Foot and Ankle Problems in Dancers

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Key points

  • The dancer’s foot and ankle are subjected to high forces and unusual stresses in training and performance.

  • To keep dancers healthy, the health care team and the dancer must work together.

  • The physician must be an advocate for the dancer and work to provide an accurate diagnosis and an effective treatment strategy.

  • Monitoring performance and rehearsal load, fitness, and general health of the dancer will help to maximize the dancer’s healing potential.

  • Creativity is needed to modify treatment plans

Ankle sprains

Ankle inversion injury is the most common traumatic injury in dance as it is in athletics.1, 3, 4, 5 Many authors report ankle sprains as the most frequent acute injury. The mechanism of injury is typically an inversion injury (rolling over the lateral border of the foot), often while en pointe or demi-pointe, or in a missed landing from a jump. The lateral ligaments are most frequently injured, with the anterior talofibular ligament (ATFL) the most commonly injured ligament. The ATFL is

Achilles

Chronic Achilles tendinopathy, retrocalcaneal bursitis, and acute tendinitis may be seen in male and female dancers. Comin and colleagues17 evaluated Achilles and patellar tendons in 79 professional ballet dancers and found a 12% prevalence of sonographic abnormalities in the Achilles and patellar tendons of asymptomatic dancers. Dancers who force their turnout, leading to increased pronation in the midfoot and hindfoot, are at risk for Achilles tendon problems. Failure of the dancer to land

Sever disease

Sever disease (calcaneal apophysitis) is a common cause of posterior and or plantar heel pain in young dancers with open growth plates. There is a high incidence in Irish dancers, but it can also be seen in any child or adolescent dancer who complains of heel pain.5 The dancer may complain of morning pain or pain with jumping, heel strike, and percussive movements. Radiographs usually are negative but may show relative widening of growth plate. On physical examination, the dancer will be tender

Plantar fascial strain

The plantar aponeurosis is a strong band of fascia extending from the base of the heel to the base of the toes. The plantar fascia may be strained, partially torn, or simply inflamed (plantar fasciitis). Occasionally there is an acute injury, most often insidious in onset after increased training intensity. Walls and colleagues21 reported on MRI findings of the right ankles in 18 professional Irish dancers; insertional Achilles tendonopathy was observed in 14 dancers, and plantar fasciitis was

Posterior Ankle Impingement

Posterior ankle impingement is a painful condition due to compression of the soft tissues between the posterior edge of the tibia and the calcaneus when the ankle is in plantar flexion. Bony impingement may be associated with an accessory bone of the ankle, called an os trigonum, or a prominent posterior lateral process of the talus called Steida process (Fig. 3).23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34 Some authors have reported concurrent flexor hallucis longus (FHL) tenosynovitis

Fifth Metatarsal Fractures

Fractures of the fifth metatarsal can be seen in all forms of dance.

Missed landings from jumps and rolling over the outer border of the foot while on demi-pointe are 2 common mechanisms seen in dancers who sustain fifth metatarsal fractures. Lateral foot pain, tenderness, swelling, and ecchymosis are the usual presentation of dancers with these fractures. Physical examination will reveal tenderness over the metatarsal, but radiographs are needed for accurate diagnosis. Treatment for fracture of

Midfoot injuries: Lisfranc sprain/fracture

Injuries to the midfoot in dancers are not common, but the physician treating dancers should have a high index of suspicion, because if this injury is not recognized or treated, it can be career ending. The ligaments of the tarso–metatarsal joints are required to support the medial and longitudinal arches of the foot. These injuries can be easily missed, as radiographic findings may be subtle, and the midfoot pain may be mistaken for possible stress fracture or synovitis. Usually these injuries

Hallux valgus

Although hallux valgus deformity is seen in dancers, conflicting data exist whether dancers have a higher incidence of bunions than the general population.19, 59, 60, 61, 62 Dancers with flexible pes planus and those who force their turnout may exacerbate an existing bunion, but dancing en pointe alone does not cause bunion deformities. Young dancers who have hallux valgus often have congenital metatarsus primus varus.

Bunions in dancers should be managed conservatively. Surgery is reserved only

Hallux rigidus

Hallux rigidus is an arthritic condition of the MTP joint. Dancers require 80° to 100° of dorsiflexion when performing relevé onto demi-pointe; therefore, loss of motion in this joint can be disabling. The stiffness in the joint causes the dancer to roll onto the lateral metatarsals in improper alignment (sickling) when rising to demi-pointe.

Dancers with this condition report stiffness and pain of the first MTP joint, and an inability to achieve full demi-pointe position. Dorsal fullness and a

Summary

The dancer’s foot and ankle is subjected to high forces and unusual stresses in training and performance. Most professional dancers employed for more than 1 year will have an injury, and the likelihood of that injury being in the foot or ankle is high.5, 8 To keep dancers healthy, the health care team and the dancer must work together. The physician must be an advocate for the dancer and work to provide an accurate diagnosis and an effective treatment strategy.

Monitoring performance and

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