Aching Achilles

This past Saturday was a big day- Saint Patrick’s Day. Four dance performances with my Irish dance school in one day. Boy do my ankles hurt! But at the same time, I can celebrate my accomplishment- read on to see why.

(These are NOT my ankles!)

In the Summer of 2013 I was working on a Physical Therapy internship at Mercy Medical Center in Baltimore, MD. It was my first of three long term clinical internships for that school year in different settings. I was running (albeit slowly) with a group of friends a few times a week. I also went to a weekly barre fitness class in Baltimore that I could walk to from my internship.

(Me while I was at Mercy!)

Somewhere among all these activities, I injured my left foot, just at the base of my big toe, and had to limit my physical activities. It took a while to get it looked at (Spring 2014) at Orthopedic Associates of Central Maryland. The diagnosis initially looked like a possible sesamoid fracture.

(This is my x-ray. You can just see the curvy dark shadow on the sesamoid bone on the left at the base of my big toe that made it look like a possible fracture. They ultimately decided I had a natural bipartite sesamoid bone.)

During my last internship for PT school in Spring 2014 I was at one of the Jackson Clinics, in Arlington, Virginia. The adult ballet classes at the Washington ballet were close and tempting, so I started dancing again once or twice a week. I had to tell Stephen, the instructor, about my injury. I wore my ballet shoes for class, but I could only manage the slightest heel raise on my left foot, and of course it hurt my toe. It hurt my pride, too. I could barely limp across the dance floor, and could not do any proper turns on my left foot.

I had an MRI of my left foot, and ended up with a diagnosis of plantar plate tear, otherwise known as “turf toe.” I was told to rest, and sold a post-op shoe to wear, as well as a steel insole. No bending at my mid foot allowed. No heel raises, otherwise known as relevés in the dance world. No running. (Why wasn’t I prescribed PT? I’d certainly want to work with someone in that situation!)

(The steel insole inside my post-op shoe limited me to only stepping flat footed.)

That year, I attended an educational day on “The Dancers Foot” that included an optional assessment with Megan Rich of Megan Rich Physical and Aquatic Therapy. She also had a representative from Bloch (a well known and popular brand of point shoes) there. It was a great seminar!

(Guess what I use as my dance bag now!)

At my individual assessment at her clinic, Megan focused on my great toe mobility. She sold me a pair of insoles to wear on top of my steel insole on the left, recommend that I go to Nordstroms to buy a Munro brand shoe with good support and almost no arch mobility, and recommended Brooks running shoes with almost no arch to also limit my foot mobility.

(I kept the steel insole in my shoes for a long time.)

The base of my left toe hurt with moderate to severe intensity, most of the time. I wore my $200 shoes from Nordstrom’s (the most expensive shoes I’ve ever bought) with my insoles and steel plate on the left. Anything to get relief! That was my primary shoe for the year. I grew very tired of those shoes.

(Graduation day for my Doctorate in Physical Therapy. I wore these shoes every day, everywhere.)

When I started working as a Physical Therapist in Summer 2014, I was wearing those shoes, and transitioning out of my steel insole. I still wore it inside my Brooks running shoes when I walked the 5K Fayetteville Color Run in Spring 2015. Now it lives in a bag in the bottom of my closet, along with those insoles and the post-op shoe. I eventually threw away the worn out Munro shoes.

(The gangs all here, waiting, just in case I ever need them again.)

From the beginning, I mobilized my foot and toe. I did stretches. I asked one of my coworkers to do Graston on my foot once or twice when we had some free time. I did theraband foot and toe strengthening, and towel scrunches, and marble pickups with my toes. Whenever I had a patient do heel raises I did them, too. Unfortunately that often resulted in me waking up my husband by screaming in pain with calf cramping in the night. I had intense, burning pain in my toe that would come and go with no evident provocation. It was frustrating. I had chronic pain, but knowing that did not make the pain any less.

(Not familiar with chronic pain or need a refresher on pain science? Here is a great video that helps to explain what is happening in five minutes!)

In Fall 2015 I once again found adult ballet classes, this time at the Linda Kinlaw School of Dance. I worked to improve my relevé height, struggled to balance on my left foot, and practiced turns with both feet. I took weekly classes there for two years. I continued to work on my left toe, foot, calf, leg, and hip strength, balance, and mobility. At some point the chronic pain finally started to die down.

In Fall 2017 I joined the Kelly Gallagher Irish Dance school. Irish dance is almost exclusively performed on the ball of your foot, skipping, hopping, and jumping without putting your heel down. There is not as much extended balance time as there is in ballet, and there are not as many turns, so in some ways Irish dance is easier than ballet. In others though, it is more challenging. It requires much more cardiovascular stamina, and puts more constant strain on the plantar fascia, achilles tendon, and calf muscles. It takes considerable leg strength. I now have the muscular endurance to make it through a short class! In fact, I’ve never had to tell my teacher about the injury that would have completely prevented me from even trying Irish dance again only a few years ago.

(A group of Irish dancers wearing the hard shoe.)

Back to the present.

Saint Patrick's Day 2018 was the most dancing I’ve done in any one day in years. I participated in four half hour shows. My role was relatively small. I only danced in soft ghilles (I just started to work on my first hard shoe step the other week), so I did not do as much as everyone else. However, I think I can be proud of my efforts. I could feel both ankles and feet fatiguing, and I could not stay up as high with either heel as I wanted, particularly by the 3rd and 4th shows. I had to limit extra skipping to conserve my flagging energy and reduce my growing pain. By the time I returned home in the evening I was hobbling on both sides with my body automatically trying to reduce my step length to avoid strain on my achilles and calf muscles.

(Irish dancing at Paddy's Irish Pub in Fayetteville, NC!)

Afterwards, I made sure to stretch my calves, some with static standing lunges, and some with dynamic repeated active range of motion with my feet elevated above the level of my heart while I was on the couch. (I was also stretching between shows.) The next day I soaked with warm water and continued with gentle stretching and self massage work.

(THESE are my ankles!)

I finally had a day of dance! I know I will be quite sore for a few days more, but I believe this will continue to improve over time, and that I will be able to do more, and more at a time in future performances. The best part for now? No toe pain, and no calf cramping!