What’s Going On? Posterior Impingement Syndrome

Hi dancers & dance lovers! If you don’t follow me on social media, this will be the first you’ve heard from me in some time. That’s actually because I’ve been out for several months with an injury. Even though that means I’ve technically had more time for writing than I usually would, creating content about dance has been too hard for me since I’ve been unable to dance. I have been posting about this on my social channels as I go along, but I know that people might be wondering where I’ve been, what’s actually wrong, and what’s coming next. (FYI if you’re not following me on socials, my Twitter is here, my Instagram is here, both @daretodanceblog, and I post almost every day). I try not to go on about my injury too much, because it is very easy to feel and act like a victim in this situation, which is not helpful, however I think that before I get back to a regular posting schedule (because more blog posts are coming!), it would be a good time to fill you guys in about my injury and what’s going to happen. I also hope that if anyone else is dealing with something similar, this might help. So here goes!

When I knew something was wrong…

My left ankle began to give me a lot of pain in the intense rehearsal period leading up to a performance, so throughout January and February this year. The pain is right in the back of my ankle, and is worst when I am en pointe or demi-pointe. It is also really restricted compared to the right side- in other words, my demi-pointe is really low, and my position en pointe is less stable and over the box of the shoe than on the right.

However this pain has been coming and going for almost my entire dance career. The first time I remember experiencing it was in pointe class, when I had just started dancing, aged 15 or 16- so 10 years ago! Throughout the years I’ve tried lots of different remedies and little things to help it, from foam rolling to tape to ice to medication, and I’ve asked doctors and physiotherapists about it. Most answered that because I do so much ballet, I spend a lot of time with my toes pointed, so the pain is a natural reaction to that. That was of course utter rubbish and a completely useless answer- if a medical professional tries to palm you off with a non-explanation for your pain, don’t doubt yourself, get a second opinion! I could have saved myself a decade of struggle!

I did have one physiotherapist I started seeing a few years ago, who was great and helped me a lot, but she didn’t manage to completely get to the bottom of my ankle pain. Everything she did helped in the short-term, and she worked with me to correct a lot of misalignments and imbalances that helped my ballet technique loads, but the pain kept coming back.

When it got really bad in the run-up to the performance in February, and when it didn’t get better afterwards even though I reduced my activity and altered it so I wasn’t doing so many painful movements, I thought maybe I needed some complete rest. So I took the week before Easter off, plus the two weeks we had off over Easter, and rested completely. I really needed that mental and physical break, and I’m glad I did it, because I was totally burned out. However within a week of being back at ballet, the pain was just as bad as ever, as if I never took time off at all. That’s when I knew it was bad and eventually sought a second opinion.

Post-Performance at Sadler’s Wells


Everything about my pain suggested tendonitis in the Achilles. The pain was at the back of the ankle, sometimes it seemed to go all the way up to the calf, the movement was restricted. My teacher suspected as much, and so did the physiotherapist. I had an X-Ray that confirmed I had a tiny spur, which is a bit of extra bone on the bottom of the heel, which is pointy and can inflame the Achilles tendon, and that’s what we thought was probably happening. Worried about causing irreparable damage to the Achilles or even tearing or rupturing it, I had to pull out of the next performance I was rehearsing for. I was referred to a surgeon to see about having the spur removed. The waiting list was huge, and I tried to get referred to a specialist dance injury clinic but it had just stopped accepting new referrals in the run-up to its closure. In the end, I was referred to the specialist sports clinic within the NHS at the Royal Orthopaedic Hospital in Birmingham. The waiting list was much shorter, but still very long, and I was unable to dance, so while I waited to see a specialist with the NHS, I sought private treatment.

Posterior Impingement Syndrome

I went to the London Podiatry Centre, which was not cheap but I really needed answers more quickly. The consultant there assessed me, and gave me an ultrasound scan of the ankle, and realised that the spur that was shown on the X-Ray didn’t seem to be causing any real inflammation at all, and the Achilles looked entirely normal. Based on my presentation of symptoms, he suspected posterior impingement syndrome. He recommended I get an MRI, which I also did privately thanks to the help of my family, and it showed I have a different extra bone, called an Os Trigonum. This is a small kind of triangular-shaped bone that some people have, and it gets pinched between the heel and the bottom of the tibia when the foot is pointed, causing pain and inflammation, not of the Achilles but of the FHL tendon and some other tendons and soft tissue around it. I won’t explain all about it here, but it’s a common problem with ballet dancers, so if you have similar pain it is worth looking into. You can read about posterior impingement syndrome here, and Os Trigonum here.

By the time I got to the NHS clinic, I already had these answers, and the doctors in Birmingham were great. They gave me an injection of local anaesthetic and steroid guided by ultrasound on the same day that I went for my first appointment, to confirm the source of the pain as well as to help it a little. They gave me a CT scan which confirmed the Os Trigonum as well as the MRI, and they scheduled me to see the surgeon to discuss having the Os Trigonum removed.

Having a guided injection


What’s Next

I recently met with the surgeon and it has been decided that I will go ahead with the surgery to remove the Os Trigonum. It will treat the pain at the back of the ankle and should help mobility in that ankle, too. It won’t necessarily help the pain in the tendons and soft tissue, I’ll need to address that with physio, although removing the source of the inflammation should help it to go away for good. I don’t have a date yet, but it will be in September or October. Following the surgery, I will need to rest, but can start moving the ankle straight away to make sure I can retain good mobility there. I’ll be doing physio and building back up to getting back to class from there.

I did decide towards the end of last academic year to leave university to focus on my ballet classes, which I do separately every day, because I was unhappy and tired out from doing so much at the same time. However in light of the upcoming surgery I have decided to return to studying to give me some purpose outside of the studio, and by the time I’m fully fit again I’ll be almost done with my degree, which is crazy!

MRI of my ankle


For real though… it’s been sh*t

I’m summarising here and it makes it sound like I moved from one appointment or scan or treatment to the next in a quick and logical chain. However in reality, it was 90% waiting. If I could afford to have it all done privately, I could have been done with my surgery months ago and be back to dancing already. While I am SO grateful for the NHS which makes it possible for me to have this surgery at all, the reality is that there is a lot of demand on NHS services, and it means a lot of waiting, even if dancing is your life and your work. I’ve been frustrated. I’ve been in pain. I’ve had days where I’m so depressed, I want to give it all up and can’t see the point in doing anything at all. I felt sick with jealousy at everyone else being able to dance, and work hard, and make progress. It’s really been so tough. When I first got my appointment to meet with the surgeon, it was scheduled for the end of October! Not for the surgery, for the first meeting with him, meaning my surgery wouldn’t be until 2020. That really was too much for me to handle and I cried for 2 days thinking that my career was over before it had started. Luckily I was able to contact the surgeon’s secretary, and the lovely people at One Dance UK helped me with it too, and my appointment was moved to 5th August, which is such a blessing.

Sometimes I have been very motivated to be pro-active with staying active in any way I can, eating well, and doing all my rehab exercises which help a lot with the pain and inflammation. However it’s not been like that all the time. I have gained a whole bunch of weight because sometimes I’m so bored and miserable, I sit around and eat all day. People might judge me for being honest about that. I have struggled with my weight but I was healthy and fit before this injury became a problem, I was on track to reach my target performance weight and physique this year, but now I am heavier than I’ve ever been. I’ve been trying to get it together in recent weeks, but there are still ups and downs, and whilst I’m trying to fuel my body right so it can heal, I still feel down a lot of the time and don’t see the point. I also can’t exercise very much, which means that diet seems to have a lot more impact on how I look than it ever has before. I had to quit coffee, too, which I love, because taking Ibuprofen long-term for this injury has given me a suspected stomach ulcer, which makes things that little bit harder, and is surprisingly depressing!

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What the deal is now

Right now, I’m in a better place than I have been throughout this whole journey, because now that I know what the problem is, and what the treatment plan is, I can actually do something about it! I’m lucky in that I can still do a lot of things- just not ballet. I can still walk around, I can exercise within reason, I can do my housework and my shopping and all the things I need to do in my day without too much pain. Last week, I danced for the first time, because I had booked the Class with Claudia London intensive before I knew I was injured. It felt so amazing to dance again. That was only three days, and I’m still in pain from it, so I can’t do that all the time, but it’s good that I can still do something.

My surgery date will dictate a lot of what happens next. I still don’t know for sure if I’m going back to university because I need to hear back from the progression board- I submitted all my assignments in a few days over the summer while they were still marking resits (a story for another post!) and I have to confirm I’ve passed them before I can progress. But I passed 2/3 with great marks so I’m pretty confident I’ll be going back. That means that from September, I will be doing a little bit of dancing as well as getting back to study. If my surgery date is ages away, I might also go back to ballet part-time, and do part-classes to start getting some technique back in my body before surgery. If my surgery is quite soon in September, I probably won’t return to ballet until after the rest period post-surgery is done and I can start training again. However I’ll still try to be at all my uni classes just doing what I can during that time!

Currently I’m looking for the best place to do my post-surgery rehab and trying to make sure I’m as healthy as I can be beforehand. I’m going to try to use some of this time to get posts and content out. I want to write about the Class with Claudia intensive, because I came away from that so inspired and with so much amazing advice I can share, and also about the whole failing second year and coming back again by doing a year’s worth of assignments in 4 days because that’s quite a story with some good lessons to be learned, haha! If you want to know anything more, feel free to comment or send me a message on Instagram! I spoke to lots of other dancers who have had similar injuries and surgeries and getting a fellow dancer’s opinion was SO helpful to me, I’d like to be able to give that same reassurance to others.

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In the studio again last week

If you’re struggling with being sidelined at the moment, just know that you don’t have to be happy every day, because it is hard, there will be bad days, but there will be good days, too, and if you make the most of them, you can use this time really effectively.

Much love, health & healing to you all!


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