Bunions, the bone or tissue enlargement on the big toe can weaken a dancer’s performance by causing pain and discomfort while dancing.
In this Q and A, I got Dr. Ernest L. Isaacson, an NYC based, board-certified podiatrist to answer some important questions about bunions. He addressed common dancers’ concerns about bunions and offered tips on prevention and the way forward.
Q. As a former dance retailer, I was often amazed (and not in a good way) at the bunions I would see on some young girls’ feet. This was primarily girls who were dancing on pointe. What is the relationship between en pointe dancing and bunions?
A. As we say correlation is not causation. Meaning a granny-sized bunion on a dancing teen is not an indication it was caused by dance. Bunions are mostly congenital and inherited from someone in the family. Dancing en pointe can somewhat accelerate the process, but in the absence of injury should not independently cause a bunion to form.
Q. First, could you address, from a podiatry standpoint, what steps you might recommend that a parent take to evaluate physiologically whether a child’s feet are ready for the strains of dancing on pointe(Is there an average age where you see that the growth plate has closed for example)?
A. It’s not a bad idea to have a podiatrist, orthopedist, or other sports medicine specialist examine the feet before starting any athletic regimen. It’s good medicine and it’s also a matter of common sense- we want to give our children all the tools to succeed and if there is some impediment to optimal performance it’s better to rectify it early or consider a different activity. Like an adult, a child needs to listen to his or her feet and understand when there is an undue strain on any one or more structure. As a rule, expect growth plate closure at around 14 for girls and 16 for boys. (Yes mom was right- girls do mature faster).
Q. Can you offer recommendations for proper foot care to help avoid bunions?
A. Dancing en pointe is hard on the feet, no doubt. However, like any other skilled physical activity, it takes training, conditioning and hard work. The feet won’t start out ready for en pointe, and some may never tolerate the strain. On its own, it should not directly cause injury as the pressure, while high, is applied gradually and evenly. My concern is for the sub-optimally trained dancer who sustains an injury while attempting en pointe moves. This could potentially lead to damage to the tendons, ligaments, and cartilage around the big toe joint. The growth plates are fairly resilient and should tolerate the strain of even rigorous dance.
“Neglecting your foot health is a mistake too many people make. Foot pain and injuries can lead to problems elsewhere in the body and they almost always affect a person’s quality of life”
Q. If a dancer develops bunions, is there anything (non-surgical) that can be done about it?
A. Well if only. Until gene therapy is perfected to the point of selecting out the bunion gene or genes, we are stuck with our DNA that we can’t escape. Of course, a competitive dancer by definition has done at least fairly well on the genetic lottery. It goes without saying that shoes should be comfortable and wide enough to accommodate the foot structure, especially if there is a predisposition toward bunions or if one has already started to form.
The best advice I can give is to wear a wider shoe to accommodate the width of the front of the foot. And it’s the actual width of the foot as it is placed on the ground in a weight-bearing position, not how it looks when sitting. The only definitive treatment for bunions is surgery but this is only necessary in case of a deformity that interferes with quality of life, and it is okay to keep a non-painful bunion in the freezer until such time that surgery is warranted. Don’t bother with the splints and devices- those are modeled on very straight feet and generally ineffective in realigning bones and joints.
1. Dancing does not cause bunions unless you inherit the gene and sustain an injury.
2. Jumping straight into en pointe dancing is wrong, you need to train and condition your body to handle the stress associated with it.
3. Having a specialist examine your feet for dance readiness is a good starting point for a dancing career or competition.
4. Surgery still remains the only definitive treatment for serious cases of bunions
Bunions are bad especially for dancers whose profession depends on having a strong and healthy foot. Anti-inflammatory cream and ice packs help relieve pain temporarily. A professional podiatrist can examine your feet, diagnose the problem and decide on the next line of action.