Your Best Body: All About Bunions

How dancers can deal with ballet's signature bony bump
Published in the December 2010/January 2011 issue.

How to deal with bunions

First, the good news: Ballet does not cause bunions directly. That said, many a dancer is plagued with the pesky bump on their big-toe joint. Fortunately, there’s no need to rush to surgery, since much can be done to treat bunions and make dancing with them more comfortable.
   
Bunion Basics
A bunion is a bony protuberance of the joint at the base of the big toe, which forces it to angle inwards toward the other toes. The bump may become red, inflamed and cause pain. Bunions are hereditary, and if your genes have passed them down to you, there is currently no scientific evidence that you can prevent them. But although your DNA is the original source, most doctors agree that ballet exacerbates the problem—which is why 90 percent of dancers have some kind of enlargement of the big-toe joint, according to Thomas Novella, a podiatrist who works with New York City Ballet, American Ballet Theatre and other dance companies. “Bones adapt to dance,” he says. Some change in the toe shape simply comes with the job. Luckily, however, plenty of dancers with bunions have no pain at all.
   
Keep It In Check
You may not be able to prevent bunions, but you can keep them from causing serious discomfort by following several simple procedures at the first sign of that tell-tale bump.

 

Good foot alignment is key. Think of the standing leg as a column centered on the foot: Keep equal weight on your heel, pinkie and big toe. Be careful to turn out from the hip: Rotating at the ankle causes the foot to roll inward, placing unneeded pressure on the big-toe joint, which can make it more unstable.

 

Frank Sinkoe, a podiatrist who works with Atlanta Ballet dancers, finds that screening ballet students can help detect future dancers who are prone to developing bunions. “A hypermobile foot will be more predisposed,” he says. By strengthening the muscles of their feet, dancers with this foot type can protect the toe joint. “Exercises can help to stabilize the first toe joint and reduce the extent of the deformity,” says Sinkoe. He suggests practicing toe push-ups: Sitting in a chair, with your feet on the ground and resistance on the knee, go from demi-pointe to full pointe with straight (not curled) toes. This will engage the arch muscles and activate the intrinsic muscles of the foot. He also recommends working with a Thera-Band: Sitting on the floor, place the Thera-Band around your toes; take the leg to a front tendu with the heel down, then lift and lower your toes using the Thera-Band for resistance.
   
Pointe Shoe Problems
Poorly fitting pointe shoes can aggravate bunions. Pay attention to the shape of the vamp, making sure it spreads the impact throughout all five toe joints when on pointe. “If you have a long first toe, you need a narrow, tapered box so that the smaller toes get some of the impact instead of it all falling on the first toe joint,” says Novella. Sinkoe cautions against letting the pointe shoe fitter opt for a too-wide shoe to accommodate your bunion. Also, make sure the vamp is long enough. “If your toes curl in plié, your shoe is too short, and that reduces the leverage and strength the toes have to support and protect the foot,” says Novella. Too-short shoes can cause metatarsal stress fractures; dancers with more advanced bunions are particularly vulnerable.

 

Novella doesn’t recommend alternating your shoes as they break in. “Shoes mold into a shape—switching shoes can cause unnecessary compression on the bunion,” he says. “It also hastens the ‘death’ of the pointe shoe by putting undue stress on its materials. Ironically, some dancers switch shoes to make them last longer, and these dancers tend to wear their shoes well beyond a reasonable number of uses. Dancing in dead shoes is a disaster and puts a tremendous strain on the toes.”

 

Padding and taping, to keep the big toe in place, can offer comfort. However, “padding can fill up the shoe too much and is not always the answer,” warns Sinkoe. Wearing a toe spacer in a pointe shoe is okay, but not for soft shoes or street shoes. Both Novella and Sinkoe caution dancers to pay attention to how the extra material affects the fit of a shoe and alters the alignment of your foot. Use trial and error to find what works for you. 
   
Outside The Studio
Although you can’t correct bunions without surgery, there is help. If your bunions become painful or inflamed, Sinkoe recommends icing for 10 minutes at a time and taking anti-inflammatories when necessary. “In some difficult cases I have used a cortisone injection,” he says.

 

Also, pointe shoes should be regularly evaluated to make sure they are accommodating the bunion. And don’t neglect your street shoes—choose styles with good support. “Sometimes, I suggest orthotics in street shoes to align the foot in a more neutral position,” says Sinkoe.

Going Under The Knife
Surgery is often best postponed until retirement, since it can lead to stiffness and inflexibility. For older dancers, recovery can take over a year. “Surgery on the big toe is usually not a good idea. Scar tissue can develop, causing a loss in relevé,” says Novella. “Not even the best surgeon can guarantee full range of motion.” Unless bunions cause major trouble, most retired dancers decide that surgery simply for cosmetic reasons is not worth the long recovery process and possible loss of flexibility. As Novella says, “Dancers’ feet are a badge of honor.”

Nancy Wozny writes about the arts and health from Houston.

 

 

Straight Talk On Sugar Substitutes

Many dancers try to cut calories by using low- or zero-calorie sugar substitutes. But are they healthy?

 

Peggy Swistak, nutritionist at Pacific Northwest Ballet School, notes that there are two kinds of substitutes. Non-nutritive sweeteners, including aspartame (Equal and NutraSweet), saccharin (Sweet’N Low) and sucralose (Splenda), are made in a lab and have zero calories.

 

Agave and stevia are natural plant products that are not technically calorie-free, “but,” Swistak says, “because they’re 200 times sweeter than sugar, you use a lot less.”

 

Swistak doesn’t see a problem with using either variety in moderation. “Everything in the world has been blamed on sugar substitutes, and there’s been no research to substantiate those claims,” she says. She advises consuming no more than two non-nutritive sweetened products per day to limit the amount of chemicals you ingest and avoid stomach aches. “Our bodies can’t digest non-nutritive sweeteners, which is why they pass through us,” says Swistak. “Too much can cause bloating and discomfort.” 

 

And beware: non-nutritive sweeteners may actually make you hungrier. Some nutritionists believe the fake sweetness causes your insulin to spike, stoking your appetite. Swistak cautions, “It’s good to have the Diet Coke instead of the regular, but not if that means you eat the bag of Oreos later!”

 

Butterflies In The Stomach?
There’s a new solution for stage fright: sun salutations. A recent study at Harvard Medical School found that yoga and meditation calmed performance anxiety in professional musicians. Vanessa Muncrief, a yoga instructor and physical therapist who works with dancers at New York’s Harkness Center for Dance Injuries, believes this finding can also apply to dancers. “When the body and mind are in sync, you can achieve a feeling of ‘performance flow,’ ”she says, or what many dancers refer to as being “in the zone.”

 

Muncrief recommends centering yourself with a few minutes of mindfulness meditation before heading onstage. “Focus on simple, regular breathing,” she says. “If any thoughts enter your mind, acknowledge them, perhaps with the word ‘thinking,’ and then let them go.”

 

Also find a short yoga series to practice on a regular basis and return to when you need to steady your nerves—the poses you choose don’t matter as much as simply performing them regularly. “By going through familiar movement, you can focus on a steady breathing pattern, calm the mind and prepare your body for a rigorous performance,” explains Muncrief. “Regular practice, just as in dance, is key for decreasing anxiety and upping performance level.”

 

Massage Your Muscles
Traditional foam rollers have gotten an upgrade. The next time your muscles are full of knots, try the RumbleRoller. It’s shaped like a traditional foam roller, but the surface features 200 specially designed bumps that are firmer than muscle but softer than bone. It gently kneads soft tissue in multiple directions, working out all the kinks. See www.rumbleroller.com.

 

Super Quinoa
This super-charged grain (pronounced KEEN-wah) is an athlete’s best friend. The ancient Incas in South America even believed quinoa was sacred because it increased their warriors’ stamina. Eat some before heading to rehearsal to keep your endurance going strong throughout every run-through.

 

Why: With a balanced set of essential amino acids, quinoa is a complete protein source. It’s also packed with dietary fiber, iron, magnesium, vitamin B9 and zinc.
Taste: It’s slightly crunchy and has a mild flavor, with just a hint of nuttiness.
How to Cook: Boil two cups of water and add one cup of quinoa. Cover, reduce heat to a simmer and cook for about 12 minutes or until fluffy.
Recipe Ideas: Add it to vegetables, beans, fish or chicken for lunch or dinner, or mix with berries, honey and almonds for a hearty breakfast.


What’s the biggest misconception dancers have about their bodies?
“Dancers have such loose hamstrings that they don’t think they need to work on flexibility,” says Adam Daredia, a certified strength and conditioning specialist who trains dancers in New York City. “But they’re extremely tight in the hips—especially the piriformis.” That’s because the piriformis is the muscle in your glutes that you use to turn out. And if you let it get too tight, it can cause lower back problems. Daredia says the best way to stretch the
piriformis is in pigeon pose: Sit down as if you’re in a split, but with the front knee bent at a 90-degree angle; square off your hips; then lower your upper body forwards to the floor.