Dancing Through the Pain: A Ballet Dancer's Guide to Hallux Rigidus and Foot Arthritis
- Veronica K
- 20 hours ago
- 11 min read
Updated: 14 hours ago
When you hear the words “moderate to advanced arthritis,” at the age of 32, it can be quite shocking news to receive. However, having arthritis at a young age is not uncommon for ballet dancers; MRI studies have demonstrated early first-MTP joint osteophyte development in dancers as young as 19–36 years old (Angioi et al., 2014).
In my 20’s I danced in college as a ballet dancer, racking up many hours en pointe, and then progressed to cruise ship dancing in character shoes as well as freelance ballet performance work. With my history of injuries including my hip and back being the prime culprits of pain, I never thought all of a sudden I would end up with chronic foot pain that would lead to a surgery.
When I was pregnant, I noticed the ball of my feet began to hurt noticeably. But, it definitely wasn’t a sore muscle kind of hurt. It was a deep, dull, achy, creaky pain that nagged at me daily but tended to fluctuate based on what I was doing.
Going back a few years, I was a dancer who was always told I had “bad feet.” I was the recipient of advice including weighting down my toes, pressing my toes under couches, and even getting sized for shoes that were slightly too small in order to make my foot appear like it pointed better.
All things I did not realize as a young dancer could contribute to an earlier development of arthritis and degenerative changes in the foot and ankle.
After having my two beautiful children, I noticed the ballet foot pain wasn’t going away. In fact, it got so much worse in my left foot that I was limping to walk around and perform daily activities.
I finally got the results back from foot X-rays, and it confirmed what I’d been feeling at the barre.
The official diagnosis is moderate to advanced narrowing of the big toe joint, combined with osteophytes (which is just a fancy word for bone spurs). Basically, the cartilage that usually cushions my big toes was worn down, causing the bones to harden and spurs to grow.
The doctors are calling it a concern for Hallux Rigidus, or 'stiff big toe'. This is a common condition in dancers where the joint eventually stops bending, leading to persistent arthritis in ballet dancer feet.
The degeneration is slightly worse on my right foot, but just to keep things interesting, my left foot has a 'loose body' (fragment of bone floating around in the joint). Later, we discovered my left foot was also suffering from symptoms associated with an irregular bone development called the accessory navicular.
The silver lining is that my bone density is normal and there are no fractures, so the foundation is strong. But it meant I was going to have to approach ballet with an entirely different focus and expectation.
Fast forward to now, I have had an accessory navicular removal on the left foot and a chilectomy to shave down the bone spur that was limiting my ability to even walk normally.
The only intervention I took with my right foot was a shot of Toradol, which provided temporary relief from the inflamed tendons around the joint. However, the mechanical problems, such as the degeneration and narrowing, continue to require upkeep.
So, as a dancer what can you expect to feel when you’re dancing with arthritis?
This is the most critical question you can ask when managing a chronic condition like arthritis as a dancer. The line between expected discomfort and structural risk is the key to longevity.
Arthritis in the foot changes the rules of pain. You must learn to distinguish between general muscular soreness or stiffness and pain that indicates true joint damage.
Here is a breakdown of what you can expect to feel and what constitutes an immediate "stop dancing" warning sign:
Expected Discomfort with Foot Athritis (Manageable)
This type of pain generally indicates muscle fatigue, stiffness from joint limitation, or inflammation that is contained and does not represent immediate structural damage. These sensations are things I work through daily whether it’s taking a ballet class or walking around the block with my kids.
Sensation | Timing & Location | Interpretation |
Dull, Deep Ache | Late in a long rehearsal, or 1–2 hours after class, pointe work, or physical activity localized around the big toe joint or mid-foot. | This is chronic, non-acute inflammation and fatigue from bearing weight on a compromised joint. It is common for degenerative joints. |
Stiffness/Tightness | First thing in the morning or after sitting for a long time. It improves significantly after 10–15 minutes of moving. | The hallmark of osteoarthritis. The joint is stiff due to lack of lubrication. It requires a longer, gentler warm-up that includes muscle activation and soft tissue work such as arch rolling or self-massage. |
Muscle Burning | In the arch or calf during a sustained relevé or balance. | This is muscular fatigue, which is a good sign that your intrinsic foot muscles (which we discussed strengthening) are working to stabilize the foot. |
Low-Level Grind/Pressure | When articulating through demi-pointe within your modified, pain-free range. | This can be the sound/feel of your joint moving over the bone spurs/worn cartilage. If it is stable and not escalating, it is often unavoidable for arthritic joints. |
Unsafe Pain (Immediate Warning Signs with Foot Athritis)
This type of pain indicates that the joint is actively being damaged, that inflammation is acute, or that a compensation is placing other structures (like ligaments) at risk. If you experience any of these, stop the exercise or stop dancing immediately!
Sensation | Interpretation | Why It's Unsafe |
Sharp, Stabbing Pain | Occurs when the big toe is forced into its end-range (e.g., forcing a high demi-pointe or rolling through demi to full pointe with pressure and force). | This is likely Dorsal Jamming, where bone spur hits bone. This is the direct action that breaks down cartilage and grows more spurs. I personally remember having this on my left foot right before I had trouble walking (prior to my surgery). |
Clicking, Catching, or Locking | A sensation that the joint gets momentarily stuck or catches in a highly uncomfortable manner. | This indicates that a fragment (loose body) or a piece of debris is physically getting trapped between the joint surfaces. This shears the remaining cartilage. |
Instability or "Giving Way" | Your foot suddenly rolls or collapses (sickling) during a relevé or while landing from a small jump. | This is the body compensating to avoid MTP pain. It puts you at extreme risk for a severe ankle sprain because the arch/lateral ligaments cannot stabilize the foot. |
Pain That Doesn't Fade | Pain that remains severe (above 5/10) for hours after cooling down, or pain that wakes you up at night. | This indicates acute, unmanaged inflammation. Continuing to train through this level of pain will accelerate the degenerative process. |
Referred Pain | Pain that travels to a new, distant spot, such as persistent knee or hip pain only after dancing. | This shows you are making large-scale biomechanical compensations (e.g., turning out from the knee instead of the hip) to avoid pushing off the painful toe. |
Some important factors to consider include the specific styles of dance you participate in and whether full participation in those styles is truly necessary for your goals.
The next section offers guidance on modifying or temporarily discontinuing certain movements based on your personal preferences, symptoms, and tolerance within each genre.
Dance Style/Activity | Why It's High-Risk | Recommended Modification |
Styles Heavy on Jumps (Grand Allegro) | Repetitive compressive shock directly impacts the arthritic joint on landing, accelerating cartilage loss. | Minimize/Eliminate large, high jumps (Grand Allegro). Substitute with terre-à-terre work (close to the floor, focus on speed) or petit Allegro done with minimal lift. |
Tap Dance | Constant, high-frequency impact and vibration creates persistent micro-trauma and acute inflammation. | Generally advised to avoid entirely due to high impact. To minimize strain on arthritic foot joints while tap dancing, focus primarily on technique modifications designed to reduce impact and joint range. Minimize lift by keeping all steps terre-à-terre, prioritizing speed and precision over the height and force of the strike. Engage softer knees (Plié) with a deeper, more controlled bend in the standing and landing leg, ensuring leg muscles absorb the shock instead of the joints. Crucially, avoid forcing the roll through the foot; modify steps to land flat or heel-weighted to bypass the painful articulation of the metatarsal phalangeal joint. |
Acrobatic or Aerial Work | Any activity involving forceful take-offs and landings, especially those requiring hyper-extension or rapid weight shifts (tumbling). | Avoid entirely unless strictly monitored and modified to bypass reliance on toe flexion/extension for power. |
Dancing on Unsprung Floors | Hard surfaces (concrete, tile, or old studio floors without a shock-absorbing layer) transmit 100% of the force back into the joints. | Avoid practicing or rehearsing on these floors at all costs. This is a non-negotiable risk factor! |
Running | Running repeatedly stresses the big toe (first MTP) and midfoot joints, increasing compression and microtrauma. This can worsen arthritis, cause pain flare-ups, and lead to compensatory injuries in other joints. | Switch to low-impact cardio like cycling, swimming, or elliptical; run on softer surfaces with supportive shoes; shorten sessions or use walk-run intervals; consider orthotics or rocker soles; strengthen foot and leg muscles to improve shock absorption. |
Actionable Steps: Strategies for Dancing with Arthritis
So, if you’re struggling with a diagnosis similar to mine, what actionable steps can you take to continue dancing?
As a Physical Therapist Assistant and Certified Personal Trainer, I was desperate to do all the research I could get my hands on to continue pursuing my love of ballet. I'm going to share the knowledge I’ve learned and my strategies for continuing to dance en pointe and in ballet classes.
Joint Mobility and Recovery
Passive Range of Motion (ROM) Exercises: Gently and consistently perform Passive ROM exercises to prevent bone spurs or sclerosis from rigidly locking the joint. This involves relaxing the toes and moving them with your hands only, requiring no muscle activation. I do this before class, before bed, and sometimes while soaking my feet in warm water.
Perform the following:
Flexion/extension big toes and outer toes 20x
Toe spreading by placing fingers between toes 30 seconds (toe spacers are also beneficial).
Gentle traction of all the toes - 5x each toe
Gentle midfoot mobility - like wringing out a washcloth, a forward and back movement of the midfoot with your hands.
Icing After Ballet Class, Pointe Work, or Heavy Exercise: Icing can reduce inflammation that might otherwise lead to further bone changes or tendinitis flare-ups. I only ice for about 10–15 minutes maximum after pointe work.
Senior Ballet Dancers: For older adults with arthritis, icing is not universally recommended. Age-related changes such as slower circulation, thinner skin, and reduced nerve sensitivity increase the risk of tissue damage or frostbite. Unlike younger dancers, whose tissues recover more quickly, seniors may also experience delayed inflammatory responses, meaning ice could blunt the natural healing and adaptation process. Focus should instead be on gentle mobility, circulation, and safe pain management, using ice sparingly and only when acute pain or inflammation is significant.
Daily Self-Massage: This is something I have to stay on top of daily. If I slack and decide not to use my foot massager, foam rolling, instrument assisted massage tools, or massage gun, I notice a big change in my feet over the next few days.
Do not just focus on the area you are experiencing the pain. I always address the surrounding muscles as well as the entire lower leg when performing my preventative routine.
I do not use all the above tools in one session but rather disperse different massage techniques throughout my week.
(In my foot and ankle course, I teach essential recovery tips and techniques to help dancers alleviate stress on the foot.)
Compression Benefits for Foot Arthritis in Dancers
Compression sleeves provide support to arthritic joints, reduce swelling, and may improve proprioception (body awareness), which can help stabilize the foot during movement. They can also help manage mild inflammation and post-exercise stiffness. I personally have found tremendous benefit from wearing them.
When to wear them:
During class or rehearsal: Light-to-moderate compression can support joints while dancing, especially if you have mild pain or swelling.
After class: Wearing compression for 30–60 minutes post-exercise can help reduce swelling and promote circulation for recovery.
Avoid prolonged use overnight unless specifically recommended by a healthcare professional.
How to know the right fit:
The sleeve should feel snug but not painful; it should not restrict circulation.
Test by checking skin color and sensation—no numbness or tingling.
You should feel support and reduced discomfort, not increased pain.
Signs it’s helping vs. worsening:
Helping: Reduced swelling, mild pain relief, improved joint stability, and better comfort during dance.
Worsening: Increased pain, numbness, tingling, or visible skin irritation—these are signals to remove the sleeve and reassess sizing or duration.
💪 Strengthening and Support
Intrinsic Strengthening Exercises: I perform exercises 3–4 times a week to strengthen, mobilize, and maintain my foot and ankle strength. Focusing on strengthening actually improves the shock absorption capacity of the foot. Whenever I stop being consistent with my banded foot exercises, I experience increased inflammation, aching, pain, and decreased function in ballet class. (These exercises can be found in my foot and ankle course on the Veronica K Platform.)
KT Taping: I’ve experimented with several different methods of KT taping for my feet. The one that brings the most comfort to my big toe is here on my YouTube channel. (There are many different Kinesiology taping methods a dancer can try; others may be found in my foot and ankle course here.)
Metatarsal Pads in Street Shoes: I no longer wear flip-flops or any shoe with an open back, as this destabilizes the heel and puts more pressure on the midfoot. I realize this has made a big impact, even though I hate not wearing cute shoes anymore! I typically wear Brooks tennis shoes or a barefoot shoe from Amazon*, and I have added metatarsal pads* to the Brooks shoe. I occasionally slip on these metatarsal pads at home when wearing the barefoot shoe to improve shock absorption while walking around. *This is an affiliate link.
Performance Modifications I have personally given up:
Jumping Modifications: I made the choice to no longer do grand allegro in class due to the high impact it places on the joints, which would increase degeneration.
Genre Retirement: Though I had so much fun performing it, I also realized that doing any kind of character, jazz, or tap work placed too much stress on the joints. I happily retired these genres when I realized it was negatively impacting my ability to do ballet.
Your Longevity in Ballet with Foot Arthritis
Overall, I want you to realize that being diagnosed with arthritis in your feet is not a death sentence nor does it mean that you have to stop dancing. It means you are going to dance with new sensations of discomfort and, unfortunately, have to care for your feet with extra special caution.
The Role of Regenerative Treatment
In my personal opinion as a PT/PTA, I strongly advocate for regenerative approaches over masking pain. I view cortisone shots as an unacceptable long-term solution due to the risk of accelerating cartilage damage.
My initial treatments, however, were guided by necessity and mechanical need:
A Toradol shot was utilized for acute intervention on my right foot to calm severe Flexor Hallucis Longus tendonitis, a flare-up caused by surrounding structures compensating for the arthritic toe. Since that shot, my right foot has calmed considerably, allowing me to stay diligent on strengthening, balance, and mobility interventions.
Similarly, surgery on my left foot was required to address mechanical issues like the bone spur and accessory navicular bone, which PRP cannot physically fix.
For the underlying degeneration, I believe treatments like Platelet-Rich Plasma (PRP) therapy should be considered, as PRP injects concentrated platelets to promote natural healing and reduce chronic inflammation. Due to the high cost and lack of insurance coverage, PRP is currently inaccessible for me. However, if the pain progresses beyond what my current meticulous care tactics can manage, I will prioritize pursuing PRP for its regenerative potential on both feet.
Finding Hope and Continuing Ballet with Athritis
I hope this article has served not only to educate you but also to give you hope that your journey with dance is not over. It may look different moving forward, and you may have to say "no" to some choreography or styles of dance that no longer work with your body, but ultimately, you are still a dancer! There are ways you can go about strengthening your feet and managing your pain to still appreciate your art.
Need Support in Your Training?
I have built a Foot and Ankle Course for Dancers to build and care for your feet. While this course isn’t intended to treat or cure arthritis or any other foot/ankle injury, it is designed to give you tools to strengthen, recover, care, and prevent further damage while improving your ballet technique.
I also work with students privately to design custom programs to decrease compensations that may lead to further degeneration of the foot and ankle, and to help decrease the painful progression of arthritis.
Click here to book a consult and start working together today!
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Reference:
Angioi, M., Metsios, G., Twitchett, E., Koutedakis, Y., & Wyon, M. (2014). Pain and functional assessments in female professional ballet dancers. Sports Medicine – Arthroscopy, Rehabilitation, Therapy & Technology, 6(1), 2. https://doi.org/10.1186/2052-1847-6-2
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