AAA - ankle answers, and Auditions

July 20, 2008

Sorry it's been a few days. Thursday was a great day!

I had my appointment with Dr. Rose at the Harkness Center. One doctor saw me first, but I can't remember his name. I explained the long story of what's going on, and he immediately began messing around with my foot and ankle, targeting the exact location of the pain. I have 90 degree flexion in my left foot as far as my toes go, but about 45 degrees in the right one. He began pressing on the FHL tendon, which sent me almost flying off the table. He also asked me to stand in 2nd position and plie, asking where the pain was. (the fact that he even KNEW what 2nd position was amazed me lol).

He discussed everything with Dr. Rose, who came in with the other doctor and THREE Other doctors. He asked me to stand in 1st position, demi plie (again I was baffled lol). It was crazy lol Dr. Rose did the same things and confirmed a diagnosis of FHL tendonitis and Os Trigonum syndrome. Here are a few more explanations of these two:

Definition: An os trigonum is a small, round bone that sits just behind the ankle joint. The os trigonum is present in about 5-15% of normal feet. An os trigonum occurs when one area of bone does not fuse with the rest of the talus (ankle bone) during growth.
Normally, having an os trigonum is of no consequence. In some people, however, this small bone can get caught in the ankle, and even prevent normal motion. This is most commonly seen in ballet dancers who assume pointe and demipointe positions. These positions maximally plantarflex the ankle (point the toes down), and can cause the os trigonum to become pinched in the space behind the ankle.
Other causes of posterior ankle impingement include tendonitis, fracture, and ligament injuries.
Trigger Toe/FHL Tenosynovitis
Trigger toe occurs most commonly in female classical ballet dancers. It results when the flexor hallucis longus (FHL) tendon on the inside of the ankle moves irregularly through its anatomical pulley mechanism around the ankle. Sometimes, the tendon actually locks distal to the tendon canal (near the big toe) and prohibits a dancer from using the strength in her big toe when en pointe. CausesTrigger toe can be the result of inflammation or a partial rupture of the FHL tendon, accompanied by swelling along the sheath in which it's contained. The tendon may become frayed and scarred down, adhering to the sheath and creating friction, inhibiting its smooth gliding motion. The condition may present as non-painful and annoying for a period of time before becoming painful. Pain is typically noticed as a dancer lowers from demi-pointe to flat. TreatmentEarly identification of trigger toe can assist in its recovery. Dancers should use ice, particularly ice massage as a way to decrease local inflammation. An athletic trainer or physical therapist consult is helpful to assist with soft tissue management of scarring or adhesions along the tendon. The dancer should take the time to perform slow, gentle stretching of the great toe prior to dancing. More significant cases may require surgery to release the ligamentous portion of the FHL sheath and repair the tendon.
Posterior Impingement SyndromePosterior impingement syndrome (dancer's heel)"I have pain with pointing my foot and relevé."Causes Posterior impingement syndrome, commonly known as dancer's heel, involves compression of soft tissues at the back of the ankle. A bony-formation or bump behind the ankle causes this compression. The dancer generally feels discomfort at the back of the ankle when the toe is pointed or in relevé. TreatmentDancers should use ice and anti-inflammatory medications to help reduce soft tissue swelling. Stretching of the tissues in the back of the heel (calf and Achilles) is important to reduce the stress placed on those structures. A physician and physical therapy/athletic training consults are indicated to identify joint mobility restrictions or other imbalances that might be contributing to the condition. Some health-care professionals may recommend steroid injections to assist with local inflammation. Finally, if non-surgical treatment does not help alleviate the discomfort, surgical intervention will be required to remove the bump that is compressing the soft tissue

I began to cry. I told them that I had been having this checked out for a year and a half now, to no avail, other than to be told to "deal with it". They told me that unless an orthopedist is really trained to detect these issues, and mainly for dancers, then it's hard to find and often misdiagnosed. I was misdiagnosed, with posterior tibial tendonitis, which is common with FHL tendonitis.

The next course of action is for me to get my xrays and mri's up here for Dr. Rose to look at himself. He doesn't want to charge me to do new ones as he's sure the current ones will show him what he needs to see. He said he wants to see if the Os Trigonum is for sure causing a lot of my pain, though he feels positive. He also wants to see the inflammation on the MRI, and to just see it all himself.

He definitely recommended surgery to release the tendon causing most of my pain, and he said if the Os Trigonum is a problem he can through the same incision to remove or shave the bone. He said there's a 98% success rate with the operation, and I would be out for 3 months (no longer), but back to "competition level" dancing immediately after that time.

So as of this week I will be trying to get those films sent up here, with a follow up on august 31st. Problem is I don't have 3 months to heal right now, and with insurance issues I might have to wait until the fall semester lets out. That would give me all of Christmas break to begin rehabilitation, and I'll be done with my dance classes for the spring. I definitely wanted to take some, but worst case is I participate in the classes without receiving credit as soon as I'm healed up.

SUCH A RELIEF to FINALLY receive some answers! They were sympathetic and so caring and kind to me. It's a great thing to have a clinic that caters to dancers.

Auditions for the Little Mermaid were AMAZING! A ton of FUN, very easy, and laid back as could be. There were 60 total non-equity dancers. I was number 5. We performed twice back to back, and at the end of the first group of 26 that I was with, they kept only 4. And I was completely happy not being one of those 4. I had such a great time, and met a few friendly dancers too!

Saturday was my audition for the Graham school. 50 people were there, including current program dancers auditioning for scholarships. I was mainly going for the Independent program as that's something I could do after graduation. They should have their selections posted on Tuesday.

Virginie singled me out with 3 other girls, right before we moved to across the floor, and said she had seen what she needed to with us. That the level was going to be seriously advanced next. They were beginning to let people go, though it didn't mean we weren't being selected for any programs. It just meant they had seen enough. I was a little perturbed, as she did something similar to me last year. I was talking ot Justin about it (whom was in town this weekend visiting me), and he said he thought I did great, that I looked just as good as everyone else, but he thinks my weight is the issue. And I think the same. I love this technique and I am good with it. Of course there's room for improvement but that's with anything and why I auditioned to be in the school. It's frustrating for me b/c I see myself as the skinny Melinda, while my body no longer reflects that. I'm very serious about getting back into shape safely, so I will be meeting with a nutritionalist when I get back to LA to try to get into tip top shape, as I am FED UP with this hindering my career thus far. Regardless I am proud of my work, and proud of my audition. I thought I hung in there nicely, and worked through the pain.

I'm very tired, as the heat is AWFUL here this weekend! The room we're renting has NO relief from the heat, as we have NO A/C. It really is miserable. I'm praying for a cold front LOL! It's draining, and the only relief that can be found is in a public place at this point.

I'll write more about my weekend with my husband *giggles*!

Love you guys! Thanks for all of your sweet words, especially those of encouragement and support!!