Q. My daughter is a dancer who does ballet, jazz and tap. Last month she increased her ballet activities while rehearsing for a performance and has developed a painful swollen lump over the top of her foot. Her x-rays were normal. Can she continue to dance?

A. I am concerned that your daughter has a stress fracture. These are especially common in dancers and are much more likely to occur around times that their dance schedule is increased in intensity, duration or frequency. Stress fractures can occur in almost any bone in the body but in dancers are most common in the metatarsals of the foot as well as the fibula near the outer ankle, or tibia (shinbone). Almost always, initial x-rays are normal so don’t be misled.

If there is high suspicion for a stress fracture, an MRI or bone scan will usually show the abnormality and should be done especially in active individuals.

A stress fracture starts as a minor fatigue fracture or crack in the internal architecture of the bone. If you continue to pound on it, it could result in a much more serious complete fracture. It is important to get an early diagnosis and this will serve to rule out other possible causes of “lump” on the foot. 

There are creative ways to keep dancers and other athletes in top shape even if they are not dancing or doing their sport. Also, female dancers, gymnasts, or distance runners with stress fractures often have nutritional issues that need to be addressed. Heavy training can lower body fat levels to the point where menstrual function is disrupted and this has a direct result on calcium metabolism and bone health.

Most stress fractures recover quickly without casts or surgery especially if detected early. Return to your activity using the “10% Rule” where your program is increased no more than 10% per week, carefully monitoring for any recurrent symptoms. Also have your daughter’s instructor screen for any technical or training issues that may predispose her to overuse injuries such as stress fractures.