Fitting Shoes to the young Dancer
by Craig Coussins
YOU ONLY HAVE ONE PAIR OF FEET SO WHY RISK DAMAGING THEM?

Although the foot is such a wonderful piece of natural mechanization we are sometimes apt to forget that it can easily be damaged through incorrect shoe fitting. This can include normal day shoes as well as ballet and other dance shoes.

If we look at three distinct types of dancing , Highland, Irish and Ballet Pointe, all require different physical abilities and use opposing tendons and muscles .The Highland Dancer works on the ball of the foot resulting in a wider width across this area. They can also develop a shorter Achilles Tendon . Great stress is put on to the heads of the metatarsals and the impact can be measured at around three to four times the dancers weight hitting at that point of impact.

The Irish Dancer uses the higher area of the foot including rising up. The action is a more forward travelling movement with impact on the ball of the foot as mentioned in the Highland Dancer. Less pressure is put on the heel.

The Ballet Dancer on Pointe needs muscle extension and strength in the ankle with less emphasis on the metatarsal heads. The weight of the body is supported with the sides of the shoe and not the great toe as some budding ballerinas mothers seem to believe. Not having support on the sides of the shoes can damage the young foot or deform it. The muscle group under the sole is important to allow correct relevè or rising up onto the ball of the foot or base of toes and stress from impact is normally associated I want to discuss the problems to which the Irish dancer is open.

The general observations cover soft shoes for Highland and Irish Dance and hard shoes or Jig shoes for Irish Dance. It is useful to read the results of my day to day work.

Bunions: Deviated toe joints, rolling feet and knock knees.
The most common problem is the bunion and the deviated big toe joint. Bunions. Remember that these are confused with the deviated toe joints, either the outer or inner toe, and inflammation resulting from abrasion or pressure. The solution is to see first of all if the young dancer is rolling in. The great toe will be compensating by twisting to the outside of the foot bringing the great toe joint into play. The area on the surface of the joint will be sore and probably inflamed. This could be inflammation of the Bursa, the small pocket of fluid around the joint but mainly it is the painful callosity on the foot overlaying a projecting bone. The rest of the condition is known as 'halux valgus' or deviated toe joint. The dancer usually needs the toes to be straightened and separated or strapped into the normal line. This can be done if the shape of the foot is spotted at an early stage as young dancers can start this rolling in at age two or three. The teacher can help by checking the foot and making the necessary corrective exercises or send the child to an experienced fitter for further help and advice. It is a good idea to phone the fitter prior to the child's visit if you are particularly concerned about something. I would recommend that you keep a list of child or adult specialist orthopaedic doctors who can improve the condition.

To conclude, the way to avoid bunions is to fit the shoe closely to the foot and make sure that the width is supporting the sides of the foot and that the sides are slightly tight.

Finding solutions:
The dancer sometimes tries to get a larger or wider shoe to allow no pressure and this will result in no support at the sides of the shoe making the foot slip down with the great toe following its line and forcing the joint even further out of alignment exacerbating the original condition. The fact is that a narrower shoe can greatly help the dancer as long as the foot has been strapped into its original line. However depending on how far the condition has developed this may not be possible. I would always work the dancers foot by hand to see how much movement was available and start remedial discussions from there.

The simple fact remains that despite the research made over the last ten years by specialists, some teachers still make young dancers wear the brand of shoe that they as dancers wore when it is quite clear that the foot shapes are so varied and different it is nonsense to assume every foot will fit into the same brand or style of shoe. Especially now that, as a dance shoes designer, I have designed so many new styles, innovations and types of dance shoe to meet the ever growing demands of the art. It is indeed fortunate for many young dancers that their teachers prefer Hullachan as the brand for their students.

If this were the case with the running shoe industry they would be on a losing streak and I am sure that the outdoor shoe manufacturers would never recommend one style of shoe and one shape for every child's foot and that's without taking into consideration the feelings of both child and parent.

To recap the problem we face as teacher, parent, dancer, shoemaker and fitter:
The Arch:

None of these points refer to the dancer as to whether or not they dance, but will help in the fitting.

There are three main shapes of arch, low, medium and high.
Three toe shapes:
The dancer with the low arch may be unable to achieve a satisfactory arch and could have trouble standing on toe or high and even on the ball of the foot. The dancer with the high arch invariably has weak ankles and without proper tuition is unable to support themselves properly as they are simply not pulling up. Using a stiff outer sole will not help.

Exercise to build up strength in the arch will help and wearing the Hullachan will allow better control. If you have no arch wearing the Hullachan will not give you one but if you have any kind of arch shape, the Hullachan will show what you have unlike many other brands. The dancer with the high arch will usually have weak ankles and that will cause her to twist or not get full strength while on half or full toe. This is a problem while learning until the teacher has taught her how to build up her strength and help her to develop the thigh muscles instead of just calf and ankles. As there is no support in the soft toe shoe or pump it is important that good muscle co-ordination is being developed through exercise and centre floor dance technique.

The Toe shapes of dancers:
Three basic shapes of toe perimeter shape will usually determine how a dancer will develop foot strength. This is not how the dancer will develop as a dancer but will indicate possible issues they will need to be aware of with their toe joints and possibly lower limb problems later on. It is worth noting that i the ballet world a dancer is not allowed on pointes or block toe shoes until around three to four years of strengthening development or the toe joints will be seriously damaged and the the knees could also be seriously at great risk. After these training years, the young dancer graduates into pointe shoes which are designed in the shape of an ice cream cone with a squared off toe with the front cone in a stiff shaping, to take some of the weight of the dancer while on their toes.


The Toe Shapes:

The Peasant Foot: The strong foot-This refers to the square foot where the first, second and sometimes third toes are almost the same length. This is a strong foot shape and there is good balance between the first two toes.
The fitting here is usually medium or wide.

The Greek Foot; A long slim foot shape.
This is where we have the longer big or great toe. This is longer than the other four toes.
This could present some problems for some dancers because the toe joint of the great toe is taking all the weight if the dancer is told to go onto their toes. Essentially this means that this dancer will have to work a lot on strengthening their toe joints, arches, ankles and knees to take the weight of their bodies if they choose to go on toes at a later stage.
The fitting here is usually narrow or medium.

The Egyptian Foot: This means either a pointed shape foot.
This is usually where the second toe is longer than the great toe. Now this is only a problem if the shoe is too wide at the toe. The foot makes a natural pointed shape and if the shoe is too wide then there will be space on either side of the toes. However making the shoe too short will pressure the second toe and cause the base of the second toe joint to possibly compress into the the foot and create arthritis later on. Great care needs to be taken ion the fitting of the Egyptian foot.
The fitting here is usually extra narrow or narrow.

General fitting:
Many children today have larger feet than the last generation but not so much fatter feet rather longer slimmer feet. Different areas of the country have predominately different shapes of foot to the other. We have a number of fitting techniques to adapt each shoe to each shape of foot and these alterations are done at the time of fitting. Teachers can also make sure that they check the condition of the young foot and mention any problems quickly to the parent. Often these issues can be observed in how a dancer does a step and whether or not they are able to manage a particular step. Walking on the inside or outside of the feet , Rolling in, sway back legs. knock knees are a quick indications. Other observations are sore backs, sore knees, sore arches. However in very young dancers, the joints are still soft and as you can read from the anatomy section, these joints may not become fully developed until early teens.

An experienced fitter will always point out any problems [or possible problems] to the parent or dancer and this information should be passed on to the teacher for further help. Barrry Kaufax, of Barrys in Scotsdale Arizona and one of Americas leading dance shoe fitters once told me this analogy: It really is vital that the fitter, the dancer and the teacher should work together like a three legged stool. If one leg of that three legged stool stool is not working with the other then something will fall and that is, of course, the dancer. So yes, we all have a responsibility to the trust the young person places in us to do the right thing by them.

Problems when fitting:

The Ingrown toenail:

Starting at any age this condition can result from shoes that are fitted too tight or too short including soft toe ballet, Pointe shoes, Highland or Irish Shoes. The solution to avoid problem conditions is clearly stated in previous paragraphs.
the solution to the condition is to cut the toe nails across the width and not to cut into the sides of the nail or shape the nail into a curve.

Avoiding narrow shoes may be a solution to ingrown Toenails but do not arbitrarily state this as the child may actually benefit from a narrow fitting depending on the where the problem toe is. The great toe is normally the problem one and the condition can be on either side of that toe. You sometimes find the toe is twisted or tight against the next toe and pressure is forcing the skin over the nail. A Podiatrist or chiropodist will give you help in curing the effect but try and avoid the case.

Rolling in or out can also be a cause.

Hammer Toes:

Shoes that are too big when fitted to the child at a young age when the parent wants room for growth and the little foot tries to grip onto the sole of the shoe leading to another condition such as hammer toes as well as ingrown toenails. Another cause is simply tights or socks that are pulled up too tightly and make the toes bend down.

Hand me downs? Second hand Shoes?::
Usually big sisters shoes have been handed down and are still too big. This can also be where a second hand shoe has been bought and previously worn by a completely different shaped foot. So I would never advocate the use of second hand shoes. Why take the risk?

Soft Corns:
In between the toes soft helomas or corns can develop on the dancers foot. Extremely painful this condition can be caused by incorrect shoes as opposed to badly fitting shoes. Warm moist conditions created by Irish or Highland shoes with plastic linings, plastic or P.V.C. insoles etc]. Hullachan do not use plastic materials to line their shoes. These corns must be professionally looked at and the shoes that create the conditions that lead to butyric acid formation through excess perspiration must be avoided. After all you have 125,000 sweat glands in your foot and it is important that the foot breathes properly. We stopped selling plastic or P.V.C. lined shoes years ago because of the damage they can cause and all our Hullachan products are made with natural materials. The special pad actually breathes and allows air to duct.

Hard Corns:
Common among dancers that had their shoes fitted incorrectly usually form on the knuckles of the second third and fourth toes. We can talk about this effect and the causes for a long time but the salient causes go back to two major situations we discussed in the other articles on my website www.hullachan.com.The first is when you ask a dancer to point their toes, unless you actually check them they invariably point their big toe and curl their other toes.

As a fitter I see this with the young Highland and, sometimes, Irish Dancer.

When the foot is young the cartilage has not hardened and the young foot can stay in this shape. The problem of course is that the foot is not being stretched and the development of the arch will never be easy but the knuckles of the foot are raised to the top of the shoe and through abrasion and pressure a callosity will grow on the head of the joint and a corn could form. The point about the shoe being too big for the young foot and a hammer toe condition developing can also apply to this problem. The other cause is when a shoe is too big or too wide and the dancer slides down into the crown of the shoe and finishes up being supported not by the sides of the shoe but by her bent toe joints in the tip of the shoe. More common than you would believe this is caused by the shop that sells only a few assorted sizes of shoe and tries to sell what they, the shop, have rather than what the dancer should have. Unfortunately there are a few bad fitters still around and you, as teachers, parents and dancers must determine the professionalism of the shop you are recommending your students to.

We all know that the job of teaching doesn't finish when the pupil leaves the class and as the young dancer looks to you for advice in dance they also rely on you to advise them as to the correct shoe and the correct fitter.

Achilles Tendonitis:
Achilles Tendonitis can be caused by a number of problems and most of these are easily solved. The first is where the drawstring has been pulled too tight and is digging into the back of the ankle creating pressure on the sheath of the tendon and causing inflammation. One of the results of this is the so called heel bump and the problem of that is the dancer can never get a shoe to fit comfortably either for dance or for street wear.

Another cause is faulty technique in landing and taking off when performing a jetè or jump. In both cases this may be the result of the shoe being too big and the drawstring being pulled too tight to compensate. This also goes back to the dancer who has developed the width of the met heads through Highland or because of a bunion or deviated toe joint. In all these cases the heel will not widen to match the width at the front of the foot. This causes the heel of the shoe to be too loose. In this case we can in some cases alter the heel shape to make the shoe a little firmer.

I would like to help with any questions that you may wish to ask about shoes, fitting or problems so please send your comments or questions, anonymously if you wish and I will be delighted to assist teachers and parents.

Teachers are welcome to use, copy or distribute these articles on condition that all articles are marked copyright © Craig Coussins-www.hullachanpro.com, and that reprinting and distribution is not for profit. All other articles must be marked with the authors name and copyright. These articles are for the benefit of our kids health and similar information should be made available to increase our knowledge of these matters.
Craig.

Interesting link to a toe care range of protectors: http://www.foothealthcare.com/acatalog/Big_Toe_Seperators.html

IMPORTANT NOTE TO ALL ARTICLES:
Doctors, Podiatrist and Medical Advice: Anything you have read here refers to my own experience and it is important that if you have any issues you must take the dancer to a specialist in any event. The notes here are to give you some general information. The Doctor and specialist can often help alleviate the condition but as as fitters, teachers, parents and dancers, we need to try and work out the cause if the cause has come about from the dance or shoe.

 

General fitting:
Many children today have larger feet than the last generation but not so much fatter feet rather longer slimmer feet. Different areas of the country have predominately different shapes of foot to the other. We have a number of fitting techniques to adapt each shoe to each shape of foot and these alterations are done at the time of fitting. Teachers can also make sure that they check the condition of the young foot and mention any problems quickly to the parent. Often these issues can be observed in how a dancer does a step and whether or not they are able to manage a particular step. Walking on the inside or outside of the feet , Rolling in, sway back legs. knock knees are a quick indications. Other observations are sore backs, sore knees, sore arches. However in very young dancers, the joints are still soft and as you can read from the anatomy section, these joints may not become fully developed until early teens.

An experienced fitter will always point out any problems [or possible problems] to the parent or dancer and this information should be passed on to the teacher for further help. Barrry Kaufax, of Barrys in Scotsdale Arizona and one of Americas leading dance shoe fitters once told me this analogy: It really is vital that the fitter, the dancer and the teacher should work together like a three legged stool. If one leg of that three legged stool stool is not working with the other then something will fall and that is, of course, the dancer. So yes, we all have a responsibility to the trust the young person places in us to do the right thing by them.




Teachers are welcome to use, copy or distribute these articles on condition that all articles are marked copyright © Craig Coussins-www.hullachan.co.uk, and that reprinting and distribution is not for profit. All other articles must be marked with the authors name and copyright. These articles are for the benefit of our kids health and similar information should be made available to increase our knowledge of these matters.
Craig.


IMPORTANT NOTE TO ALL ARTICLES:
Doctors, Podiatrist and Medical Advice: Anything you have read here refers to my own experience and it is important that if you have any issues you must take the dancer to a specialist in any event. The notes here are to give you some general information. The Doctor and specialist can often help alleviate the condition but as as fitters, teachers, parents and dancers, we need to try and work out the cause if the cause has come about from the dance or shoe.

Introduction to dancers Anatomy for teachers and dancers

 

A TEACHERS AND DANCERS GUIDE FROM CRAIG COUSSINS
Forward: Due to the complex nature of this subject I thought it would be beneficial to cover the salient points of how anatomy can assist a teacher during a class by recognizing the more common problems of the young dancer.

Intro to Anatomy for the Teacher and Dancer
The Knee
Knock knees
Osgood-Schlatter disease or Growing Pains
Shin-splints
Achilles Tendon 2
The Knee and Bending
Bow Legs
Sway Back Knees.


Intro to Anatomy for the Teacher and Dancer
When a teacher looks at a dancer, they see a blank canvas onto which they can apply the experience of their years as a teacher. Perhaps this young dancer will become World Champion or a Principle Dancer in a company. Maybe they will go on to teach other young hopefuls in turn but one thing is for sure though and it is this. If the dancer does not do exactly what the teacher says they will not learn enough to succeed on the narrow path to becoming a professional dancer or teacher.

What we have to assume is that the teacher is aware of three things and is able to apply all three in equal measure and at the right time.

The first is an all-encompassing knowledge of Dance techniques.
An ability to motivate and make the dancer succeed at class work.
A complete understanding of dance anatomy and physiology.

The Teacher can not do the first without knowledge of the third in case they damage the dancers anatomical structure. A young dancer is growing and can be damaged by faulty technique in teaching.

The second is dangerous unless the teacher is aware of stresses on the young dancer, both mental and physical. Individual dancers can have problems executing certain movements and in pushing themselves or by getting pushed may actually cause anatomical trauma or damage.

The third relies on the teachers willingness to explore this area of study in order to improve their own teaching ability. All young trainee teachers should study anatomy and specifically dance anatomy at an early stage in their schooling to protect their charges. Respectable already look at this aspect of teaching on a regular basis through regular articles like this one continue to ensure the high standard of qualified teachers.
What I will look at is some of the basic names of anatomical parts but without mentioning everything in detail. This will cover the teachers interest in body anatomy and problems.

THE KNEE
Starting at the lower part of the femur, the knee joint is one of the most difficult of joints to heal if damaged. Most of you will know that a sprained ankle can heal relatively quickly but a sprained knee can take up to three times as long and indeed may never recover fully. I will go into the reasons for this later but suffice to say the knee is very delicate and is one of the most complicated joints in the body.

Comprising of two CONDYLES at the front, they become a smooth surface that fits into the PATELLA that allows articulation.
At the rear of the PATELLA, the CONDYLES create a depression that is the back of the knee. This is called the INTERCONDYLOID FOSSA.

On either side is a projection called the EPICONDYLE or this is easily felt.
The top area of the TIBIA fits into the femur that allows the knee to articulate and these forms the KNEE JOINT itself. Although it essentially makes a straight up and down action possible, slight rotation is also possible when the knee is bent.The head of the FIBULA can be felt on the outer side of the TIBIA, just below.

The PATELLA is not part of the knee joint although it is called the KNEECAP. This is because the PATELLA is attached to the TIBIA below by ligament tissue and is attached at the top by the QUADRATES FEMORIS MUSCLE on the front of the thigh. The QUAD straightens the Knee Joint.

In between the PATELLA and the FEMUR is a sac of fluid called a BURSA that protects the two bones against friction.A smaller BURSA protects the front of the Knee and yet another lies below the PATELLA.

On the upper part of the TIBIA lies the half moon shaped SEMI LUNAR CARTILAGE.
The complicated arrangement of the LIGAMENTS in the Knee holds the bones together in a horizontal and vertical fashion. Problems of the knee are as follows: Too much kneeling can cause inflammation of the main bursa. If a dancer comes down hard on the knee, either badly or constantly, e.g. rehearsal, the swollen bursa may start to leak causing extreme pain and stiffness. Damage to the smaller bursa will be a lot more serious.
Normal bending and stretching the Knee will cause little or no problems for the average dancer, as the ligaments are tight, protecting the knee joint. However, in a partial bending or flexed position the ligaments are looser across the knee joint which in turn destabilizes the joint allowing more movement than the joint can safely take. What happens in a simple movement, such as a transfer of weight from one leg to the other? It puts a strain on the medial ligament and while the muscles that surround the knee can take this strain, any sudden twist can cause too strong a pull. The ligament then stretches or drags the cartilage, which in turn can dislocate or move. Movements that can cause this include any slight rotation of the performed with a relaxed knee and can start the problem that will move the cartilage eventually.

Any movement that increases rotation of the knee must finish each rotation by straightening the knee joint using strong extension as a counter active movement.

Treatment is difficult but not impossible but can leave the knee permanently weak and therefore liable to reoccurrence of trauma or injury.

PULLING UP

The knee locks when fully straight but just before it locks; a small muscle on the inside of the thigh locks the joint with a small rotation inward and unlocks with a small rotation outward. Your instruction to your student to pull up their thighs actually means that they should lock their knee joint. This in turn gives the knee a smooth appearance instead of a knobbly look.The problem arises when the child is a little too enthusiastic and the patella is pulled up. This can cause, either the ligament attaching the patella to the tibia or the tendon of the muscles at the front and at the back of the knee, to stretch. This will result in pain above or below the knee. Rest and treatment is advised for two or three days and you must watch that the child does not jerk or pull the knee while at exercise.

Although I have explained that pulling up is in fact a locking action, this is different from a knee that actually locks or indeed a knee that gives excessively easily. The causes are possibly a patella slipping or cartilage being pinched but the knee may recover temporarily. The dancer must get to the doctor or specialist to ensure that there is no inflammation under the patella or other condition that may re-occur if not attended to. If inflammation is discovered it could lead to a complete stop to dancing. Overuse of a weak joint or a joint inclined to this condition could bring this about.

At this point, I will look at the dislocation of the patella. This happens mainly to female dancers. The usual thing is that they feel is a partial dislocation as it goes out then clicks back in. If the kneecap actually goes right out of place, one should first look at whether the quadriceps muscle is out of condition or not strong, enough or perhaps the dancer has poor leg alignment.

Whatever the answer is it usually happens to girls because of the wider hip placement gives an increased angle of quadriceps pull on the tendon. It may be caused by another dancer accidentally kicking the dancer in question when the dancer is relaxed and this will make the patella slide over and lodge in the lateral aspect of the knee. Not turning the knee out and over the foot the foot on the first step of a jumping action from one leg can force the patella to be pulled latterly. The dancer is unable to move his or her leg in a semi flexed position. If it happens, then Ice therapy, cast or rigid bandage should be used with a two or three week layoff.
Knees that are well aligned tend to give little if any trouble. It is when the student has knock-knees and those with sway back legs. Also look out for dancers with short hamstring muscles; identified by being unable to straighten their knee joint without some effort.

KNOCK KNEES
Knock knees are loose at the joint and this will make the dancer unstable and may affect the muscles, ligaments and structure on both sides of the knee. I mentioned in my last article that some dancers unfortunately turn out from the knee instead of the hip and it is this condition that allows them to do this quite simply. The tibia is slightly turned out and it is this that allows them the necessary movement to turn out from the knee. The results are strain on the foot and the knee with secondary strain on the upper outside thigh and eventually the hip and lower back. Talking about Knock-Knees leads me to discuss this condition in relation to Irish and Highland. Knock-Knees are the result of an exaggerated slope inward from the width of the pelvis or from a very small angle at the upper part of the femur. Girls are more prone to the pelvic situation where they have wider hips than boys and therefore have a greater slope inward.

To test for knock-knees ask the pupil to stand facing away from you with their knees together and feet slightly turned out. If there is a gap at the heels greater than one and a half inches then the pupil will have great difficulty studying for advanced work for the reasons I will give later. The resultant stance will invariably also show that the dancer rolls in, as this is normal in Knock-Knee condition. This test is made with the smallest amount of turnout, as the inner condyles of the femur will prevent the heels from coming together. The condyles are quite large at a young age, and get progressively smaller as the child grows and with a large turnout may give a false impression as to the amount of Knock-Knee condition.

Although not a curable condition, there are specific anatomical examples that you should know about. This may help in slight improvement.

Very young children may grow out of this condition due to the flexibility of the skeleton and the unequal development of the two femoral condyles. The child can appear knock-knee at three or four then completely recover by five or six. As the child gets older and the bones get progressively harder, the condition becomes irreversible. Rolling in or out are conditions that can be helped if caught at a young enough age. Trying to change the line of the foot at a later age will put stress on other areas of the feet, legs, knees or hips.

The neat strong type of child can work through this condition with a degree of Knock-Knee up to two inches. In a thin or tall child, there may well be some looseness at the knee joint that will identify later trouble.

Speed will be affected, as it will be difficult to acquire it, as will be good elevation and good elevation work. The push up from the floor is not taken in a straight line from foot to hip as determined but through an angle at the knee joint that will of course put strain on the feet and the knees. On the other hand, dancers with a stiff knee as opposed to a loose knee will experience strains of the ligaments, cartilage problems and possible inflammations.

The child will give you indication if you encourage them to mention if they are experiencing any slight pain or discomfort while performing new or repeated exercise. Far from encouraging them to complain, it brings them closer to the teacher that can solve these problems by perhaps correcting a movement they are doing incorrectly.

Osgood-Schlatters disease or Growing Pains

Let us look at the child who complains about pain on the inner or the outer part of the knee. From age 12 to 14, the child can suffer Osgood's-Schlatters, commonly called growing pains. The inner side can also be ligament strain or cartilage displacement. If you first have a look at the exercises, and specifically any kind of knee bending action, you may find that this movement is being done incorrectly. Osgood-Schlatter disease is a very common variety of overuse injuries that occurs in knees of young people between the ages of 11 and 14. It is related to growth of the bones and occurs in dancers or sports persons who have not yet finished growing.

The symptoms are pain, swelling and inflammation about the tibial tubercle. This is the bump on the front of the shinbone (or tibia) where the kneecap tendon (or patellar tendon) is attached. If the muscles at the front of the thigh are forced the pain will be transmitted through the thigh or into the inside of the knee. It will then be painful to straighten the knee. The tibial tubercle is also the site of a growth plate. This is an area of cartilage where bone growth occurs. The growth plate cartilage is weaker than the underlying bone and the tendon attached to it. Invariably we are looking at incidences where the bones are growing faster than the tendons and causing stress in these areas.

When the forces across the knee are greater than the muscles can accommodate, the growth plate is pulled away from the underlying bone. This results in the pain, swelling and inflammation that is indicative of the disease. Activity such as dance exacerbates the pain. Often pain occurs in both knees. As with other overuse type injuries, symptoms are more common after the summer or winter break, or after a sudden increase in competition preparation.
While Osgood Schlatters is more common in boys we see it more in girls as we see more girls in dance than boys. The age is important, as this is a time of fast bone growth, which is the common cause. In addition, the foot, ankle, and leg pains are associated with growth plate centres. The period of problems arise between 11 and 14 years.

The thin, flat, crescent - shaped growth centres separate bone and cartilage in younger children. As a child nears puberty, these growth centres close and ossify the process by which cartilage becomes bone as it develops from the centre of the bone itself. It is softer at the ends when the child is young and continues to harden as the child matures. Indeed the bones sometimes continue to grow until the age of 20 but usually fully ossify or harden around age 16 to 18. As I said the bones grow so much faster than the muscles and tendons and these are unable to match that growth. This means less flexibility and strength, which in turn increases stress on the tibial tubercle. Adolescents do experience accelerated growth spurts.Between the ages of 8 and 12, dancers become more competitive, these children may complain of pain or parents may notice limping.

I suggest that before a new class season starts conditioning can help to prevent development of Osgood-Schlatters disease. Incorporating stretching to increase flexibility into the workout routine is also important and it is very important to stretch to cool down after a class. It is not only dance that makes the condition worse it can also be P. E, Gym class etc, football, other sports etc that contribute to the condition. An overall approach must be considered from the parental side in this case as well as the dance teacher.
 

Shin Splints
Shin-splints could be considered:
Shin-splints usually involve pain in the front or inside part of the lower leg. This pain frequently results from tendonitis or the inflammation of the muscles where they attach to the bone.
When a dancer has Osgood-Schlatters disease, x-rays are necessary to make sure that they do have more serious problems such as tumours or possible infections. X-rays may show small extra pieces of bone forming in the patellar tendon where the growth plate cartilage has been pulled away from the underlying bone.

Treatment begins with a short period of rest and methods to reduce the inflammation, such as ice and inflammatory medications. Exercise programs are begun, emphasizing flexibility and strength, particularly in the quadriceps muscles. A brace may be advised which decreases the force on the tibial tubercle and is often used to keep the dancer competing. The general reason for this treatment is to control the symptoms until the growth is finished. Once the growth plate has fused to the underlying bone, the problem resolves.
Lacing the Hullachan properly will help reduce this tendonitis.
Achilles Tendon
2-Growth Pains

A common pain is the severe pain behind the heel, which stems from overusing the foot and ankle in hard competitive preparation. The fibres of the Achilles tendon pull on the growth plate of the heel and create inflammation within the heel bone.

However, growth centre pain which can include Achilles Tendonitis is even more common among children who have flat feet, toe-in or have other foot problems. For these youngsters, an orthotic, a splint or soft cast is usually enough to properly position, strengthens feet and ankles, and prevents future pain and injury in their walking shoes. We can apply suitable soft orthotics in their Hullachan Pros as well.

With prompt treatment, growth centre pain persists only a few days or weeks and usually without the need for any surgery. However untreated, growth centre injury can require long term treatment.

The notable features of growing pains includes:
1. Intensity - Usually mild, sometimes a few children complain of a lot of pain that makes them cry. The pain can be short or it can last for over an hour.
2. Frequency - Intermittent, Some children get the pains every day or at night, others once a week or so, and some get them every so often. The pains tend to occur after a child has had sports at school or attends a dance class.When Normally, late afternoon or evening before going to bed. Occasionally the pain will make a child wake up at night.
5. Where - In the muscles but not in the ankles or knee joints. Many children report that the pain is in front of their thighs, in the calves, or behind the knee. Joints can be affected by other more serious diseases and appear swollen, red, tender, and warm. The Osgood Schlatters joint looks normal.

Other symptoms - restlessness, but usually no tenderness, redness, swelling. or fever.
Paediatricians find one symptom useful in making a diagnosis of Osgood Schlatters and that is how the child responds to being handled while in pain. Children who have pain from a serious medical disease do not like to be touched because any movement tends to increase the pain. Children with "growing pains" respond quite differently; in liking to have their legs massaged. That makes them feel better and they like to be held and cuddled.
The child's physician should be notified if any of the following occur with your child's pain: Regular pain, swelling, or redness in the joint or lower limb area, fever, limping, unusual rashes, loss of appetite, weakness, lethargy, or uncharacteristic behaviour. These signs generally do not accompany Osgood Schlatters and may be an indication of a more serious disorder.
Growing pains may seem harmless enough from an adults perspective or even a teachers perspective, but to a child, they are very distressing. Since the child seems better and is free of pain in the morning, parents sometimes suspect that the child is faking the symptom. This is generally not the case ---the pain is quite real and it is at these times that they need their parents reassurance and support more than ever! If you do not believe me, just ask your own parents! I did and it was explained to me that I too suffered this condition. Both my children have been through it as well.
These recommendations must not be relied upon as medical advice and it is not intended to replace the advice of your child's doctor.

 

 

 

 

Achilles Tendonitis,

The most common tendon injury amongst dancers. The tendon is easily strained and repeated damage causes inflammation of the tendon. The difficulty is that the Achilles tendon affects almost all the foot movements of the dancer and it then becomes hard to stop or reduce further irritation or damage after the tendon becomes inflamed. . Treatment includes rest and raising the heel with a small pad such as the Heel Pop sold by Hullachan. The thicker heel padding in the new Hullachan Jig Shoes acts as a preventative. This shortens the tendon and alleviates some of the pressure. Strapping of the tendon area must be done if you need to continue to dance. This strapping allows the dancer to work but stops the tendon from over stretching in use.

History and the name:

When I speak to dancers that have serious injury, it is usually the Achilles tendon around the back of the heel that seems to be the most common of these. Around 18% of dancers get this painful condition at the back of their heels. It was called the Achilles tendon from the Greek legend of Achilles.

I know we are talking about this part of the body but I thought you would like to hear the background to this myth. It was not always Achilles’ heel that was his weak point.

Thetis was Achilles mother. She wanted him to be immortal so holding him by the heel; she dipped him into the river that runs into the underworld, The Styx. The legend goes; she held him down once and forgot to immerse him a second time holding the other heel so the magical waters of the Styx did not cover the heel. That part then stayed vulnerable and not immortal. Since the 15th century, from writers on medicine such as Ambroise Pare and others, the term, Achilles Heel, referred to a weak point, not only physically, but also mentally.

Writer, Michael Macrone, in his excellent book called, It’s Greek to Me, (Harper Collins, New York, 1991) explained that Achilles did not always have a vulnerable heel. Certainly, he had a weak spot, but according to the original story about Achilles, Homer, in the Iliad, said it was his pride. Later versions indicate his weakness was his love for the Trojan princess Polyxena. In his Metamorphoses, Ovid suggested that Achilles had a vulnerable spot on his body; but the Roman poet, Statius (c. A.D. 45-96), was the first to imply in a poem that it was his heel.

Back to the actual problem.

What is the Achilles Tendon?

The Achilles is connected to one of the strongest groups of muscles in the leg. Huge pressures build up in this area and athletes are very prone to damage in this area. The tendon we are discussing is attached to three muscles. The tendon itself is the end part of that muscle group. These are the gastrocnemius, (gast) which has two ends and the soleus muscles.

The problem is that the gast muscle crosses over three main joints. The knee, the ankle and the subtalar joint. Please let me explain a little anatomy as this really does affect you when you do Irish Dance. The foot is divided into three sections. The forefoot, the back, or hind foot and the mid foot. The back foot is the anklebone or talar joint, and the calcaneus or heel bone. The subtalar (or subtalus) joint is formed by these two main bones and why it is important for you as an Irish dancer is that it is responsible for its amazing flexibility. When you do a rocking side-to-side movement with your ankles, it is the subtalar joint that allows this.

The major part of the Achilles is in the lower part of the leg near the foot and attached to the heel bone or calcaneus. See the drawing.

Unlike other most other tendons, the Achilles is not inside a sheath and does not have a rich blood supply of its own.

Symptoms.

A sharp pain; painful heel up the back of the leg when you start to dance. The pain can subside during dancing and then return before you finish. This is the problem. You are lulled into a sense of false security. Just grin and bear it; work through the pain; deal with it?, I don’t think so!

Causes.

Achilles tendonitis can be caused by a number of factors. These can include simply ignoring any pain at the back of the leg of heel, extra classes preparing for a Championship or show, such as dancing twice a week and suddenly practicing five times a week. Breaking in a new shoe that is far too stiff, and not warming up, or cooling down properly. Fortunately, you are a body and not a machine, however, machines break and so can bodies. Be sensible and warm up correctly.

Shoe pressure at the back of the foot, tying laces around the mid foot which stops the full functionality of the foot joints, getting kicked or damaging the tendon at the heel or just above the heel area.



I was asked about this in November 2005 and the question was that 18% of ballet dancers will suffer an achilles injury at some stage in their dance life. This was my answer:

It depends on the dance discipline. In Highland Dance, around 35% of dancers will get some form of tendonitis injury and Achilles is one of the more common ones. In ballet the damage can be caused by faulty landing and twisting but the cause of achilles in dance is nearly always caused by the tapes or laces being tied too tightly around the ankle, causing compression of the sheath and subsequent damage. In Highland and Irish Dance, the damage is further caused by tying around the arch that can reduce blood flow to the extremities of the foot. The tying around the ankle is secondary here but in tandem with the arch constriction then that sets the dancer up for an Achilles or tendonitis injury. In Irish Dance, there is likelihood of around 30 to 40% chance for an Achilles or arch tendon damage if the dancer ties their laces around the arch.

This was well researched by both me and many leading dance injury specialists including work done by the famous Justin Howse who wrote the book, Dance Technique and Injury Prevention with his associate, Shirley Hancock back in 1988. Mr Howse was the senior consultant and orthopaedic surgeon to the Royal Ballet Schools, The Royal Academy of Dance and the Remedial Dance Clinic, London. Ms. Hancock was the senior physiotherapist to the to the Royal Ballet Schools, The Royal Academy of Dance and the Remedial Dance Clinic, London. I have consulted with them over the years when I was the fitter for over 150 Ballet companies all over the world. My own research in the 35 years of fitting to improve my range of Ballet shoes and to try and reduce injury which is rampant in Ballet, resulted in the creation of the Hullachan range of shoes. None of the ballet shoe manufacturers I spoke to was, at that time, willing to invest in that research to reduce injury and so I started my own company making Highland and Irish Dance shoes. Why? Well I am part Scottish and Irish and I invested everything I had to make that dream happen-at least for Irish and Scottish dancers.

Treatment for Achilles Tendonitis.

R.I.C.E. treatment is, Rest, Ice, Compression and Elevation, so please get that into play immediately to reduce the problem and do it at least three times a day over three or four days.. See a doctor as soon as you can. If your Achilles is getting less painful still continue treatment of R.I.C.E. for the next two to four weeks or until it is healed.

Reduce practice of course to about half of that you normally do. Avoid too much stretching. However saying that use correct stretching and if you do get an attack of Achilles tendonitis from your dancing, do not stretch too enthusiastically, but continue to stretch gently or if attending a doctor, follow their advice. Avoid stair, wall, incline and towel stretches. Try not contract the muscles in the initial period of pain.

If this does not show positive results, use a firm heel support or lift of no more than a quarter inch or half a centimetre. Do not use flat shoes in day-to-day use such as trainers. The idea is to relieve the pressure on the tendon so that it does not stretch too much. A good preventative part of your general warm up should be gentle calf stretches.

Do not use overly cushioned insoles in Jig Shoes or in Pumps that are too soft. Some materials feel great to start with but then collapse and become hard.

I should point out that when I designed the Hullachan Jig Shoe I inserted a special medically approved thin heel cushion covered by a firmer insole. This was not too thick and had the benefit of helping prevent heel strike as well as stopping too much depression following an Achilles tendon problem. Too much cushioning is very bad, as, after contact with the floor, the heel of the foot will sink down lower as the shoe absorbs the shock. That will then further stretch the tendon as the body moves over the foot. Too thick a heel cushion such as a rubber-cushioned insole can have the opposite effect of the preventative measures I incorporated into the Hullachan Jig Shoe. Avoid all trainers when practising if you get Achilles tendonitis.

Other problems in this area.

Heel bump may be diagnosed as Haglund’s Deformity. It can possibly indicate that the tendon is pulling away from the heel bone, or that a bony growth is caused by pressure at the back of the heel. Ascertain if there is any pain while you are barefoot and while you are wearing a shoe. The Achilles Tendon problem will be painful while you are barefoot. Haglund’s is painful while wearing a shoe but, normally, not barefoot. Heel bump, while in some cases, not too serious or indeed even painful can cause shoe fitting problems and this could mean you buying a shoe that is not the right overall fit. Width is probably the answer here. I have an answer for this but will discuss this later on.

Achilles Tendonitis Bursa,

Is where the tendon overstretches, and causes an inflammation of the bursa, or pocket of fluid that allows movement at the joint where the tendon joins the heel bone or calcaneus. Please note that this bursa can also become inflamed if pressured by your dance shoes and creates a similar condition that feels like Achilles tendonitis. The new Hullachan regular pump and Gel Toe has looked at this problem and inserted elasticised side panels to stop the heel being pressured.

Achilles Tendon 2-Growth Pains

A common pain is the severe pain behind the heel, which stems from overusing the foot and ankle in hard competitive preparation. The fibres of the Achilles tendon pull on the growth plate of the heel and create inflammation within the heel bone.

However, growth centre pain which can include Achilles Tendonitis is even more common among children who have flat feet, toe-in or have other foot problems. For these youngsters, an orthotic, a splint or soft cast is usually enough to properly position, strengthens feet and ankles, and prevents future pain and injury in their walking shoes. We can apply a suitable soft orthotic in their Hullachan Pros as well.


With prompt treatment, growth centre pain persists only a few days or weeks and usually without the need for any surgery. However untreated, growth centre injury can require long term treatment.

The notable features of growing pains includes:

1. Intensity - Usually mild, sometimes a few children complain of a lot of pain that makes them cry. The pain can be short or it can last for over an hour.

2. Frequency - Intermittent, Some children get the pains every day or at night, others once a week or so, and some get them every so often. The pains tend to occur after a child has had sports at school or attends a dance class.
When Normally, late afternoon or evening before going to bed. Occasionally the pain will make a child wake up at night.

5. Where - In the muscles but not in the ankles or knee joints. Many children report that the pain is in front of their thighs, in the calves, or behind the knee. Joints can be affected by other more serious diseases and appear swollen, red, tender, and warm. The Osgood Schlatters joint looks normal.

Other symptoms - restlessness, but usually no tenderness, redness, swelling. or fever.

Paediatricians find one symptom useful in making a diagnosis of Osgood Schlatters and that is how the child responds to being handled while in pain. Children who have pain from a serious medical disease do not like to be touched because any movement tends to increase the pain. Children with "growing pains" respond quite differently; in liking to have their legs massaged. That makes them feel better and they like to be held and cuddled.

The child's physician should be notified if any of the following occur with your child's pain: Regular pain, swelling, or redness in the joint or lower limb area, fever, limping, unusual rashes, loss of appetite, weakness, lethargy, or uncharacteristic behaviour. These signs generally do not accompany Osgood Schlatters and may be an indication of a more serious disorder.


Growing pains may seem harmless enough from an adults perspective or even a teachers perspective, but to a child, they are very distressing. Since the child seems better and is free of pain in the morning, parents sometimes suspect that the child is faking the symptom. This is generally not the case ---the pain is quite real and it is at these times that they need their parents reassurance and support more than ever! If you do not believe me, just ask your own parents! I did and it was explained to me that I too suffered this condition. Both my children have been through it as well.

These recommendations must not be relied upon as medical advice and it is not intended to replace the advice of your child's doctor.



Further research:

http://www.hullachanpro.com/achilles.htm

http://www.coretherapy.com/health_news/articles_lower_
leg_injuries_in_dancers.html
http://hsc.csu.edu.au/dance/core/performance/dance_technique
/prevent_injury/achilles_tendonitis.html
http://www.drnick.com/sports_med/dance_medicine/dancemedicine.asp
http://www.wheelessonline.com/ortho/achilles_tendinitis_in_
ballet_dancers
http://www.shape.bc.ca/resources/pdf/MSIDanceInjuries.pdf
http://www.danceart.com/Mechanix/preventinjury.htm

Treatment:
http://www.200.com/tendonitis.htm
http://www.coretherapy.com/health_news/articles_lower_
leg_injuries_in_dancers.html


General Information:

I have done research for you and you will find suitable articles here:
General Info on Retro Calcaneus Heel Pain: http://straws.com/a_retroc.htm
Retro Calc Bursa: http://www.shands.org/health/information/article/001073.htm
Surgery of RC Bursitis:
http://www.podiatry.curtin.edu.au/encyclopedia/bursa/
Heel Bone Spur: http://www.merck.com/mrkshared/mmanual/section5/chapter60/60c.jsp

General issues with Heel and Achilles injury or Trauma:
http://www.aafp.org/afp/20020501/1805.html

Questions:
Blisters
I keep getting blisters on my heel and sometimes on my toes. What is causing this and what can I do about it?

The first thing that comes to mind as a shoe designer is that when your shoes were fitted they were either too wide for you or too big. The friction of shoes sliding on your feet will cause overheating and subsequent blister formation. The second thing you need to make sure of is that the inside of the shoe is not causing the problem. Inside the hard shoe at the heel, area is a material that should be slip proof. If it is not then the shoe will slide up and down on your feet. It’s an easy test when you get your shoes fitted. Rise onto the ball of your feet and the shoe should stay on the heel. If you feel it slipping then it is either too big or the material being used is not slip proof. The central seam of the soft shoe can cause blisters on your toes. Even from a hard shoe where the toe puff, or stiffened area at the toe over your own toes, has a distinct ridge and it catching your toes when you dance. Feel that with your fingers before fitting. Spenco and other manufacturers make special blister plasters that cover the tender area. If you are prone to blisters, you need to keep your feet clean and dry between dances and classes. Change your socks or tights during a competition or dance.