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foot pain, 15 yr old dancer

Discussion in 'General Issues and Discussion Forum' started by linrox, Jul 15, 2009.

  1. linrox

    linrox Guest

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    Hi I'm looking for some advice please.

    I saw a 15 yr old girl yesterday. She came in complaining of pain in both her 1st toenails, particularly the left. O/E both 1st nails had been subjected to repeated trauma from practising her Irish dancing 3 times a week. The right nail had previously split and then fallen off to regrow damaged. On dorsal pressure both toenails were painful, the right at the lateral sulcus and the left at the medial sulcus. No signs of ingrown nails. The girl also presented with marked dorsal lipping at BF 1st MTPJ and the start of Hallux Valgus. The rest of the toenails were perfectly shaped and no trauma to them. The girl has to wear soft shoes in which she is dancing on the mets, and at other times hard soled shoes in which she dances on the apices of her toes like a ballerina.
    The right toenail is seperating from the nail bed at the distal end.

    The girl is otherwise healthy, no meds, no medical conditions and competes regularly in dancing competitions.

    I'm not experienced in this field. Can anyone please recommend toe protection for this girl to wear while she is dancing, or any modifications to her footwear whilst dancing. All advice and suggestions gratefully welcome.

    Thanks, Lin
  2. Fraoch

    Fraoch Active Member

    Hi Lin,

    Not sure if this will be of much help. For ballet dancers I use an "Ouch Pouch", silipos type cup that you place over all toes, to line the shoe. This works for hard shoes such as points, tap shoes and the hard Irish shoes - mainly prevents blisters and sores however I have limitted experience of this helping with nail pain/pressure too. It could add to pressure or it could cushion. Worth a try

    Two of my dancers with nail damage did well with regular drilling/ filing and generally keeping the nail short.

    Hope this is of some help to you. Otherwise, perhaps she can take up some other past time?

  3. carolethecatlover

    carolethecatlover Active Member

    I used to live with lots of ballet dancers when I was younger....before I studied pod. They all wrapped their toes with lambs wool. This reduced the friction. I seem to remember there is a better way of using it. It you just stuff your shoes with it, it felts, but twist and wind it disperses the frictional forces. Can you get advice from a ballet teacher? There may not be much 'cross=over' between Irish and Ballet.
    Would a fake nail, acrylic or gel, protect the affected nails?
  4. Andre Hugo

    Andre Hugo Member


    Did you check the amount of dorsiflexion she has at her 1st MTPJs? It sounds like she is also developing a Hallux Limitus/Rigidus. Furthermore, the fact that you've noticed a Hallux Valgus developing suggests to me that there might be excessive STJ and/or MTJ pronation during midstance of gait (A toe-off seen on the medial side of the forefoot), if this is so... I would recommend implementing orthoses with an incorporated Kinetic Wedge. Because of the Kinetic Wedge, you should also consider a plantar fascial accommodation groove on the orthotic, otherwise one might cause plantar fasciitis iatrogenically.

    I know it's easy for me to say - considering her shoewear is probably not able to accommodate orthoses? Consider then putting her into orthoses in her normal every day shoewear...

    Hope this helps.
  5. Brandon Maggen

    Brandon Maggen Active Member

    Hi Lin

    In considering the differences between your 15 year old and her contempories (to which I'll assume the majority don't have a similar problem), perhaps the hallux valgus may be redirecting the ground reaction force into the hallux at an abnormal angle, when on point or other type of impact.
    I remember a case history presented at a symposium some years ago that showed a similar case with a resultant sub-ungual exostosis. I then (as it so often happens) saw a 12 year old ballet dancer with similar pain, the following week - shown as central on her hallux nails. She too had hallux valgus. I asked her to put a silicone toe separator to try and correct the hallux angle and better position her proximal phalanx relative to her metatarsal to deal with GRF better. She did much better and a 3 week follow up revealed no more central hallux nail pain.

    Hope this helps


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