Foot, Ankle & Lower Leg

Health Tips

JANUARY 1, 2018

“When should my ballet dancer go en pointe?”


In ballet, an important decision in the development of a young ballet performer's training is when to begin pointework. Because of the risk of serious injury in the skeletally immature dancer, it's important to consider all factors when deciding to start this strenuous training. The answer is not as simple as deciding a specific age to start, but has more to do with physical maturity, strength, technique, and proper guidance and commitment to the process.


In terms of age, most dancers can begin pointework around age 10-12. The growth plates in the foot will stay open and continue to ossify past this age, so it's important to protect them both internally and externally. Externally, a properly fit pointe shoe is critical. This can be done under the guidance of these special shoe makers. An improperly fit shoe can lead to injury despite proper technique. Internally, the muscles that stabilize the ankle when in such extreme positions should be optimized. This will come with proper ballet training and mastering of the other fundamental positions.


Being able to maintain balance on high demipointe on one leg, have correct technique for plié and tendu, and relevé and piqué up to balance are essential. Dancers must also maintain a strong core and leg, thigh, hip, and gluteal muscles. When a young ballet dancer is able to demonstrate all of these things as well as full commitment to the process, enpointe training can be considered. A qualified instructor and proper supervision are also key.


Here's to all your dancing dreams...may they come true!

JUNE 27, 2017

“Will wearing an ankle brace weaken my ankle?”


We get this question fairly often. The answer depends. If you wear a rigid ankle brace that doesn't allow the ankle to move naturally, it can change your ankle mechanics by prohibiting natural movement. Your ankle area becomes out of balance, and in time, you may end up with a host of new problems caused by the rigid brace. The new problems could even go right up the body, so you may end up with knee, hip, or spine issues when you had just an ankle problem to start! 

If you wear a soft ankle brace that adds support but still allows natural movement, it won't usually weaken the ankle. In this case, the bigger question might actually be: "Should I wear an ankle brace for added support at all?" Again, the answer depends on the situation. A soft ankle brace can be beneficial in preventing recurring injuries in athletes who have had previous sprains or "loose ankles" from rolling the ankle too many times. Using the brace solely as a preventative measure is not usually recommended, though. If you've been able to perform your sport and stay active without injury, that's ideal. It would be rare for a doctor to recommend adding a medical device like a brace into your routine in that case. 

A board certified orthopedic doctor specializing in the foot and ankle area is the best choice to properly diagnose and treat ankle problems. It's a good idea to seek medical treatment after a problem occurs if it doesn't resolve itself in a reasonable amount of time with R.I.C.E.: rest, ice, compression, and elevation. Acute pain and recurring ankle issues also usually need medical attention.

NOVEMBER 17, 2016

Flat feet problems? Ankle, knee, or toe pain? Custom orthotics may help.


Custom orthotics are exactly that: one-of-a-kind shoe inserts or ankle braces molded just for you. They can relieve pain and discomfort in the foot and correct deformities. They can also provide stability and improve performance of the ankle and knee joints, especially during high injury-risk activities like sports. A custom orthotic is better quality than a standard off-the-shelf orthotic and usually lasts longer. 

A board certified orthopedic doctor specializing in foot and ankle care is the best type of medical professional to diagnose and treat problems in that area. Why not just go straight to a physical therapist or podiatrist? Orthopedic doctors have earned a medical degree and trained extensively to evaluate the entire body from a medical perspective. That means, for example, they can properly diagnose a pain in the lower leg that turns out to stem from the hip, knee, or back. Other types of practitioners don't have the training to find the problem at its root like that. 

While many of our patients have benefited from custom orthotics, many more have been helped with other solutions. A well-informed stretching or physical therapy regimen prescribed by an orthopedic doctor, ice, rest, anti-inflammation medications, or less commonly, surgery, may be just as effective or better in many cases. The only way to know is to see a doctor who can give the most comprehensive medical diagnosis.

APRIL 26, 2016

“There's a bump on my big toe joint. Should I show my doctor?


A bump on the foot that isn't going away or is painful can give you a good reason to see an orthopedic doctor. He or she can provide a diagnosis and set a up a treatment plan to help you recover. A bump on the toe may be a type of bunion. Bunions, bunionettes, and adolescent bunions are all painful conditions specifically affecting the second toe joint (metatarsophalangeal joint (MTP)). There are some differences between the three types of bunions: 

Bunions are painful and develop over time. Typically only adults (mostly females) complain about these large bumps on the inside of the foot at the big toe joint. The big toe also becomes angled inward toward the rest of the toes. This is usually caused by frequently wearing pointed shoes that pinch the toes together. Eventually one or both big toes may even overlap or underlap the toe next to it, causing even more problems. While bunions can be hereditary, wearing shoes that squish the toes together is considered the primary cause. These can often be helped or prevented altogether by wearing roomier footwear. 

The name "bunionette" sounds like a miniature bunion. It's actually a bunion located on the little toe MTP joint instead of the big toe. Bursitis, a callus, or a corn over this tiny joint may develop as the body responds to the pain and irritation. 

Adolescent bunions afflict kids, usually ages 10-15. They're the same as regular bunions but they're caused by heredity, not footwear. 

All three types of bunions can also be caused or exacerbated by inflammatory or neuromuscular conditions. 

The most common symptoms of bunions:

  • Painful or tender red bump on the MTP joint

  • Outside toe angled inward

  • Hard skin on the bottom of the foot under the affected joint

  • Limited range of motion in affected toe

  • Difficulty walking (severe cases)

In addition to the common symptoms, bunions or any other painful foot condition can negatively affect athletic performance or daily activities by causing a person to walk, run, or move differently to compensate for the pain. This can alter the correct body position, which may cause other musculoskeletal issues affecting balance, accuracy, and even endurance. Improper body position is also known to increase the chance of injury to joints, muscles, and tendons. 

There are effective treatments available for bunions. Changing footwear, padding the bunion, getting custom orthotics (toe spacers, toe splints, inserts that reposition the foot), ice, and anti-inflammatory medications are the most common ways to relieve symptoms. Surgery is an option if these treatments don't help, although recovery is long. Surgery for adolescents is normally not recommended because the bunion can return after they are full-grown.