The Relationship between Lateral Ankle Sprain and Ankle Tendinitis in Ballet Dancers

Abstract

The lateral ligament complex of the ankle is the most frequently injured structure in the body. Although most simple ankle sprains do not result in long-term disability, a significant number do not completely resolve, leading to residual symptoms that may persist for years. The most commonly reported symptoms, particularly among athletes, include instability, re-injury and tendinitis. Ballet dancers are a combination of artist and high-performance athlete; consequently, they are subjected to the same types of injuries as other athletes, including lateral ankle sprains and their sequelae. Furthermore, ballet dancers perform in unusual positions such as en pointe, which places the ankle in extreme plantar flexion, requiring stabilization by surrounding muscles. Dancers’ extraordinary performance demands place them at risk for other ankle injuries as well, including inflammation of several tendons, especially the peroneals. This report reviews the relevant literature to characterize the scope of lateral ankle sprains and sequelae, discuss the importance of the peroneal muscles in ankle stability, and explore a relationship between lateral ankle sprain and ankle tendinitis in ballet dancers. Informal interviews were conducted with physical therapists who specialize in treating ballet dancers, providing a clinical context for this report. An extensive review of the literature was conducted, including electronic databases, reference lists from papers, and relevant reference texts. Numerous studies have investigated ankle sprains and residual complaints; nearly all report that lateral ankle sprains commonly lead to chronic ankle instability. Studies exploring ankle stability have demonstrated that the peroneal muscles play a crucial role in ankle stabilization; EMC studies confirm they are the first to contract during ankle inversion stress. The dancers need for exceptional ankle stabilization may lead to peroneal overuse and tendinitis. Studies have linked peroneal pathology to a history of ankle sprain, but there is no dance medicine literature linking peroneal tendinitis to prior ankle sprains. A growing body of literature confirms myriad connections between lateral ankle sprains, residual instability, peroneal muscle increased activity, and tendinitis. It is our belief that ankle sprains lead to instability, particular en pointe, for which the peroneal muscles attempt to compensate. Their overuse for this static stabilizing function, as well as for dynamic dance movements, then leads to tendonitis. This knowledge may heighten awareness of the potential for developing tendonitis following ankle sprains, and lead to better rehabilitation of the injured ballet dancer.

Musculoskeletal injuries in young ballet dancers

“…For example, our finding that the majority of injuries were due to overuse is consistent with the results of previous research [6-8, 14, 15, 24]. In addition, several previous studies have shown, in accordance with the results of the present study, that the most common site of injury is the foot and ankle region [8,14,15,24,32,35]. In contrast, some previous studies based on self-report found the spine to be the most common site of injury in ballet dancers [4,6,31].…”

Biomechanical Risks Associated with Foot and Ankle Injuries in Ballet Dancers: A Systematic Review

“…In the continuous training and performance of dancers, repeatedly jumping and landing as well as the extreme plantarflexion or rotation is required. During these dance movements, the repeated shocks and pressure will impact the injured area, and the commonly reported symptoms in dancers include ankle re-injury and instability [44]. All of the articles reviewed mentioned that wearing a pointe shoe and overuse on their foot may accelerate rates of muscle fatigue and ankle sprains [25,45].…”

Peroneal tendinosis as a predisposing factor for the acute lateral ankle sprain in runners

“…To our knowledge, the incidence of peroneal tendinosis and its correlation with lateral ankle instability has only been investigated in ballet dancers [27]. Peroneal tendinosis as a predisposing factor for ankle sprain trauma in runners has not been addressed so far.…”