Contrary to popular belief, dancing does not usually cause bunions. Bunions are primarily genetic and consist of certain tendons, ligaments, and supportive structures of the big toe being positioned differently. A bunion is an enlargement of bone or tissue around the joint where the big toe meets the foot. In dance bunions, or any bunion type, the big toe may turn toward the second toe and the big toe’s joint may be swollen and tender.
While bunions are mostly genetic, the moves that a ballet dancer does, especially the classic “en pointe’ stance, can put the foot at risk for dancer bunions. The en pointe stance is when a ballet dancer balances on the tips of the toes. This classical ballet technique, made possible by specially reinforced shoes, places abnormal pressure on the big toe.
There are two types of bunions most often found in ballet dancers; the first being slowly progressive bunions.
Dancers with slowly progressive bunions have a normal range of motion and are usually helped with lamb’s wool or orthopedic felt pads placed inside the ballet slipper. Other treatments include: ballet slipper stretching, ice packs and anti-inflammatory medicine (i.e. Ibuprofen or Advil). These dancers should also stretch their Achilles tendon 2-3 times a day for 15 minutes.
The second type of bunion that can affect dancers is the rapidly progressive bunion. This bunion actually causes a loss of motion in the big toe joint, a noticeable deformity in the joint and worsening pain. As this condition gets worse, a dancer is going to have less “push off” power from the big toe and will start using the second and third toe. These ballets dancers are first treated with moleskin padding in their ballet slippers, ice packs and anti-inflammatory medications.
That dancer will often have problems performing and may need an osteotomy: surgery where bone (in the foot) is cut to shorten, lengthen, or change its alignment, and screws are placed inside to hold it in place. After an osteotomy, a dancer can exercise on a bike or swim three weeks later. Dancers can do gentle floor exercises eight weeks after surgery. Dancers have to wear a toe spacer three months after surgery and must also wait three months before trying any dance moves. It should be noted that surgery, even if successful, could end a dancing career.
Of course prevention is the best medicine. Dancers should be encouraged to avoid “winging,” where the feet are forced outward from the ankles toward the fifth toe in a winger formation. This extra pressure can contribute to bunions over time. Also, dancers should place the center of their foot inline with the midpoint of the ankle and the leg to avoid winging.
Another good trick is practicing releves with a tennis ball placed between the ankles while the legs and feet are parallel. This can help dancers avoid poor techniques that can lead to bunions. The human has more bones in it than any part of the body, so it’s smart medicine to take care of your feet.