Breaking Pointe: 5 Common Foot and Ankle Injuries in Dance

Breaking Pointe: 5 Common Foot and Ankle Injuries in Dance

February 17, 2022

One of the things we love to do at ESP is take student physiotherapists on placement before they qualify. If you have attended our Stirling or Grangemouth clinic before Christmas then you may have met Rachel Hendrie who qualified last year before starting a post with the Scottish Ballet.

As we see an increasing number of dancers and gymnasts in our clinics we felt Rachels knowledge in this field would be invaluable and she has kindly put together this months blog with some information on the most common injuries you can get with dance and how to fix them.

Dance places a high demand on the feet and ankles, possibly more than any other sport, due to the repetitive nature of the movement’s dancers perform. Dancers train for long hours often in either bare feet, soft shoes or pointe shoes and the high physical demands associated with class, rehearsal and performance can predispose dancers to injury.

Posterior Ankle Impingement

Posterior ankle impingement relates to pain at the back of the ankle at end-range plantarflexion (pointing) due to compression of bony (e.g. os trigonum) or soft tissue (e.g. flexor hallucis longus) structures. This often results from overuse due to the excessive and repetitive pointing of the toes, particularly in ballet dancers. Symptoms include posterior ankle pain intensified by extreme pointing of the toes (relevé and en pointe positions), swelling or tenderness at the back of the ankle and pain with aggravating activities.

Achilles Tendinopathy

Achilles tendinopathy is also a common overuse injury in dancers caused by repetitive movement, impact and excessive loading. This can commonly occur due to a sudden increase in training volume such as getting back en pointe after a long break or starting harder jumping combinations. One of the main symptoms of achilles tendinopathy is morning stiffness or pain because the achilles tendon must tolerate full range of movement when first weight-bearing. The pain can often appear to reduce once warmed up but can be aggravated by jumping, relevé or pointe work.

FHL Tendinopathy

The flexor hallucis longus (FHL) tendon can become irritated and inflamed due to a combination of its location and function as well as poor dancing technique. The FHL muscle flexes the big toe, enhances the dynamic stability of the foot and plays a substantial role in jumping, both during push-off and landing. Therefore, dancers place increased amounts of stress and high demands on the FHL. FHL tendinopathy is commonly associated or co-existent with posterior impingement, especially in ballet dancers. Symptoms of FHL tendinopathy can include pain with forefoot activity, pain along the length of the FHL tendon and pain around the posteromedial ankle when performing a plié. 

Stress Fractures

A stress fracture is a microfracture of a bone that often occurs in response to repetitive exercise stress when bone breakdown temporarily outpaces bone formation. It can be caused by overtraining or overuse and improper training habits including sudden increase in intensity/volume and insufficient rest. There are several areas of the foot that are most susceptible to stress fractures in dancers: metatarsal bones (1st, 2nd and 5th), navicular and tibia. Symptoms of a stress fracture consist of sharp pain while walking in the affected area, aching at night even when the foot is offloaded and pain when pressure is applied directly to the area. 

Lateral Ankle Sprain

The most common traumatic ankle injury in dancers is the lateral ankle sprain due to the frequency in which their foot is pointed. The mechanism of injury typically includes improper jump landings and rolling over the lateral ankle whilst on demi-pointe/pointe. Often multiple ankle sprains can lead to chronic ankle instability in dancers, therefore, appropriate rehabilitation is important. Symptoms can include tenderness, swelling and bruising on either side of the ankle, the ability to only partially weight bear on the foot and symptoms are reproduced with movement of the ankle in the same direction it rolled.

So What Can You Do?

  1. Listen to your body, if you are experiencing pain then back off, and get an assessment.
  2. Use ice to settle any pain and inflammation, 10 minutes at a time is adequate. Be careful to cover the ice pack so as not to burn your skin.
  3. Make sure you have good range at the ankle in all planes of motion, and if you are tight in one then stretch it.
  4. Work on your strength and control through the range with balance, isometric holds and banded exercises.

Closing Thoughts

As with any injury, it can be challenging to find accurate and trustworthy information on the internet.

Despite the information we have supplied being helpful it is also quite generic and in our experience it is always worth your while to speak to a qualified physiotherapist, to get an accurate diagnosis and treatment plan that’s tailored specfically to you.

If you would like to speak to one of our team then call us on 01324 227 370 or you can book yourself in for a physiotherapy appointment with us here 

Written by Rachel Hendrie, Student Physiotherapist 🏴󠁧󠁢󠁳󠁣󠁴󠁿