Tiptoe ballerinas: is it bad for your feet?

assemble, I withdrew, ballonné pas, sissonne, battement dégagé, brisé, échappé on the tips… They are the names of some of the steps and jumps that ballerinas and ballet dancers execute during their choreography. They spend a lot of time with their heels raised off the ground (relieved), sometimes even supporting all their weight on their fingertips.

Therefore, it is understood that dancers are a population group that is especially sensitive to foot and ankle injuries. Almost as much as professional athletes and elite athletes. Added to the high physical demands, dynamic overload, extreme positions and movements, dance is normally practiced with bare feet or with shoes that do not help absorb shock.

Flamenco: bunions, hypermobility and claw toes

Not only ballet puts pressure on the feet. Each dance discipline has its particularities, and that also means that there are more frequent injuries.

Flamenco, for example, involves great biomechanical demands, comparable to those of a high performance sport. The technical movements of stomping, jumping and turning increase the prevalence of injuries and pathological disorders of the foot. In fact, it has been calculated that up to 75% of flamenco dancers present hallux valgus (medical label with which “bunions” are known), hypermobility of the foot or claw toes.

All these alterations cause pain to the dancers, reduce their ability to move, affect their quality of life and cause a negative aesthetic alteration that, finally, forces them to wear special shoes (orthopedic or extra wide shoes).

Shutterstock / Q77photo

The problem of hypermobility

Hypermobility is common to many dance disciplines. This is the name given to the increased mobility of the joints resulting from keeping them in extreme positions, and it has serious long-term consequences for dancers. Suffering this alteration in the feet causes the support of these on the ground to be modified and the distribution of the weight of the body through the plant is not adequate.

In fact, although we are not usually aware of it, the good support of the foot on the ground plays a very important role in maintaining the balance of the body. In addition, it also favors shock absorption, thus protecting the nervous system, spine and internal organs from injury.

To all these phenomena we must add, in the case of ballet, the aggravating circumstance of the tiptoe position. Being on tiptoes increases the weight load on the tip of the feet, when the natural area that is destined for that use is the entire sole of the foot.

This position explains why both the development of bunions and balance disturbances among ballet dancers appear prematurely compared to other disciplines. Although there is no ideal type of foot for classical dancers, it has been described that the greater length of the second toe is a risk factor that favors the development of injuries.

Added to these problems are the numerous turns that ballet dancers perform. A technically correct turn is achieved mainly through the work of the hips. However, inexperienced dancers, with postural changes or who rehearse despite pain or fatigue, can worsen their techniques and strain their ankles.

These gestures are repeated innumerably throughout the practice of ballet during the intensive practice that characterizes this discipline. In other words, in addition to some movement characteristics that favor injuries, overuse and overexposure, this risk factor causes dancers to “buy more ballots” with each rehearsal session so that they can win this undesired raffle. Incidence estimates of between 1 and 5 injuries per 1,000 hours of dance training and rehearsal have been reported.

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Shutterstock / Yulia Ivleva

Recovery, better without haste

Fortunately, these injuries are usually minor dysfunctions that, with non-invasive treatments, can be resolved by podiatrists and physiotherapists. The difficulty in the recovery of the dancers tends to reside rather in their desire to resume dancing.

It is at this point that more research efforts are being directed. In other words, clinicians specializing in the treatment of dancers need to figure out how to help an injured ballet dancer resume full participation. All this while preventing her from having a new injury or chronic musculoskeletal problems. Being both a sport and a performing art, ballet is highly physical, technically demanding, and has unique rehabilitation requirements.

A recent investigation has defined as indicative signs that a dancer can safely rehearse that the pain has disappeared, that the cardio-vascular capacity has not worsened due to rest, and that the muscular strength (especially of the legs) be the appropriate one.

These three conditions should be non-negotiable before returning to routine. In addition, it should also be checked that, during the rest time, the dancer has not modified her lifestyle (sleep and eating habits, fundamentally).

Although the specialty in dance is not a specific area of ​​medicine, it can be concluded that the treatment and complete recovery of these patients has particular characteristics that are different from those of other professionals and athletes and, of course, from those of the general population. .

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