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Ballet shoe Control

Discussion in 'General Issues and Discussion Forum' started by ackers, Jul 26, 2010.

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  1. ackers

    ackers Member


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    Hi all,

    I have a 16 year old patient that has been en pointe dancing since december 09. She has had Patella tendon pain since. Part of her successful pain management has been with the use of 38mm rigid strapping tape to her feet to control her STJ motion and Tibial Rotation. What has anyone else used as a more permanent fix as her skin integrity is starting to degrade?

    Apart from a choice of 12 month or 365 day break that is??

    Thanks

    Vaughan
     
  2. mike weber

    mike weber Well-Known Member

    Vaughan,
    I´m notsure there is anything you can do besides some felt in the pointe shoes which will not have much effect but worth a try.

    Dance treatment for me often focus around when the patient is not dancing, ie icing after dance , NSAIDS, increase muscle strength length and balance , orthotics and good shoes when not dancing.
    ps have you looked at taping the knee ? if this works you can tape the knee for awhile ,then foot, then knee gives the skin a rest.

    Not sure if it helps

    Goodluck
     
  3. Admin2

    Admin2 Administrator Staff Member

    Related threads:
    Other threads tagged with dancing
     
  4. Kevin Kirby

    Kevin Kirby Well-Known Member

    Vaughan:

    Even though it is not the same as adhesive tape, you could try an elastic or neoprene ankle sleeve or elasticized wrap on the foot and ankle to minimize skin irritation and give some mild arch and ankle support. Getting this young lady on a daily program of muscle strengthening exercises for the posterior tibial, peroneus longus, deep digital flexors and plantar intrinsics will also usually help in young dancers over time.
     
  5. This is my first time sumbitting a reply. Hopefully this is helpful.

    As a past professional dancer, I'd like to add to to the discussion the idea that with recreational dancers, particularly en pointe, we need to be cognizant that there are many studios who do not condition dancers properly for the task. It is possible that this dancer is not ready to be en pointe. For example, in plie is she overpronating or do her knees roll in? If so, it's likely she's not turning out out from the hips and likely not using her legs correctly. How is her ankle alignment en pointe? Is she 'pulled up' in the shoe? Did she receive a professional pointe shoe fitting?
    If any of these warning signs are present, getting 'back to basics' with technique in addition to the strengthening program recommended by Dr. kirby is going to be critical.

    Good luck!

    Chiropody Girl
     
  6. DTT

    DTT Well-Known Member

    Hi Vaughan

    I have had and have patients from the Royal Ballet Company.

    Let me tell you they are a nightmare :eek:

    The punishing practice / performance schedule will not give you any chance to resolve a clinical situation.

    We are not designed to stand on our toes so... it is an unsolvable problem to resolve injury from our point of view IMHO....

    Most of mine are taken for Physio and then surgery by the in house medical staff unless I can provide an instant cure ( latest example fractured sesamoid :wacko:) No chance..

    The performers come back to me for routine care :empathy:

    BUT

    I cannot hope to meet the in house facilities provided so...

    I go with the flow :cool:

    Good luck
    Cheers
    Derek;)
     
  7. ackers

    ackers Member

    Hi,
    Thanks everyone for the responses,
    After having the patient perform some of the basic stance positions in her en point shoes, (We have 2 ex ballet myotherapists for supervision), We will implement the treatment protocols provided here.

    Thanks again

    Vaughan
     
  8. carolethecatlover

    carolethecatlover Well-Known Member

    I agree, as serious ex dancer, with chiropody girl, not old enough in bone age, not enough muscle strength training prior.
     
  9. Sally Smillie

    Sally Smillie Well-Known Member

    Ditto Carole and Chiropody girl. Some schools/students/teachers are a bit too gung-ho with going to point too soon. I have many dancers as young as 13 en point locally. However back to the point in addtion to adequate preparation, I would be looking at muscular control at the knee, preferably jointly with a physio before fiddling excessively with feet. The sympotms are at the knee but yet you've not said how or why you've discounted the funtional elements there and focussed on the feet.
     
  10. Kerrie

    Kerrie Well-Known Member

    Hi There,
    Much like some other members who have commented here I am an ex ballet dancer. I did it for 14 years and was en pointe for a good few of them. So in a sense I feel your patients pain haha.
    I have to say that I agree with chiropody girl in that she is probably not ready to be en pointe if she's getting pain, like everyone says she's probably not conditioned/trained appropraitely for it. I think I was 17 before aI tortured the tootsies and even then it was agony.
    From personal experience I found that a neoprene ankle support helped me and lambs wool on the block for comfort. Admittedly a nice blue or white ankle support does not really go with the whole ballet ensemble but it does help alot. Alot more forgiving than tape and easier to apply :)
    Hope this helps
     
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  12. Jenene Lovell

    Jenene Lovell Active Member

    I am a podiatrist, dancer and fully qualified dance teacher. I know what the poor girl is going through from all aspects...

    All the points above are valid, the foot en pointe has to be strong enough to suppport the entire body weight of the dancer, stretching and strengthening exercies are going to be your best friend with this case.

    You do also need to consider seeking a physiotherapist that deals with ballet dancers frequently as they would understand the pressures that one would put on the body. It is not just about the feet, it is about the whole leg and body..

    Unfortunately, most dancers are not trained to turn out (externally rotate) from the hip, and to be fair, most children (and I mean those around 5-6 years old) will have no idea what proper turn out means. To be honest, most teachers tell the students to "turn their feet out" and not demonstrate that the turn out has to come from the hips. It took me a while to fully comprehend what my dance teacher was on a bout, with the squeeze your bottom in knees to goes to the side walls, knees over feet, you get the picture.

    Maybe we need to educate the dance teachers more on correct technique for externally rotating the hips, so that the prevention of injuries such as the one you describe above (and others) will not happen in the future... Having said that, I think that would be a huge undertaking and it would be hard to reach all teachers to tell them this.

    Treating professional dancers is more than daunting as they are professional athletes. You will have to walk (or dance) a fine line of trying to heal and treat a problem, compared to managing it. The neoprene sleve will give her the suppport that she needs and temporary relief, but ultimately you will have to consider the full biomechanics of the foot, knee and hip, and core...
     
  13. terigreen

    terigreen Active Member

    I like a thin dress orthtotic that is about 3 mm thick. The dress is a narrow cut and fits well in ballet shoes. Usually we glue or double tape it into the shoe. We heat mold them for a custom fit. The other option is to glue in a felt arch support.
    Thanks,
    Teri Green
    Atlas Biomechanics
     
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