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By Glenn Gabisan, MD, FACS

 

All forms of dance place unique stresses on the foot and ankle. While the level of participation varies from recreational to professional, dance remains one of the most physically demanding activities on the musculoskeletal system. The hours of practice in dance may improve strength, flexibility, and balance. Sometimes an overuse or chronic injury may occur.

Stress fractures are frequently seen in dancers. Repetitive impact upon the foot with dance may lead to weakening of bone resulting in a stress fracture. Bone has the ability to make itself stronger in response to stresses placed upon it. A stress fracture may occur if there is inadequate rest to allow bone remodeling.

Stress fractures typically occur insidiously over days to weeks. Progressive pain after activity, tenderness, a limp, and swelling are findings associated with stress fractures. The most common stress fracture in dancers occurs at the second metatarsal. Diagnosis requires X-rays and MRIs occasionally. Like most stress fractures, a second metatarsal stress fracture requires a few weeks of rest to allow healing. A walking cast or boot may be necessary for more severe metatarsal stress fractures. Other rare stress fractures, such as those involving the navicular bone, require a non-weight bearing cast or even surgery.

Sprains of the foot and ankle are common acute injuries in dance. Ballet positions, such as en pointe, place significant demand on the muscles stabilizing the ankle. A loss of balance may invert the ankle and stretch or tear the lateral ligaments. The more severe the injury, the longer the time required for healing.

Some mild sprains without swelling or bruising require only a few days of rest. More severe sprains may require two to six weeks of rest, bracing, and rehabilitation. Radiographs are obtained to look for fractures when the dancer is unable to bear weight. Severe sprains may remain sore for several months but usually heal. Persistent pain or instability occasionally requires surgery to allow full return to dance.

Finding the right physician is as important as finding the right dance instructor. Early diagnosis and treatment of injuries help to prevent long-term complications and allow a safe return to dance. An understanding of the unique demands placed upon the musculoskeletal system in dance is beneficial for a performer's recovery.