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Ankle Pain

Dancers Heel

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7 months ago

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by james

What is Dancers Heel?

Dancers heel which is also known as Posterior Ankle Impingement is a term associated with pain at the back of the heel bone. It is most often found in ballet dancers. When a dancer goes ‘en-pointe’ it closes down the space at the back of the ankle and when this is carried out regularly, it can irritate the back of the ankle.

Related Article: Posterior Ankle Impingement Symptoms And Treatment

Dancers Heel Symptoms

  • Pain on the back of the ankle in pointe position
  • Pain relief in non-weight bearing dorsiflexion
  • Pain at the back of the ankle when jumping
  • Pain at the back of the ankle wearing heels

Dancers Heel Causes

The talus bone is a bone 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 irritation of the heel. This leads to Dancer’s heel.

Dancer’s Heel Diagnosis

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 any 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.

Dancers Heel Treatment

Physical Therapy

Physical Therapy is the most effective form of treatment for Dancers Heel. This involves massage and ankle mobalisations to gap the joint and provide pain relief. Exercise Modification is often recommended which includes reducing the amount of time on demi-pointe and pointe work can help reduce pain and inflammation.

Home Exercises

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

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.

Other Treatment Options

Injections

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

Surgery can be helpful for an Os Trigonum or a Stieda Process. This type of surgery is normally 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.

Online Physiotherapy with James McCormack

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 which is located 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.

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