ballet slippers and because of the abnormal forces rubbing the side of the big toe, and causing them to grow into the flesh. It is quite common for a ballet dancer to experience Plantar Fasciitis. The plantar fascia is tissue that runs from the heel to the base of the toes. Many ballet dancers experience this pain when the tissues swell due to over exertion. There are a number of remedies for plantar fasciitis, such as stretching the area, icing the area and taking anti-inflammatory medications. I usually make them Orthotics (custom-made insoles) to wear in their everyday shoes which help to distribute weight evenly across the whole foot, thereby alleviating weak areas.
In conclusion, although many foot problems cannot be completely prevented for dancers, understanding proper motion and posture, and not attempting skills before you are ready and able to do them will cut down on foot problems.
In addition, the importance of proper footwear is essential because great pressure is exerted onto the feet and toes of a ballet dancer. Ballet shoes are one of the most important factors to take into consideration when thinking about foot health. Ballet pointe shoes should always match the shape of the foot, and should therefore always be fitted by a professional shoe fitter. From the vamp to the toe box, the ballet pointe shoes should always be fitted to ensure the best possible protection for the feet. It is also important to wear comfortable everyday footwear, because ill-fitting shoes can also lead to a host of foot problems and make dancing painful, ultimately ending the career of a ballerina.