Unique and specific repetitive high impact movements of ballet performed on a daily basis ? increased risk for injury.
For children popular activity – can improve mobility, co-ordination and confidence and can help as adjunctive treatment for gait disorders (eg in toe gait).
For adolescents the added burden of beginning to make a commitment to a career path in dance, with increased training loads, just as the adolescent growth spurt starts may temporarily affect technique and increase risk for injury. This is also a time in which a number of emotional issues are occurring for the adolescent challenge to manage.
Ages:
• no generally accepted lower age limit to start ballet training
• need to focus on “pre-ballet” up until about age 8 with more formal training after that
• toe (pointe) dancing should not be used in children unless they are planning on becoming a professional dancer and should be preceded by 3-5 years of proper ballet instruction. Should be at least 11 – 12 years old. This also assumes that the strength and range of motion is available to carry out this.
Turn-out:
Turn out stance abductory force on foot subtalar and midtarsal joint pronation if cannot get full 180º at hip foot pathology associated with the excessive pronation. This also may be affected by variation the putative STJ and MTJ joint axes positions may be able to get more transverse motion (adduction) of foot with minimal calcaneal eversion.
Plie:
• flexed knee position with or without heels on the ground forced to end range of motion of ankle dorsiflexion increased risk for anterior ankle impingement problems.
• may pronate foot to flex knee more (incorrect technique)
Common injuries in ballet dancing:
• foot & toes (24%); ankle (13%); leg (6.1%); knee (6.8%)
• low back pain (up to 80% may have history of low back pain) – often associated with increased lumbar lordosis
• Dancer’s hip – a painful ‘snap’ on the medial and anteromedial aspect of hip when the leg descends from a position of full abduction and external rotation – tendonitis of iliopsoas tendon as it impinges on the neck of the femur.
• stress fractures – especially base of second metatarsal; cortex of first and second metatarsal thickens with time in response to pointe work stress fracture if sudden increases in workload or pointe work started prematurely
• overuse syndrome at base of second metatarsal seems to be a unique problem to ballet
• flexor hallucis longus tendonitis (especially at posterior medial aspect of ankle) – has been reported as being associated with trigger hallux
• os trigonum syndrome/posterior impingement (can be confused with flexor hallucis longus tendonitis).
• hallux abducto valgus has been shown to not be more common in dancers compared to non-dancers .
Footwear for ballet dancing:
• designed to fit foot live glove provide no shock absorption or stability to foot; different shoes have different amounts of flexibility/stiffness
• pointe shoes have rigid toe box and firmer shank – body weight is taken on tips of second and first toes on the toe box – broader toe boxes increase stability
• toe box is cardboard or paper mache when looses structural integrity, shoe should be replaced
• some brands do have a thermoplastic shank can be used to give some support
Orthoses management in ballet dancing:
need to use strapping and other modalities
molded silicone devices can be used in the end of shoes to accommodate digital problems
orthoses can be used in everyday and warm up footwear, but not performance footwear
may get away with thin insole/support with some balance/posting that fits in ballet shoes
Braver (2000) described a foot orthoses for use in ballet with a sulcus length flexible shell with cut outs or posting adhered to the extended shell – it is attached to the foot with an elastic band around the midfoot and a “thong” strap between the first and second toes.
Green (unpublished, personal communication) has developed and orthoses to put pressure in the arch area to increased what is suggested as a contraction of the intrinsic muscles when the heel is off the ground via a sensory mechanism
https://www.washingtonpost.com/entertainment/theater_danc/pain-satin-and-paper-towels-what-it-takes-for-ballerinas-to-dance-on-their-toes/2017/05/26/b4824cd6-3cd0-11e7-b9e3-606b45ad1e5b_story.html?utm_term=.cb9e8ee1dbea
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