MRI features of foot and ankle injuries in ballet dancers

Abstract

Foot and ankle pain is common in ballet dancers. Although clinical examination often points to the underlying cause, imaging is often necessary to confirm the diagnosis and thus ensure appropriate future management. Factors predisposing to the increased incidence of injuries in this population include the classical position in which ballet dancers stand, which is on the tips of the toes in the en pointe position or on the balls of the feet in the demi-pointe position. Furthermore, the repetitious nature of ballet and the long hours spent rehearsing cause over-use injuries. The causes of foot and ankle pain can be thought of in four different groups: the impingement syndromes; tendon abnormalities; osseous pathology; and ligament abnormalities. These will be discussed and illustrated.

Sintomatologia dolorosa e fatores associados em bailarinos profissionais

“…Some authors (14)(15) still suggest that the increased number of dancers with pain and injuries in the lumbar region and lower extremities partly occurs due to the classic position of ballet, in which the lower limbs are in extreme external rotation; rest in the toes extremities at pointe position or at balancing with feet at half pointe. Besides that, ballet's natural repetitions; muscle-tendons imbalances, bad anatomic aligning of lower extremities; use of slippers; floor surface and long hours spent in rehearsals cause injuries due to repetitive exertion.…”

Impingement-Syndrom des oberen Sprunggelenks

“…Besonders häufig tritt dies bei Athleten, wie z. B. Fußballern ("soccer player's ankle"), Tänzern oder Läufern auf [10,11,12,13]. Als Resultat der wiederholten forcierten Dorsal-und Plantarflexion sowie durch die direkt reziproke Krafteinwirkung auf den vorderen Anteil des Sprunggelenks beim Aufprall des Fußballs während des Schusses leiden Fußballer typischerweise unter dem anterioren Impingement des OSG [14].…”

“…Bei Balletttänzern führt die forcierte Plantarflexion während der "En-pointe"-Position (Spitzentanz) zum posterioren Impingement des OSG, was durch Einklemmung z. B. von Osteophyten an der distalen Tibia und/oder hypertrophiertem Weichteilgewebe im posterioren Kompartiment des OSG entstehen kann [13].…”

“…Allerdings findet sich diese Pathologie auch bei anderen Sportlern wie Fußball-und Basketballspielern oder Langstreckenläufern. Bei Balletttänzern führt die wiederholte forcierte Plantarflexion in der "En-pointe" und der "Demi-pointe"-Position zur Kompression des Talus und der angrenzenden Weichteilstrukturen zwischen dem Hinterrand der Tibia und dem Kalkaneus, auch "Nussknackerphänomen" oder "dancer's heel" genannt [13]. Die vorgegebene Anatomie des hinteren OSG ist ein entscheidender Faktor für das Auftreten des posterioren Impingement.…”

Uso de sapatilha de ponta e ocorrência de sintomas musculoesqueléticos (SME) em bailarinas

“…Thus, toes, plantar arches and anterior border of the feet are compressed and built the main support and sustaining site to the ballerina, resulting in neuromuscular, physiological and bone stress. Therefore, Hiller et al 5 state that the sue of pointe shoes leads to the incidence of injuries, as well as repetitive training and long rehearsal hours are factors which interact and cause injuries by effort excess 6 . Concomitantly, ballet and modern dance practitioners present high incidence of injuries (67% to 95% and 17% to 24%, respectively), out of which, the lower extremity equals to 75% of the cases 1,7 .…”