Four Toe Problems Common To Ballet Dancers

Health & Medical Blog

There is a saying among horsemen: "No hoof, no horse." The same might be said about ballet dancers; without healthy feet, all the great technique in the world can be for naught. Here's a look at four common toe problems that plague dancers and how you can treat them if they're keeping you sidelined.

Onychomycosis

Onychomycosis is a fancy word for a toenail fungus infection. They are very common among the general population, and even more so among athletes for a number of reasons:

• increased sweating
• jamming of the toe against a shoe surface
• higher level of exposure to dermatophytes (fungi) through locker rooms, dancing barefoot, etc.
• use of shoes that retain sweat, creating an atmosphere ripe for Candida (yeast) infection

How do you know if you have a fungal infection? The nail may become discolored (yellow, green, or even black). It may also become very soft and "friable"--easily dented or peeled.

You need to consult a podiatrist if you think you have onychomycosis. A professional foot doctor can take a sample of the afflicted area to confirm the presence of fungus or yeast. They can also make sure you don't have any bacterial infections at the same time.

Onychomycosis treatment used to be confined to topical agents applied directly to the toenail, but these sometimes have a hard time penetrating and staying on the area that needs them. Now there are also several systemic (oral) medications that can be given for fungal infections that may have a better chance of reaching the infection.

These products are all prescription only. Sometimes it takes several rounds of treatment with different medications to eliminate an infection.

Bunions

Bunions, AKA hallux valgus, are those overgrowths of the joint between the foot and the big toe. The big toe may even point inward towards the other toes. You may have seen elderly women with this condition, as it can be caused or exacerbated by wearing high heels with pointed toes.

That same pressure on the big toe joint that little old ladies experience is what happens when you wear pointe shoes. Other causes of bunions can include the structure of your foot and a genetic predisposition towards them. If your street shoes mimic what your ballet shoes do to your feet, you'll only make the condition worse.

Sometimes bunions require surgery to remove excess bone that develops at the joint. Often, however, you can head off a trip to the OR by taking a few preventive measures:

• Wear street shoes with square or rounded toes that don't pinch your feet.
• Use a toe spacer between your big toe and second toe, which can be purchased at many drugstores or from a podiatrist.
• Have an athletic trainer, podiatrist, physical therapist, or orthopedic surgeon show you how to tape your feet under your shoes, so it pulls the big toe back towards the midline of the body.

Subungual Hematoma

A subungual hematoma is a bruise under the toenail. While this can happen on any toe, most commonly with dancers it happens on the big toe, as this one takes the brunt of pressure on pointe and jams against the front of your shoes the most. If the hematoma is large enough, especially near the nail bed, it can cause the entire nail to eventually fall off.

To prevent subungual hematomas, try to wear the best fitting shoes possible--snug but not too tight. Woman can also try padding their pointe shoes better or giving up pointe altogether.

If you have a hematoma under the nail, it's best to deal with it while it's still fresh. A podiatrist can drill a tiny hole in the nail and allow the blood in the bruise to drain out, relieving pressure and pain. Once the blood has dried, there's not much that can be done other than letting the nail grow out until all evidence of the bruise is gone.

Blisters

Most people have had a blister or two, but as a dancer you probably get them more frequently. They are caused by your footwear rubbing on the skin, creating a hot spot that eventually fills with fluid. If the fluid bubble bursts, you wind up with a painful open sore that can take weeks to heal.

There are several ways to avoid blisters:

• Reduce points of friction on your feet. You can experiment with anti-chafing lubricants like runners use or tincture of benzoin on blister-prone areas.
• Improve the padding in your pointe shoes.
• Stop and remove or change your shoes when you feel a hot spot developing, before it turns into a blister.
• Avoid street shoes that rub on the same spots.
• Use donut-shaped pads around hot spots to protect them.

If you do get a blister, try to deal with it before it bursts. Insert a sterilized needle at the edge of the blister, and bearing down gently, expel the fluid from inside onto a gauze pad. Apply antibiotic ointment and cover with a bandage or gel protective pad.

Your feet are your paycheck, so treat them right, and they'll reward you with years of support. If you do run into trouble, take action right away, including consulting a foot professional, and you'll be back on your toes (literally) in no time.

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9 March 2015