Title: Dealing with Bunions En Pointe Word Count: 810 Summary: Many girls who start on pointe are scared that they will get bunions from doing pointe work. If a bunion is present it can cause real problems with fitting pointe shoes and dancing en pointe. Dance Physiotherapist Lisa Howell discusses the reality of dancing with bunions and offers practical solutions to working en pointe more comfortably. Keywords: Bunions, Pointe, Dance, Ballet, Lisa Howell, Exercises Article Body: Many girls who start on pointe are scared that they will get bunions from doing pointe work. Pointe work will not 'cause' bunions, however if you do have a family predisposition to bunions (check out your Mother and Grandmothers feet!) then wearing ill fitting shoes (whether they are street shoes or pointe shoes) may hasten their development. People usually say that they have a bunion if they start getting a lump out at the base of the big toe. You can get a 'pseudo' bunion by the rubbing of the pointe shoe if the wings are too short and do not come up to the level of the big toe joint, or wear a very narrow box. This causes the toes to be squashed together, and the ball of the foot sits above the box, rather than being supported within it. Often picking a shoe with longer wings and a wider box will help reduce pressure on the area, and the irritation will subside... A ‘real’ bunion is when the end part of the big toe begins to angle in towards the other toes, and the knuckle of the toe (head of the first metatarsal) drifts away from the second metatarsal. The protruding piece of bone thickens and often gets red and irritated. Sometimes it may feel hot. Several things are often present in the physical examination of a dancer with bunions. 1) Often she has quite mobile feet but tends to overturn the feet in first and fifth positions. 2) She may have good turnout range, but may not have the strength to use it in standing and when dancing. 3) If this is the case, when she is standing the rolling in of the feet puts pressure on the inner edge of the big toe and this encourages the drift towards the second toe. 4) If she has good turnout range she often walks with the feet slightly turned out, and rolls off the inner edge of the big toe, rather than pushing off from the underneath part of it. 5) The muscles that support her arch are usually too weak to support the foot, and especially the one under her big toe (Flexor Hallucis Brevis) is unable to assist the movement from demi to full pointe. 6) There is often an isolated restriction in mobility between the top end of the first metatarsal and the mid foot bones (Cuneiforms). 7) If there is reduced mobility of the big joint when attempting to go onto demi pointe, this often results in either sickling in, or sickling out en demi-pointe 8) The metatarsal of the big toe is often rotated in, and angled out away from the second metatarsal. 9) She may demonstrate poor pelvic stability, with the thigh, knee and foot rotating inwards with single knee bends in parallel. Depending on how many of the above points are true for the dancer, she should commence a series of exercises based on turnout strength, arch control and control of the intrinsic muscles of the feet. Many exercises to target these areas are described in detail, with photos in The Perfect Pointe Book. (http://turkiyespot.com/theperfectpointebook.com/index2.html)</a> The dancer with bunions often needs mobilization of the mid foot to help re align the toe correctly, and then taping and padding in the shoe to keep the toe in alignment. There are various taping techniques that can be used to help the dancer with bunions. Many people use toe separators, and this may help prevent the big toe from crossing the second toe, however it does not solve the real problem. It is preferable to tape under the head of the first metatarsal, before drawing the tape up and over the knuckle, de-rotating the first metatarsal. The tape is then wrapped around the big toe. This often helps align the toe more correctly in the shoe. A tape can also be used to keep the head of the first metatarsal in closer to the second, to reduce the sideways drift. Any padding should be in a donut configuration so as to distribute the pressure to the area around the bunion, rather than to increase the pressure on the already tender area. Create custom designed shapes by cutting pieces out of a simple foam rubber shoe inner sole that you can buy from the supermarket. They are cheap, comfy, and you can even get deodorizing ones. Cut a circle larger than the inflamed area, and then remove the center portion so that there is no increased pressure on the inflamed area. Adhere the padding onto the foot to keep it in place with thin hypoallergenic white tape so that it does not slide around when dancing. Having a family history of developing bunions is not a barrier to commencing pointe work; however the dancer must take special care of her feet to avoid early development of this often painful condition.