Foot care for Pointe Shoes and Dancers
Sprains, fractures, and tendinitis are foot injuries common to both ballet and modern dancers. Several injuries sustained by ballet dancers are peculiar to dancing on pointe, ironically, many modern dance foot injuries are caused by the lack of protection provided by shoes.
Pounding on the toe tip for up to six hours per day will cause adaptive thickening of the toenail, which is desirable. When factors overpower this thickening, problems result. The most common causes of toenail problems in the ballerina and dancer are improper maintenance, fungus, and getting stepped on or dropped hard during partnering.
Toenail Maintenance: Good maintenance includes cutting nails close to the quick in the centre, then straight across out to the edges. Cutting nails short in the corners can result in them becoming ingrown. If your corners are presently too short, round each one slightly with an emery board. Once your nail grows ever so slightly beyond the corner, maintain this length with an emery board two or three times a week. Another aspect of good maintenance is making sure that your pointe shoes fit properly.
Many pointe dancers suffer from nails that bruise, which can range from a temporary soreness to an acute, bloody loosening of some or all of the nail plate. To reduce the chances of bruising from impact or jamming, keep the centre of the nail trimmed close to the quick.
If your nail becomes loose, it may tear and get infected. To prevent tearing in a nail that has been loose for a while, cut all the loose nail away at the attachment site. First aid for freshly torn nails starts with gentle cleansing in warm water or saline solution. Next, douse the site with a skin disinfectant such as Betadine (unless you are allergic to iodine, which this product contains), and cover it with a Band-Aid (not too tightly). In most cases of nail tearing, however, you should probably see a Podiatrist.
Some dancers live with a partially torn nail by avoiding pointe for a few days and thereafter taping the loose nail down with a Band-Aid (only the non-sticky part should touch the nail) until a new nail plate forms underneath, which often takes at least three months. If the pain is severe and unrelenting, or if your torn or ingrown nail is getting hot, swollen, fiery red, or odorous, see a professional as soon as possible.
The symptoms of fungal nail infection include: discoloured (yellow, brown or white), thickened, brittle or crumbling nails. As the infection progresses the nail may become detached from the nail bed.
How is it Transmitted: Fungal Nails are extremely contagious.You can pick up a fungal infection of the nail by walking barefoot in communal areas and via bodily contact such as sharing towels. Nails which are cut too short or are traumatised may allow an opening for infection to enter under the nail bed. Fungal nails are extremely common in dancers, because shoe trauma can initiate and perpetuate fungus growth.
Treatment: You can use topical treatments such as Dactarin which you paint directly onto the nail/s or you can take oral medication. This must be prescribed by your Doctor. Intelligent hygiene will minimize the likelihood of contracting a fungal infection. Keep your feet dry and don't use someone else's nail clippers.
The formation of calluses is caused by an accumulation of dead skin cells that harden and thicken over an area of the foot. This callus formation is the body's defense mechanism to protect the foot against excessive pressure and friction. Calluses are normally found on the ball-of-the-foot, the heel, and/or the inside of the big toe.
Treatment: Many people try to alleviate the pain caused by calluses by cutting or trimming them with a razor blade or knife. However this treats the symptom not the cause. Some common causes of callus formation are, shoes that are too small, abnormalities in the gait cycle (walking motion), flat feet, high arched feet, bony prominences, and the loss of the fat pad on the bottom of the foot.
Corns are similar to calluses except that they contain a cone-shaped core with a point that can press on a nerve below, causing pain. They are produced at pressure-sensitive sites. Because corns are so pointy, and because they continue to build at pressure sites, they can become painful.Corns are a very common ailment that usually form on the tops, sides and tips of the toes.
Treatment: Podiatrists remove corns by cutting them out, and by treating the cause of the corn.
Prevention of Callous and Corns: First and foremost, check the fit of your pointe or dance shoes. Inspect the underside of your old shoes. If the pattern at the back of your heel extends more than one inch beyond the end of the shank, your pointe shoes are probably too small. Experiment at the barre with a half-size larger shoe. Also, remember that feet get bigger over the years. It is not unusual for a ballerina to develop corns later in her career because her feet have grown and she's wearing the same size pointe shoes she wore at seventeen.
Shoes may also not fit properly if one of your feet is substantially larger than the other. You can check this by standing on a big piece of paper and having someone draw one line at the hindmost part of your heel and another at the tip of your longest toe. (Make sure that the person measuring keeps the pencil completely vertical.) If there is more than a half-inch difference, you need a different size shoe for each foot.
Lamb's wool or doughnut pads can be extremely helpful if your corns don't go away after properly fitting your shoes. Avoid the chemical pads or drops for corns available at the pharmacy--they can burn away your good skin and cause infection. Removal of the corn is important if it gets too thick, but it will come back unless the pressure is removed. You may need to have your corns periodically trimmed by a professional. This may sound scary, but it shouldn't hurt at all. The young dancer must keep in mind that thick skin, knots, and non-painful corns or calluses are totally normal and part of the "toughening-up" process all dancers go through.
Blisters are the accumulation of fluid between the skin's inner and outer layers. They are rarely serious but can become infected and force a layoff from dancing if not treated properly.
Blisters can be minimized if the shoes fit properly. Nevertheless, almost everybody develops blisters when experimenting with an unfamiliar shoe. Blisters develop where a new area of the foot is getting rubbed all of a sudden.
Causes of Blisters: Blisters occur when the shoes and tights rub hard against the skin, especially if excess heat is generated. People most susceptible to blisters seem to be those whose outermost layer of skin is not so strongly attached to the skin layer directly underneath. In addition to care in fitting, ways to avoid getting blisters include applying a Band-Aid or tape to susceptible sites. Another preventive measure is applying "tincture of benzoin compound” also known as TB Co available at Pharmacies, to the skin before carefully pulling on your tights (avoiding wrinkles). The benzoin causes the tights to stick to the skin, and the shoe then rubs against the tights; some people also believe that benzoin thickens the skin. All of these "preventive" measures ultimately lengthen the time it takes the skin to toughen up. Some people's skin never toughens; for them, these are necessary measures.
Treatment: It is best to leave most small blisters alone. They should be kept clean and covered with an antibiotic ointment and a bandage. If you are going to continue dancing, there are Band Aids that you put on over the blister that contain gel which help reduce friction. Blisters usually drain by themselves. The overlying skin is a natural protective layer. It should be left in place until it is very dry and the underlying skin has become tough and painless. Then you can trim off the layer of dry skin.
Large blisters may need to be drained. It is important to do this in a way that does NOT cause an infection. Optimally, puncturing should be done by a professional.
If you have a blister that becomes infected, you need to see your doctor. Your doctor may want to prescribe you an antibiotic. Use metholated spirits on healed blisters to toughen up the skin.