HOW TO

1 THE PATIENT REALLY DOES KNOW BEST

All podiatrists should listen to their patients, but it’s particularly important with high-level sportspeople and dancers who know their bodies incredibly well. Although you are the professional, dancers and athletes know their feet much better than you do. The best thing any podiatrist can do initially is just to talk to them about what they like and don’t like.

2 FORGET CLASSICAL ENUCLEATION

Some dancers like to keep a little bit of hard skin because they know that provides protection for them. In dance, there are a lot of shearing forces and friction. If you’re treating someone who is dancing that night and they can’t really put too much padding in their shoe – and you’re going all the way down to a classical enucleation or debridement – then they are going to be quite sensitive after that process. It’s got to be a balancing act of not going too far but still taking enough off to relieve pressure.

3 NO PROBLEM TOO SMALL

Always be aware of any niggling problems and treat them as quickly as possible. I’ve looked after a world champion boxer. He came to me with something very small and simple to treat, which he knew would affect how he generated his power. At elite level, small issues with the feet can actually lead to major compromises in performance.

HOW TO...

Treat dancers and athletes

For podiatrists, the world of professional sports and dancing is less about finding marginal gains, and more about ruling out marginal pains, explains Royal Ballet podiatrist Denzil Trebilcock.

Interview Matt Lamy

DENZIL TREBILCOCK

is principal podiatrist with the Royal Ballet and Royal Ballet School. He practises at Simon Costain’s Gait and Posture Centre in Harley Street, London. Read more about Denzil on page 16 and at

gaitandposture. com 4 DON’T JUST LOOK AT THE FEET

There may be another reason why a foot isn’t happy. It could be that there is a restriction in the hip, the ankle joint or the knee, or a small limb length differential. Unless you have a more holistic view, either it is going to be a constant problem, or you’re never going to get a great result. So stand back a bit and think about the bigger picture.

5 USE TECHNOLOGY TO EXPLAIN

At our clinic, we use X-rays, pressure analysis and video capture. This helps with our diagnosis but, perhaps even more importantly, it really helps during a consultation to explain what is wrong. When dancers and athletes look for themselves and see how they’re walking, how they’re moving, or see the results of pressure analysis, they’re instantly switched on. So use any technology you have access to as a communication aid rather than just as a diagnostic tool.

Images: Shutterstock

Foot-strengthening exercises

If a patient doesn’t want orthotics, there are exercises they can try instead. If these are followed properly – and it does take some work – at the very least they will reduce the pain being experienced.

Short foot exercises – tense muscles in the feet but keep them flat and try to retract the toes in order to create an arch profile.

Re-engage with the feet – try to abduct the big toe from the lesser digits or try to move the big toe on its own to the midline of the body.

Dorsiflex – lift up the big toe independently of the lesser digits and, equally, try to lift the lesser digits independently of the big toe.

Barefoot cheek

There is a big push for the ‘barefoot generation’. The whole concept is that surely we should be looking at strengthening our feet, and if we strengthen our feet then we never need to worry about orthotics or shoes. But if weekend runners read an article that says they should go running barefoot, and they do it, they’ll simply get injured because they haven’t conditioned themselves for it.

They may argue that if they keep on exercising, then they’ll get stronger. But if you go to the gym and lift weights, and you lift those weights incorrectly, at some point you’re going to create an overwork situation and injury. It’s the same for the foot. If the foot can’t strengthen itself in the correct position, then you may be building some strength, but not necessarily in the areas that you want it.

6 CONSIDER EXERCISES AS TREATMENT

Some patients dislike the idea of orthotics, so something I have taken from the ballet is a focus on intrinsic muscular exercises (see Footstrengthening exercises): of powering up the foot and getting the foot core strong. In the same way people with back pain are encouraged to do exercises to strengthen the musculature around their core, so it is with the foot. The great thing about this with dancers and athletes is that they are used to training. So if you tell them to sit and do eight hours of intrinsic muscle exercises, they will do it and you really will see the changes.

7 REMIND THEM OF GRAVITY

Dancers in particular like to think they can control their feet and manage any problem they may have. But when they’re walking down the road, talking to friends and they’re thinking about everything other than their feet, the one thing that wins out is gravity. Gravity will always bring them back to base level and if their base level is always in a compromised position, it doesn’t matter how hard they try to fi ght it. Highlight the importance of putting measures in place to address foot problems even when they’re not consciously thinking about them.

8 DON’T TAKE IT PERSONALLY

Some dancers or athletes you won’t be able to treat because you simply cannot provide quite what they want. It’s nothing personal, it’s just that dancers and sportspeople are especially particular about issues relating to their bodies. Equally, though, once a dancer fi nds a podiatrist that they like, they will always go back to them.