Physiotherapy   [back to the Category]

BUNION PAIN   [read the french version]

Author :   Errol Toran, D.C

Bunion pain relief and injury to the great toe will be the topic of this month's case en pointe. Flexed or on pointe, the dancer is grounded via this small focused surface area. This region of the foot suffers great punishment is it bears the focused forces of a dancer's precise movement. This dancer was like many of you, she landed from jumps, practiced chenne and pique turns, with endless releves in class and especially in rehearsal. She happened to be a classical dancer so she also had to fight the stiff toe box en releve in addition to going on pointe.

Many feel that the bunion forms not so much due to the activity during dance, but from the forces exerted on the foot after class. In class the dancer's muscles are all supported and prepared for work. The arches are lifted and the muscles of the foot are supported. The feet resist rolling in when in second or a tight fifth. After class the dancer relaxes letting the warmed ligaments and musculature stretch out. Without the proper support the foot begins to roll in, causing the toes to separate inside the shoe as the foot flattens. The toes are pressed together at the shoe tip as it resists the flattening movement of the foot. Proper support, stimulus and guidance are essential to activate and engage the foot musculature during non-dance related movement. As the great toe bends towards the midline of the foot, the fibers that make up the joint are stretched and torn. The stretched and torn fibers then grind back and forth on the inside of the shoe. The chronic grinding of the bone on bone as well as the bone on shoe, result in arthritic degenerative changes.

While in class, every time the dancer landed from a jump, the balls of her feet would produce sharp pain that shot to her foot and ankle. The right was significantly more painful than the left. It didn't matter whether she used the traditional rigid support of a Cappezio pointe shoe or the soft "tennis shoe" feel of the Gaynor Minden shoe, rolling through half point produced similar pain. It became apparent that the two small bones underneath bunion had shifted. Because they are embedded within a tendon under the great toe, they move with the tendon as it moves towards the center of her foot. Consequently she had sharp pain in the ball of the foot in addition to the red swollen bunion on the side.

Rehabilitation for this girl consisted of addressing the acute inflammation of the joint initially then setting up the foot so there would be minimal irritation during non-dance time. Her toe was electrically stimulated to reduce the inflammation, mobilized gently in an effort to keep the toe
flexible, iced and taped. We asked that she not take pointe classes and instead take floor barre, intermediate ballet classes or modern classes marking jumps. We also asked her to use a toe separator in ballet slippers. This kept the toe straighter, reducing the toe angle and the shifting of the tendon. Finally, we cast her for a pair of orthotics. These are custom shoe inserts that help support the foot through non-dance movement. As you can see there are things that you can do that will either help or make the condition worse. The better you understand your body, the better you can take care of it.