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DANCERS HAVE BEEN KNOCKING ON Dr. William Hamilton's door for thirty years. Hamilton is orthopedic consultant for the New York City Ballet, the American Ballet Theatre, School of American Ballet, and White Oak Dance Project. At the moment, 600 professional and pre-professional dancers seek his care.

Since the best injury is the one that never happens, care of the feet becomes critical to a dancer's success and longevity. With proper guidance, treatment, and common sense, dancers can keep their feet capable of withstanding the demands of the discipline.

Hamilton says certain foot types can make a dancer more susceptible to foot injuries. The Grecian, the most common in North America, is marked by a long second toe, which makes it prone to what Hamilton calls the "dancer's stress fracture" at the base of the second metatarsal bone. This fracture is especially common in dancers who suffer from female athlete's triad and do not menstruate. The Grecian foot is also susceptible to fracture near the little toe, which can occur when a dancer is on demipointe and rolls to the outside of the foot.

The model's foot type is very narrow and tapered. It is hypersensitive and does not absorb energy from impact very well, Hamilton says.

The ideal foot type for dancing is the broad, square peasant's foot. The lengths of the toes and metatarsals are roughly the same so that the dancer's weight and energy are distributed evenly.

"THERE ARE SO MANY [DANCERS] who are working in pain or feel they need to work in pain," says Jacqui Haas, director of dance medicine for the Cincinnati Ballet. "It's not always the case. We can narrow it down to what it is and fix it, if they are patient enough."

First, dancers get an injury assessment, with recommendations for exercise, stretching, and anti-inflammatories, Haas says. If the injury does not improve, they see an orthopedic surgeon or physical therapist for more evaluation. They may need to do Pilates for core conditioning, strength-train weaker muscles around the injured area, or get manual therapy to loosen stiff and rigid joints.

Among younger dancers, overuse injuries like shin splints and Achilles tendinitis are common. Haas insists that dancers stretch, use a Theraband, alternate heat and ice, get warm, and stay warm while they're learning new

choreography.

Overuse injuries can also waylay professional dancers. Haas says the "big three" this season are stress fractures of the fibula, extensor tendinitis (which affects the toes), and posterior tibialis tendinitis (which runs along the back of the tibia to the inside of the ankle). Recovering from a stress fracture requires dancers to hang up their shoes--for a while. Dancers with posterior tibialis tendinitis, which is linked to pronating (flat) feet, can still learn new choreography. Occasionally, they're allowed to work in sneakers, which gives their feet a rest. They maintain their conditioning through mat work, daily Pilates sessions, and workouts on the stationary cycle. A wider shoe can help dancers with extensor tendinitis, giving the foot more room to maneuver and stretch. Such dancers should also regularly stretch their gastrocnemius and soleus muscles, which tend to be very tight.

Hamilton, meanwhile, sees many sprained ankles in his practice. He also treats his share of fractured and dislocated toes, which often occur when a dancer is wearing ballet slippers. Most toe fractures do not involve the joints and heal uneventfully, Hamilton says. Standard treatment involves taping the toe to the adjacent toe, a sort of "buddy system." Injuries treated in this way usually heal in three weeks. Hamilton recommends that injured dancers always seek professional help, and he tells those on the mend to let their bodies be their guides. "We tell people, `Don't do what hurts,'" he says. "And don't take medicine to kill the pain. Mother Nature is trying to tell you something is wrong. Be active within your limits."

Dancing on an injured foot can lead to compensating injuries, says chiropractor Larry DeMann Jr., a consultant to the New York City Ballet. Dancers typically see DeMann for spine problems, which can originate with an injured foot or ankle. Without proper treatment, other body parts such as the hips and spine may begin to compensate. In turn, those areas become susceptible to injury.

After a layoff, dancers should toughen up their feet gradually before resuming their full schedule, Hamilton says. This will help minimize those annoying blisters. Hamilton recommends that they wait until the end of class to put on their pointe shoes.

Dancing on pointe has its own complement of foot-related concerns. Contrary to popular belief, pointe shoes do not cause bunions. Rather, a dancer is genetically programmed for them. "Your grandmother causes bunions," Hamilton says.

With proper training, dancing on pointe won't damage the bones of the foot. George Balanchine once told Hamilton that it takes four years of serious training before a child should be on pointe. Serious ballet training usually starts around age 8, so by age 12, girls are ready for pointe shoes. That is about the age--in girls--when the bones are mostly grown, Hamilton says.

# posted by Medical Information : 2:17 AM