Athletes or Artists?
counter inside the shoe around the bony prominence
can offload the pressure on the Achilles tendon. In
severe cases a silicone elastomer shield can be custom
molded to further reduce shear resistance.
Hallux Rigidus:
This is a major problem for dancers. Again, due to
the extremely demanding movements in ballet, this
condition often restricts the dancer from achieving
en pointe as the hallux becomes increasingly stiffer.
Several in-shoe devices can help in the early stages
and add life to the dancer’s career. A softer recessed
pad under the first metatarsal phalangeal joint (1st
MPJ) helps to lower the metatarsal head and release
the hallux. Dr. Clough’s ‘Cluffy Wedge’ added to the
insole under the hallux has been shown to improve
range of motion in the first metatarsal phalangeal
joint. If the dance discipline allows, a midsole rocker
with stiff forepart in the shoe will give greater range of
motion and relieve pain in the joint.
4Posterior Impingement
spread naturally. A good arch support and metatarsal
pad changes the relative position of the metatarsals to
help relieve pressure on the metatarsal heads. A more
specific neuroma pad placed immediately proximal
to the affected web space will lift the metatarsal thus
relieving pain as well as changing the biomechanics
of the foot.
Medial Tibial Stress Syndrome:
This condition, which has been sub-classified into
three types, is quite common in running and jumping
sports, hence it is also frequently diagnosed in
dancers. Dancers suffering from MTSS complain of
recurrent exertional pain along the posterior border of
the middle and distal tibia. The pain usually presents
itself as a dull ache, but may become intense focal
pain during toe-off. Rest, adequate cushioning in the
shoe and dancing on a layer of softer mat will help.
Changing to a different shoe with increased padding
may help with additional support from an orthotic.
4Sesamoiditis
Interdigital Neuroma:
Due to the pointed or semi-pointed toe boxes
traditionally worn in many dance categories,
compression of the interdigital nerves between the
second and third, and third and fourth metatarsals
may cause pain during toe-off. If possible, a wider toe
box in the shoe is recommended to allow the toes to
4Shin Splints
Metatarsalgia:
This term refers to general pain experienced in the
metatarsal region, hence the name matatarsalgia.
Perhaps more of a constant in dancing than in
most sports, the foot is subjected to pounding, high
tensile stresses and shearing on hard surfaces often
without adequate cushioning under the metatarsals.
Current Pedorthics | January/February 2019
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