Ballerina stays en pointe after ankle surgery

“I have a love for dance,” said Philomena Maggard of New Canaan, an accomplished ballerina who knows the joy of moving across the stage en pointe. The 18-year-old has been honing the classical technique for nearly a decade, including two years in the preprofessional program at Miami City Ballet, practicing more than four hours a day, six days a week. She grew concerned, though, when her left foot began to hurt. At first, she used over-the-counter medications to dance through the pain. But when the worsening condition threatened her ability to dance, Maggard knew it was time to act. She sought the advice of Greenwich Hospital’s Sean Peden, MD, a Yale Medicine orthopedic surgeon specializing in ankle and foot surgery.

“I was hesitant at first, but surgery was the only solution if Philomena wanted to keep dancing en pointe,” said Maggard’s mother, Amédée. Unlike her mother, Maggard had no reservations in 2022, when she had the surgery. “The surgery was a good experience. I can dance en pointe with no pain at all,” said the teen, now a freshman and Elon College Fellow at Elon University in North Carolina. “I plan to do a lot of dancing at college.”

Greenwich Hospital’s orthopedic surgeons use minimally invasive techniques to treat a range of foot and ankle conditions, including bunions, hammertoes, ankle instability, fractures, arthritis, flat feet, cartilage injury, plantar fasciitis, Achilles tendon tears and tendinitis. The foot has 33 joints, 26 bones and more than 100 muscles, tendons and ligaments that work together to allow people to bear weight. The ankle is the joint that connects the foot to the lower leg.

“Minimally invasive techniques help orthopedic surgeons to visualize and repair the damage, which leads to less scarring, pain and anesthesia, along with a quicker recovery. Patients like it because they heal faster,” said Dr. Peden. Ballet stresses feet and ankles in many ways, sometimes causing foot pain and injury. Ballerinas who dance en pointe are more vulnerable because their feet are completely extended to support all their body weight as they move. “Ballerinas spend lots of time moving up and down on their tiptoes, which puts the ankle into an abnormal position. This constant movement pinches the space in the back of the ankle joint,” said Dr. Peden.

In addition to the enlarged muscle and tendon, Maggard had an extra bone in the back of her ankle. “Most people never know they have this extra ankle bone until a problem occurs,” said Dr. Peden. “Dancers can develop pain, swelling and scar tissue around the extra bone.”

As with many foot and ankle conditions, Dr. Peden recommends patients try nonsurgical options at first, including rest, anti-inflammatory medications, a walking boot or a cast for total immobilization. “If these don’t work, then patients must determine how much they want to keep dancing because this condition can affect their ability to perform at a high level,” he said.

In Maggard’s case, Dr. Peden performed a posterior ankle arthroscopic procedure making two miniscule incisions (1 - 2 centimeters) in the back of the ankle to visualize the area, move the tendons and nerves out of the way, and remove the extra bone and scar tissue. He also used stem cells drawn from the patient’s pelvis and injected into the surgical site to enhance the healing process. “The surgery provides immediate gratification because we decompress the area,” he said. “Patients can get back to using their ankle. The goal is to restore function and quality of life.” As for Maggard, the surgery restored her quality of life by preserving her ability to dance en pointe without pain. A professional dance career may or may not be part of her future, but one thing is certain: “All I know is that I want to keep dancing,” she said. 

Sean Peden, MD, a Yale Medicine orthopedic surgeon, at Greenwich Hospital’s Long Ridge Medical Center, 260 Long Ridge Road, Stamford, where he sees patients with a variety of foot and ankle conditions.