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

Abstract

The ankle plays an essential role in establishing lower extremity stability that is important for such physically demanding sports as ballet. Non-physiological movements in the joint that force the ankle into extreme positions and repetitive stress during intense practice and performances predispose to the development of pathological conditions. Radiological studies are an integral part of diagnostic algorithm for the search of the causes of pain. The aim was to conduct a literature review on diagnostic imaging of ankle pathology in ballet dancers. Methods Literature searching was performed via databases of PubMed, Cochrane library, eLibrary.ru, etc. using the following terms: ankle pathology in ballet dancers, bballet ankle imaging, ballet ankle. Conclusions Standard radiographs are usually the initial screening modality to evaluate patients, including ballet dancers with lower extremity symptoms, nonetheless, MRI provides a superb global evaluation of each joint, including deep structures and detecting possible causes of pain.

In Pursuit of the Perfect Dancer’s Ballet Foot. The Footprint, Stabilometric, Pedobarographic Parameters of Professional Ballet Dancers

“…With time, pes cavus loses its flexibility, becomes hard and stiff, and its ability to transmit loads falls dramatically [ 3 ]. The lack of flexibility reduces shock-absorbing properties in the foot, potentially leading to sprained ankles, overloads and instep fractures [ 1 ]. For this reason, during the recruitment to ballet schools, it is of utmost importance to be able to distinguish the high arch (desirable in terms of dance), restricted within the Clark angle range of 48 degree to 55 degree from pes cavus > 55 degree [ 3 ].…”

“…The phenomenon of the perfect foot results directly from the fact that the classical dance requires very high efficiency of the ankle. The dancer’s foot must perform the maximum dorsal flexion and the maximum plantar flexion, above the maximum ranges in the ankle in relation to the population mean, which ranges between 20° dorsiflexion and 50° plantarflexion [ 1 , 2 ]. The feet of professional ballet dancers may reach a mean ankle-foot plantarflexion of 113° [ 1 ].…”

“…Related investigations indicate that injuries affecting these structures constitute between 4.7% and 54% of all injuries suffered by ballet dancers [ 4 , 7 , 8 , 9 ]. The most common injuries are ligament abnormalities, impingement syndromes, tendon abnormalities and stress injuries [ 1 ].…”

“…Most injuries of the ankle are connected with performing “pointé” and “demi pointé” [ 1 , 2 ]. Apart from “turnout”, these two are the most characteristic technical elements of the classical dance [ 10 , 11 ].…”

“…An excessively arched foot (pes calvus) will lose its flexibility over time; it becomes hard and stiff, and its load-bearing capacity drops drastically [ 3 ]. Pes calvus is characterized by a significantly reduced contact surface with the ground and this may cause excessive accumulation of loads in this structure and susceptibility to injuries [ 1 ]. However, feet with transverse flatfoot, which is defined by the WI index, will exacerbate this defect in the everyday technical tasks of classical ballet [ 1 , 2 ].…”