The nature of ballet movements is unusual, and therefore leads to some unusual injuries. Dancers frequently suffer minor trauma, which would not trouble an average person however they make such demand on their bodies as to prevent the ballerina from performing. Many dancers attribute the cause of injury to the hardness of the stage floor. Most are wooden and lay directly on concrete to provide a very hard, unremitting surface. This is essential to support the body mass when landing. Traditional pointe shoes provide no shock attenuation and subsequently the number of injuries increased exponentially after the introduction of pointe shoes.
Constant use destroys the pump’s shoe box which means the foot is no longer supported. Segmental deterioration of the shoe forces the dancer to use her body to compensate when standing on pointes. This was thought by many experts to be the reason why the ankle was so often damaged when the dancer sprang onto the full pointe position.
Pointe work often results in damage to the great nail with Black nail, Onychauxis and ingrown nails commonly reported. According to Quirk (1988) ballet dancers are no more prone to suffer arthritic changes on the first metatarsal phalangeal joint leading to hallux rigidus or hallux abducto-valgus. Corns and calluses are common. Everting the foot when the dancer adopts a turned out position can lead to tendinitis. Repeated jumping and landing may irritate the sesamoid bones causing sesamoiditis.
Dancers are taught to land lightly and with a small bend of the knees to dissipate the shock of hitting the hard floor. To ignore this may lead to chondromalacia of one of the sesamoid bones. Stress fractures are frequently reported with the most common site in the second metatarsal. This is thought however to be more common in demi-pointe work.
Impingement syndrome is caused when repeated pointing of the foot which compresses the lower tibia and the upper calcaneum, thus flattening the posterior tubercle (os trigonum). Another consequence of repeatedly pointing the foot is the development of traction osteophytes at the front of the ankle. These can break off forming loose bodies in the front of the ankle joint that lead to anterior impingement when the foot is dorsiflexed. The ankle tendons are often overused and sometime crepitus occurs. The most vulnerable is the flexor hallucis longus. This tendon plantarflexes the big toe and helps the dancer get up onto pointe. Overuse of this tendon can produce a nodule which can be felt moving with the tendon just behind the medial malleolus.
The tendo Achilles is often involved with a calcaneal bursa forming where the shoe ribbons are tied too tight. Anterior compartment syndrome (or shin splints) may also be found with tibial stress fracture.
The most common age for girls to start ballet classes is five years but pointe work would normally not commence until around the age of 11 years. Most authorities agree the introduction of pointe work at earlier years is dangerous and may harm normal development. In contrast to ballet injuries, some modern dance performers wear stiff boots or hard clogs to amplify their stomping sounds. Instead of dancing softly on pointes, dancers stomp on their feet. Many are not trained dancers and subsequently their accidental and repetitive-motion foot problems are more similar to injuries suffered by the general public than those seen in traditional dance companies.