Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Ballet School Students

Discussion in 'Biomechanics, Sports and Foot orthoses' started by david meilak, Oct 14, 2004.

Tags:
  1. david meilak

    david meilak Member


    Members do not see these Ads. Sign Up.
    I had a patient a couple of weeks ago who is a Ballet Student. She presented herself with onychocryptosis (ingrown toe nail) on both her hallux, she mentioned that her 2nd digit (bilateral) are usually painful. Since I qualified only in July, I did do some research and found these symptoms to be common to most ballet dancers. My research on the internet has lead me to find this very interesting article, which can be found on http://www.podiatry.curtin.edu.au/ballet.html#military

    Please post your comments and past experiences with Ballet Dancers, and would appreciate your treatment proposals.

    the article I mentioned is the following:

    The nature of ballet movements is unusual, and therefore leads to some unusual injuries. Dancers frequently suffer minor trauma, which would not trouble an average person however they make such demand on their bodies as to prevent the ballerina from performing. Many dancers attribute the cause of injury to the hardness of the stage floor. Most are wooden and laid directly on concrete to provide a very hard, unremitting surface. This is essential to support the body mass when landing. Traditional pointe shoes provides no shock attenuation and subsequently the number of injuries were higher prior to the introduction of the newer pointe shoes. Deterioration of the toe box with use meant no support was given to the foot. Segmental deterioration of the shoe also caused the dancer to use her body to compensate when standing on pointes. This was thought by many experts to be the reason why the ankle was so often damaged when the dancer sprang onto the full pointe position. Pointe work often results in damage to the great nail with Black nail, Onychauxis and ingrown nails commonly reported. According to Quirk (1988) ballet dancers are no more prone to bunions than non ballet dancers but may suffer arthritic changes on the first metatarsal phalangeal joint or hallux rigidus. Corns and calluses are common however and pressure to the Achilles tendon at the posterior aspect of the malleoli is reported. Everting the foot when the dancer adopts a turned out position can lead to tendinitis. Repeated jumping and landing may irritate the sesamoids causing sesamoiditis. Dancers are taught to land lightly and with a small bend of the knees to dissipate the shock of hitting the hard floor. To ignore this may lead to chondromalacia of one of the sesamoids. Stress fractures are frequently reported with the most common site in the second metatarsal. This is thought however to be more common in demi pointe work. Impingement syndrome is caused when repeated pointing of the foot which compresses the lower tibia and the upper calcaneum, thus flattening the posterior tubercle (os trigonum). Another consequence of repeatedly pointing the foot is the development of traction osteophytes at the front of the ankle. These can break off forming loose bodies in the front of the ankle joint that lead to anterior impingement when the foot is dorsiflexed. The ankle tendons are often overused and sometime crepitus occurs. The most vulnerable is the flexor hallucis longus. This tendon plantarflexes the big toe and helps the dancer get up onto pointe. Overuse of this tendon can produce a nodule which can be felt moving with the tendon just behind the medial malleolus. The tendo achilles often involved with a calcaneal bursa and this is caused by tying the ribbons too tight. Anterior compartment syndrome (or shin splints) may also be found with tibial stress fracture. The most common age for girls to start ballet classes is five years but pointe work would normally not commence until around the age of 11 years. Most authorities agree the introduction of pointe work at earlier years is dangerous and may harm normal development. In contrast to ballet injuries, some modern dance performers wear stiff boots or hard clogs to amplify their stomping sounds. Instead of dancing softly on pointes, dancers stomp on their feet. Many are not trained dancers and subsequently their accidental and repetitive-motion foot problems are more similar to injuries suffered by the general public than those seen in traditional dance companies.
     
    Last edited: Oct 14, 2004
  2. paulm

    paulm Member

    ballet student

    The pointe shoe
    The following is an extract taken from a lecture given by Dane LaFontsee, an American C.Ped (certified pedorthist)
    Fitting the pointe shoe.
    1st the vamp, this should not be too long. ie from the ground to the midfoot, if this is the case it can cause stress fractures in particular the 2nd metatarsal.
    If its too short, ie dropping down to a point where the digits enter the foot this can cause hallux rigidus and digital fractures.
    The correct positioning of the vamp should be where it fits just passed the digits and fits snugly around the digits
    The width of a shoe, if its too narrow then this will create to much of a point at the tip and could cause the toes to be bunched together giving rise to neuromas...
    Drawstring...holds shoe onto foot if tied too much of a knot and vamp not in correct position the dancer can have injuries..
    The rear of the shoe...
    When standing on the tips of toes we should be able to "pinch an inch" at the rear of the shoe, this causes the shoe to bunch up, when standing flat on ground this smooths out and does not pull the shoe towards the toes..
    the elastics and ribbons support the foot and pull the shoe snugly through the arch...
     
  3. Don't take advice from a C. Ped.

    Expecting to learn something about foot pathology from a C. Ped. is a waste of your time. With due respect, C. Peds. are technicians who are supposed do what is prescribed for them to do.
    I contend that Mr. LaFontsee is dead wrong about what causes what when pointe shoes are worn.

    A Jagger DPM
     
  4. paulm

    paulm Member

    Hi Anthony, hope this finds you well



    Expecting to learn something about foot pathology from a C. Ped. is a waste of your time. With due respect, C. Peds. are technicians who are supposed do what is prescribed for them to do.
    I contend that Mr. LaFontsee is dead wrong about what causes what when pointe shoes are worn.

    i attended the recent PFA symposium in Florida earlier this month, it was well worth the trip (from UK). Whilst there i learnt a bit of Mr Lafontsee's history,
    Mr LaFontsee;
    Pedorthic provider for the Medical College of Wisconsin Department of Sports Medicine.
    Pedorthic services for; Marquette University basketball, soccer,track and field; Milwaukee Ballet; Milwaukee Brewers; Milwaukee Bucks; Milwaukee Rampage; Milwaukee Wave;
    Mr Lafontsee was appointed Assistant Clinical Professor of Physical Medicine and Rehabilitation at the Medical College of Wisconsin in 1999.

    Also Mr LaFontsee has 30years experience in body alignment and movement, especially of the feet and legs, through his career as a principal ballet dancer, artistic director, for several major ballet companies including the Milwaukee Ballet, also a ballet instructor and lecturer.
    Training in foot anatomy, pathology, biomechanics and orthotic construction.

    My thoughts are, "maybe this guy does have some idea of what causes what when pointe shoes are worn"

    best regards
    Paul
     
  5. josh

    josh Welcome New Poster

    Give credit where credit is due

    Paul,

    As one of the first to be both a podiatrist and a certified pedorthist, let me complient you on recognizing Dana LaFontsee's expertise as a foot biomechanist. Its crazy as noted in previous thread from a podiatirst that to expect to learn anything about foot patholgy from a certified pedorthist is a wste of time. While the author is entitled to his opinion, I am reminded of a quote from another physician:

    There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.
    Hippocrates, Law
    Greek physician (460 BC - 377 BC)

    Josh White, DPM, CPed
    www.safestep.net
    joshwhite@safestep.net
    New York City
     
Loading...

Share This Page