Your Body

Understanding Foot Pain

The day-to-day grind of class, rehearsal and performance can, over time, strain the ligaments and tendons in your feet, eventually leading to overuse injuries. Whether from bad habits, such as rolling in and not keeping heels down in plié, or from wearing shoes that are too tight, these foot conditions plague students and pros alike. Here’s how to treat, prevent and rehabilitate three common injuries.

ACHILLES TENDONITIS

Definition: Inflammation of the Achilles tendon, which attaches the calf muscle to the heel bone.

Symptoms: Achilles tendonitis is first noticeable as a mild pain during and after exercise that gradually worsens with continued use. Running and jumping generally increase this pain, and feet may feel weak during repeated relevés and fast allegros. The tendon will often feel stiff until calf muscles warm up. Sometimes there is a point about an inch and a half above the heel bone that is tender to the touch.

Causes: Tight and/or weak calf muscles, jumping without being fully warmed up, chronic rolling in and not putting heels down in successive relevés or when landing jumps.

Rehabilitation: Ice for 10 minutes, 2-3 times a day, and rest from activities that strain the tendon—especially petit and grande allegro. Release tension by massaging the calf (with hands or a small ball) while stretching. Also, pay attention to how you stand in and out of class. For example, when standing on flat, weight should be divided evenly between the pads of the big and little toes and the heel. If your arches continue to roll in, your doctor or physical therapist may prescribe orthotics—supports that are worn inside street shoes to keep arches lifted.

Dangers if untreated: Continued inflammation of the tendon can irritate ankles, including the bursas (see “Bursitis” for more on bursas), to the point of a partial tendon tear or rupture. A rupture is an emergency requiring surgery. If the tendon ruptures, you won’t be able to stand or walk on the affected leg. Rehabilitating from a tear or rupture takes much longer than treatment for tendonitis.

Prevention: Maintaining both flexibility and strength in calf muscles is essential. Warm up calf muscles with ankle circles and by sitting with legs extended straight in front of you and pointing and flexing feet 30 times or more. Release tension from the calf muscles by stretching after every time you dance. Assess foot mechanics, taking care to put heels down during demi pliés, before taking off for and when landing from jumps. Stretching the calf muscle regularly will help to break the habit of popping heels.

BURSITIS

Definition: Bursitis is an inflammation of the bursas, soft fluid-filled sacs located between tendons and bones and tendons and skin. Bursitis may develop quickly and severely (acute) or over time (chronic). In the foot, the most common site is where the Achilles tendon attaches to the heel bone.

Symptoms: Pain or tenderness at the back of the heel bone. Often, there is swelling or redness in the area, and movement may be restricted or painful during pliés or relevés.

Causes: Normally, bursas decrease friction between surfaces, but when inflamed, ankle movement becomes painful as these surfaces rub against each other. Bursas can inflame from a direct blow or from chronic pressure caused, for instance, by poorly fitting street or dance shoes. Pulling the strings on ballet slippers too tightly will press on bursas. Some dancers prefer to wear shoes without drawstrings or to sew elastics directly from the heels of their shoes to take pressure off tender tendons.

Rehabilitation: Symptoms subside in 7 to 14 days after the source of stress on the bursas is removed. Elevate and rest feet whenever possible to keep swelling down. Frequently massage with ice: Fill a child’s sized Styrofoam or paper cup with water and freeze, then tear a small amount from the top and massage exposed ice firmly over the injured area for 15 minutes, three to four times a day.

Dangers if untreated: The longer you take to treat bursitis, the longer the healing time once you begin treatment. Swelling may limit the movement of the ankle; repeated flare-ups damage joints and ultimately restrict dancing.

Prevention: Don’t wear street or dance shoes that pinch the backs of ankles or are too tight across the balls of the feet.

PLANTAR FASCIITIS

Definition: Plantar fasciitis is a painful foot condition caused by inflammation of the plantar fascia, a thick band of connective tissue between the heel bone and the ball of the foot. When you walk, run and dance, this tissue transmits your weight through the foot.

Symptoms: Pain on the bottom of the foot close to the heel. Discomfort is most acute when trying to walk first thing in the morning or after prolonged sitting. Many patients with plantar fasciitis also develop a heel spur—a protrusion of bone that can be seen in an X-ray jutting from the heel bone.

Causes: Pronation (rolling in), very high arches, sudden weight gain and tight Achilles tendons can all cause plantar fasciitis. Less common causes are poorly fitting shoes or running without warming up.

Rehabilitation: It may take weeks or even months to heal. After class, roll your foot on a frozen 3/4–full plastic water bottle. Massage the bottoms of feet by rolling them across a small rubber ball or tennis ball first thing in the morning and whenever you have a chance throughout the day. If your feet roll in, try taping arches during class; outside of class, wear shoes with good arch support. (No flip-flops!) Gentle and consistent stretching of the calf muscles is also helpful. When the plantar fascia flares up, take a break from big jumps in class.

Dangers if untreated: Left unattended, an inflamed plantar fascia will continue to pull on the bone spur, making it larger and more painful. Continued spur growth could require surgery.

Prevention: If you were born with high arches, regularly massage the bottoms of feet with a pinkie ball. Maintain strong and flexible feet and ankles through daily exercises with an exercise band. When dancing, keep weight equally divided between the pads of the big and little toes and the heel. Toes shouldn’t grip the floor when standing or in demi-pointe.

Neuromuscular specialistDeborah Vogel directs the Institute for Performance Studies in Ohio, cofounded the Center for Dance Medicine in NYC, and is the author of Tune Up Your Turnout.

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