Several years ago this high school sophomore came to me from Ohio. She'd incurred stress fractures at the fronts of both ankles when she decided to join the school's cross-country track team. She was a little bit overweight, and never had done regular sports before. One of the things she had to do in her training was run up and down bleacher steps. This always hurt the fronts of her ankles, but none of the other kids complained and she said the coach thought she was being a sissy and told her to gut it out. The last time she ran the steps she incurred stress fractures in the front of both ankles. This was verified by bone scan, ordered by the team orthopedist. He advised her to quit the cross-country team and wear flat sneakers. Problem was, she continued to worsen to the point that she couldn't walk across a room without extreme pain. She saw 6 more orthopedists and three podiatrists in Ohio, Kentucky, and Pennsylvania. She'd gotten orthotics, which made her worse, and had been prescribed physical therapy, which also made her worse. In desperation, after 21 weeks of worsening disability, her mom decided to bring her to visit me in New York City, after having heard about me from a ballerina friend. It turns out this was the supernatural part of the whole thing, because my approach to this case would never have happened if I hadn't been a doctor who treats dancers.
I took a look at her bone scan--indeed she did have stress fractures. I then took a look at her ankles, and the pain was in exactly the same spot in each ankle, right in the fold in front where the foot meets the leg. This happens to be a very common place for dancers to sustain stress fractures. Usually it's because the ankle joint doesn't have enough upward motion, or "plie." There is a way to measure this, which I devised in 1980 and have been teaching my students for 25 years. I apply this measurement technique, as well as a few critical others which I devised out of necessity from the early days when I was one of the first dance doctors in the country, to most patients requiring an investigative approach. When I tested this young lady, I found she had one of the shallowest plies of anyone I'd ever measured. Her ankles simply didn't bend up.
It then was easy to figure out why the bleacher step running caused her stress fractures. If she were running on the ground, her heel striking the ground would keep her ankles from bending too far up. But running the steps, there was nothing to stop her heel from sinking way below the toes each time she jumped from one step to the next. Her calves, by the way were fairly weak, so they didn't help keep the ankle from bending up into a zone it didn't have. Thus she got bone on bone jamming in the fronts of her ankles which led in short order to the stress fractures.
Her treatment? I said, "I want you to go over to Bloomingdales with your mom, treat yourself to a pair of high heels, and lose these sneakers. Just use the high heels for the next seven weeks as your only shoes." They looked at me like I was crazy. The ten previous doctors had cautioned her to only wear sneakers. But she was getting worse, and I persuaded them to try my suggestion. They called me from Bloomingdales--pain decreased as soon as she put the heels on. They called me 6 weeks later from Ohio. Pain had been gone completely for four weeks. We talked about what athletics she should do in school from then on.