Unfortunately, dancers are probably more susceptible than lay people or other athletes to fracture of the fifth metatarsal. Specifically, an oblique spiral shaft fracture (see figure) is commonly referred to as the “dancer’s fracture”. This injury sometimes coincides with a sprained ankle and typically occurs by rolling out (laterally) while landing from a jump or en demi-pointe. Fatigue is often implicated in the occurrence of rolling out, which is why many of these injuries occur late in the day, late in the week, and/or late in the season.
Symptoms of dancer’s fracture include lateral foot pain, tenderness, swelling and ecchymosis (discoloration of the skin due to bruising).
There is an increased risk of fracture in dancers with ankle instability or prior injury such as ankle sprain or stress fracture. The main preventative measures against fifth metatarsal fracture in dancers is to be persistently diligent about foot and ankle alignment, particularly when fatigued. Early prevention can also include monitoring pain at the metatarsophalengeal (MTP) joint. “Sickling” as a compensatory measure for MTP joint pain places the dancer at a higher risk for fracture.
Since the dancer’s fracture can coincide with ankle sprain, it can be easily ignored or overlooked. If you suspect fifth metatarsal fracture, see a doctor immediately. Treatment rarely involves surgery, and typically consists of a removable boot for six weeks, combined with rehabilitation exercises. Because of the tendency for late diagnosis due to a perceived ankle sprain left untreated, recovery may be impeded and take longer the longer the dancer waits to get her foot checked out. Initial therapies after removal of a boot might consist of pool exercises and range of motion activities, progressing to proprioception and strength training, and finally a gradual return to dancing.
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