Flexor Hallucis Longus Pain
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Dancers heel is the compression of a bony growth at the back of the ankle that causes localised pain and swelling.
Dancers Heel, also known as Posterior Ankle Impingement, is associated with pain at the back of the heel bone. It is most often found in ballet dancers and gymnasts. Repetitive movements such as a dancer goes ‘en-pointe’ can cause micro-trauma to the back of the ankle, which can cause an additional bony growth such as a bone spur of the formation of an extra bone called an Os-Trigonum.
Related Article: Posterior Ankle Impingement Symptoms And Treatment
The Talus bone is located at the back of the ankle. It sits between the heel bone (calcaneus) and the Tibia and Fibula. Repetitive heel raises, especially in the early years of life, can lead to an additional bony growth on the talus bone. This is referred to as a “Stieda process“. This extra bone growth combined with repetitive demi-pointe and pointe can lead to a build-up of inflammation. This can result in a posterior ankle impingement syndrome.
The formation of an extra bone at the back of the ankle is known as an Os Trigonum. During the teenage years, the talus bone should complete its formation, but in 7-14% of people, it does not complete this process leaving an additional piece of bone in the back of the ankle joint. This can then be pinched in a demi-pointe or point position, causing Dancer’s heel pain.
Finally, a sudden increase in the amount of pointe when training can cause mechanical heel irritation. This leads to Dancer’s heel.
It is recommended that you see a medical professional such as a Physical Therapist if you are experiencing any heel pain.
A Physical Therapy appointment will include clinical tests such as a posterior ankle impingement test to establish a clinical diagnosis. This involves the patient lying on their front with their knee bent to 90º. The foot is placed into terminal plantarflexion; pain provocation is a sign of a positive test.
An MRI is the most accurate form of imaging for a Dancers Heel as it can identify any bony growths, an Os Trigonum, or joint effusion. A simple lateral view x-ray can be very helpful for diagnosing a Stieda process or an Os Trigonum, and it is much more cost-effective than an MRI.
Physical Therapy is the most effective form of treatment for Dancers Heel. Exercise Modification is often recommended, including reducing the amount of time on demi-pointe and pointe work to help reduce pain and inflammation. Manual therapy involves massage and ankle mobalisations to gap the joint and provide pain relief.
Icing can help reduce the pain and inflammation in the area and this may be applied in addition to taking anti-inflammatory medication. Strengthening and stretching exercises, initially with a band and progressing into weight-bearing are excellent at strengthening the ankle joint and reducing the amount of load that goes through the joint.
Custom Insoles may be recommended to address any biomechanical issues. Excess foot movement when walking could be contributing to the irritation of your heel pain and insoles help to address this.
A Cortisone injection is a form of anti-inflammatory injection into the back of the heel that can be used alongside Physical Therapy, and it is not unusual to have 2-3 of these if necessary.
Surgery can be helpful for an Os Trigonum or a Stieda Process. This surgery is usually an arthroscopic removal of the extra bone formation. It may be followed by 1-2 weeks in a boot and 4-6 weeks of Physical Therapy.
This is not medical advice and we recommend a consultation with a medical professional such as James McCormack to achieve a diagnosis. He offers Online Physiotherapy Appointments for £45.
Related Article: Posterior Ankle Impingement Exercises
Do Dancers get heel spurs?
It is common for Dancers to get bony spurs on the talus bone. This can lead to a Posterior Ankle impingement at the back of the ankle. However, dancers are no more likely to have a common heel spur on the underside of the foot than anyone else.
Why Do Dancers put their feet in ice water?
Dancers put their feet in ice water as a form of pain relief alongside its anti-inflammatory properties. Dancers spend a lot of active time on their feet which can lead to significant pain and discomfort so putting their feet in ice water can help with their recovery.