Clinical Evaluation and Treatment of Posterior Impingement in Dancers

Abstract

Os trigonum impingement is a frequent cause of posterior ankle pain in ballet dancers because they need extreme plantar flexion during the execution of relevé in demipointe and en pointe positions. Clinical examination and standard and modified x-rays should be carried out to clearly identify the site and entity of the impingement. If a posterior impingement is clinically diagnosed, standard and modified magnetic resonance imaging should be also performed. From September 2005 to September 2006, we considered 186 young trainee ballet dancers. Twelve suffered from posterior ankle pain, and six of these had os trigona. We treated all the ballet dancers nonoperatively, and nine of them had good results. Conservative treatment failed in only three cases after 1-4 mos of physical and medical therapies, and, in these cases, good results were obtained through surgical excision of the accessory ossicle. Modified x-ray and magnetic resonance imaging help to determine the site and entity of the posterior impingement. If this is properly diagnosed, good results can be obtained through a nonoperative approach in a majority of cases.

Disorders of the Flexor Hallucis Longus and Os Trigonum

“…31 The most common location of tenosynovitis is within the fibrous-osseous tunnel posterior to the medial malleolus; however, it can occur along the master knot of Henry or beneath the intersesamoid ligament. [31][32][33] FHL tenosynovitis is typically ascribed to the female ballet dancers 22,34,35 ; however, it can be seen in patients with os trigonum syndrome; forceful plantarflexion activities such as soccer, downhill running, swimming, ice skating, and gymnastics; and flexor digitorum accessorius longus. [34][35][36][37][38][39][40] It is a part of the os trigonum or posterior ankle impingement syndrome.…”

“…29 The success rate is approximately 60% to 84% after 4 to 6 months of conservative treatment as reported in the literature. 26,32,58 The success rate of corticosteroid injection varies (range, 29%-100%). 26,58,59 Temporary pain relief can delay surgery in professional or collegiate athletes 69 and confirm diagnosis as a planning step for surgical excision.…”

Rehabilitation nach Arbeitsunfällen im professionellen Bühnentanz: Empfehlungen unter Berücksichtigung tanzmedizinischer Gesichtspunkte

“…Tab. 3 Beispiel einer stufenweisen Wiedereingliederung über einen Zeitraum von 6 Wochen (vereinfacht und modifi ziert nach [ 2 ] ).…”

Diagnostic imaging of pathologic changes in the ankle joint of ballet dancers (literature review)

“…V. Zwiers et al (2018) found a prevalence of 30.3 % of os trigonum in patients with no signs of posterior impingement syndrome [17]. W. Albisetti et al (2009) examined 186 young trainee ballet dancers. Twelve suffered from posterior ankle pain, and six of those (50 %) had radiologically detected os trigonum [18].…”

“…W. Albisetti et al (2009) examined 186 young trainee ballet dancers. Twelve suffered from posterior ankle pain, and six of those (50 %) had radiologically detected os trigonum [18].…”