Meagan Kolakowski December 3, 2012
Dance Injury The Dancer’s Fracture, which is a fracture to the 5th metatarsal bone, is actually more common to dancers then you think. I never heard of this injury before so I was really interested and intrigued when I saw this on my card. Another name for this injury is Jones fracture. Signs and symptoms:
When pressing on the outside of the foot, there will be tenderness at the base of 5th metatarsal. There may also be tenderness over a large area of the outside the foot. However, the main tenderness will be at the base of the 5th metatarsal. Typically, the blood supply and sensation to the foot is normal. It is determined at the exam if the patient can still move their foot to the outside (eversion of the foot). This is done by placing the foot in an everted position and asking them to maintain that position while applying some resistance. This allows the doctor to gain access of the injured tendons that evert the foot. Doing this usually creates some discomfort for the patient. However, they usually are able to perform the action. Other symptoms include pain, swelling, severe bruising, severe pain while walking, and/or complete immobility. Anatomy of the region:
I believe the 5th metatarsal joint is a hinge joint because it is similar to the knee in the range of motion it has. Two of the major muscles that are in this region are the peroneus brevis tendon and the peroneus tertius tendon which connects right to the fifth metatarsal bone and the brevis tendon connects right to the tuberosity near the heel of the foot. The injury itself occurs at the base of the fifth metatarsal bone (the one connected to the pinky toe), at the “metaphyseal-diaphyseal” junction, ¾ of an inch away from the base of the fifth metatarsal. Injury to both the muscle and the bone is done, which is why immobility is a possibility for some dancers, depending on the severity of the metatarsal injury. A Dancer’s fracture is often mistaken for a sprain or an avulsion fracture. This is why it’s important to have your injury diagnosed as soon as possible so you know exactly what type of injury you have. Causes:
The most common cause of Dancer’s Fracture is a dancers partner stepping on their foot. You can work with your dance partner to keep your feet safe from dancer's fracture. Stepping on a partner's foot is one of the most common causes of dancer's fracture, so take measures to avoid doing so. If you're working on a new or complicated move, start slow and count the steps until you both feel comfortable trying it at tempo. Be responsible for your part of the dance floor, and maintain space so you're not stepping into your partner's dance area or on their feet. It can also be caused by coming down off of releve the wrong way and then not taking care of the foot. If you’re injured take care of it, take care of your injury, take care of your instrument. Treatment:
There is no surgery required for Dancers Fracture which is probably the greatest thing a dancer can hear. But the treatment period does require you to be off of your feet for at least 2 months with your foot wrapped. This injury also requires you to do daily physical therapy exercises in order to regain strength in your foot/ankle. One exercise that is very common for this injury is called the “doming” exercise. This exercise consists of you placing your foot flat on the ground and pushing your toes against the ground to create a “dome” where your arch is.. You repeat this over and over to help build strength. Another exercise you may do is eversion exercises with a theraband to build those eversion muscles to protect them from any other injuries and to protect from fractures.
Piriformis Syndrome Piriformis syndrome is an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve. The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. This muscle is important in lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body. This allows us to walk, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs -- in short, in almost every motion of the hips and legs. Signs and Symptoms:
Piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks. Pain can be severe and extend down the length of the sciatic nerve (called sciatica). The pain is due to the piriformis muscle compressing the sciatic nerve, such as while sitting on a car seat or running. Pain may also be triggered while climbing stairs, applying firm pressure directly over the piriformis muscle, or sitting for long periods of time. Most cases of sciatica, however, are not due to piriformis syndrome. Diagnosis is usually determined by history of trauma to the area and a physical exam in which your doctor will have you do a variety of exercises to see where the pain may be coming from. Anatomy of the region:
The pirifromis muscle is a muscle deep in the gluteal muscles across the upper buttock. It originates from the anterior surface of the sacrum. It also has attachment to the capsule of the sacro-iliac joint and also the sacrotuberous ligament. Superficial to the piriformis is first the gluteus medius muscle followed the larger gluteus maximus, which covers the entire muscle. The sciatic nerve, which passes deep into the piriformis muscle, in most cases (approximately 85% of people) can pierce the piriformis itself, likely resulting in piriformis syndrome and subsequent sciatica. Even if the sciatic nerve runs deep to the piriformis, spasm in this muscle put direct pressure on the nerve, causing pain and discomfort.
Causes:
Since piriformis syndrome is usually caused by sports or movement that repeatedly stresses the piriformis muscle, such as running or lunging, prevention is often related to good form. Avoid running or exercising on hills or uneven surfaces. Warm up properly before activity and increase intensity gradually. Use good posture while running, walking, or exercising. If pain occurs, stop the activity and rest until pain subsides. See a doctor as needed.

Treatment:
If pain is caused by sitting or certain activities, try to avoid positions that trigger pain. Rest, ice, and heat may help relieve symptoms. A doctor or physical therapist can suggest a program of exercises and stretches to help reduce sciatic nerve compression. Some health care providers may recommend anti-inflammatory medications, muscle relaxants, or injections with a corticosteroid or anesthetic. Other therapies such as iontophoresis, which uses a mild electric current, and injection with botulinum toxin may be used. Surgery may be recommended as a last resort. Some stretches you can do includes laying on your back and pulling your one leg towards you while your other leg is stretched out straight. Another one is to put the foot of the leg that’s affected on your other leg and pull it towards your body to stretch out that area.