Slow recovery…

Someone recommended I e-mail you, because we have been unable to get answers from doctors and physical therapists who know enough about ballet.

My daughter, stepped on a pencil a year ago. She is 14 and loves ballet. The pencil graphite lodged deep in the bottom of her foot. She was operated on by a good podiatrist. He had to cut through 3 layers of muscle and the plantar fascia was repaired. She seemed fine. She went back to ballet and was still doing fine. After a few months, she went slowly on pointe. She was fine until she started doing pointe for longer periods. At that point, her progress went way backwards to the point where it hurt to walk. We went to a great physical therapist and she got much better. She massaged it, iced it, put on ultra sound, had Ashley do exercises..etc.She is just getting back to ballet this month, but her foot is hurting again. It isn’t hurting as much as before, but it began to hurt after she was doing ballet classes again. She danced the first few classes for only 15 minutes. She was fine at that point. When she went up to 30 minutes, she began to have trouble. She is not on pointe. Ashley is still doing massage on the foot, putting ice on it, and doing stretches based on the physical therapist’s orders.

Her physical therapist and podiatrist are very good, but really don’t know about ballet. Any ideas on how to get her better and back to ballet? Your input would be greatly appreciated.

A concerned mom,
Joan

Joan – you’ve been very fortunate to have a good podiatrist and physical therapist. It is encouraging that she does respond very well with the physical therapy. I suspect that there was a compensation that occurred after surgery that hasn’t been fully addressed. When we injure something on one of our legs, whether that is a foot injury like your daughter had or a knee or hip issue – our body automatically compensates. It is quite amazing in that respect – we start to stand with more weight on the other leg, potentially start having a muscular imbalance between the two sides, and so on. It is so automatic that we don’t realize going back to class that there still may be some compensatory movement happening.

I would also question if there has been some fascial restriction above the level of the plantar fascia. I wrote a post about flexibility and fascia that you’ll want to read. I wonder if there is some fascial pull in the torso or pelvis that has not been dealt with yet. If there is a pelvic/torso shift or a rotation that is occurring it could be changing her muscle usage and ballet technique. While it is hard to assess these shifts yourself, have your daughter face a mirror and stand in a neutral position with her arms just hanging by her sides.

When you look at the figure below you can see she has a pelvic shift right, torso shift left (you always describe the direction from their point of view) Notice how she makes her shoulders look square, but when you look at the arms and how they hang there is more space between her left arm and pelvis, while her right arm touches her pelvis. She is not standing with equal weight on the two legs. If she turns out into first position she most likely will continue this imbalanced pattern.

There may be something like this that is going on with your daughter. Perhaps her dance teacher could meet with the two of you before or after class to look at her alignment markers. Is the middle of the ear over the middle of the shoulder, hip, knee and ankle from the side? From the front if you drop a plumb line from her nose does it fall evenly between the 2 feet? Are her hips, knees and ankles in alignment?

While everyone is asymmetrical, and I would expect to find some shifts, rotations, etc., it could be that her shifts are causing enough of an imbalance in class where she is not working evenly on her two feet. It might also be very useful to find a massage therapist that will look at your daughter’s standing alignment and based on what she sees, work to release the myofascial tensions. This will be different from a regular massage. He/she will slowly stretch and lengthen the fascia – not always a comfortable technique, but the results are well worth it.

Hope this gives her a few more suggestions for a speedy recovery. I’m rooting for her!

Warmly,

Deborah

“Education is the key to injury prevention”


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