Treating Foot And Ankle Injuries In Ballet Dancers

Start Page: 76

Detecting Posterior Pain Syndromes Of The Ankle In Dancers

FHL Tendinitis
• Posteromedial pain
• Tenderness over the FHL tendon
• Pain with motion of hallux
• Mistaken for posterior tibial tendinitis

Os Trigonum Syndrome
• Posterolateral pain
• Tenderness behind the fibula
• Pain with forced plantarflexion of the ankle (the plantarflexion sign)
• Mistaken for peroneal tendinitis

80
Author(s): 
By Mark A. Caselli, DPM

A Guide To Anterior Ankle Impingement And Os Trigonum Syndromes
The extreme dorsiflexion required by the demiplié position in ballet can lead to impingement of the anterior lip of the tibia on the talar neck. Anterior ankle impingement results from osteophytes occurring on the anterior tibia and talar neck.
The dancer’s first recognition of the syndrome is lack of depth in the plié, which is often associated with poorly localized ankle pain. With time, the dancer may experience more localized symptoms to the anterior aspect of the ankle. These symptoms often include mild swelling. You can attain symptomatic improvement by encouraging the use of a 1/4-inch to 3/8-inch heel lift in street shoes, antiinflammatories and having the dancer discontinue forced plié.
Definitive treatment consists of excising the offending osteophytes, either arthroscopically or through an anterior arthrotomy. Keep in mind that you’ll often see secondary inflammatory changes involving the capsule, the fat pad and local synovium. An exostectomy merely extends the dancer’s career. Repeated impingement will invariably lead to recurrent exostoses, usually within three to four years. Repeat excision may therefore be required in some cases.
While it is rare in the general population, posterior impingement of the os trigonum is common in dancers. In extreme plantarflexion, an os trigonum, a large posterior tubercle or less commonly, a large dorsal process of the os calcis, is compressed intermittently for periods of up to six hours a day from the dancer standing in the demi-pointe position. The dancer with symptomatic posterior impingement presents with posterior ankle pain aggravated by relevé and relieved somewhat by plantar grade stance.
The differential diagnosis includes Achilles, peroneal and flexor hallucis tendinitis. However, for these conditions, the symptoms are rarely aggravated by plantarflexion. You can reproduce the pain of posterior impingement via forced plantarflexion. When it comes to treatment, you should emphasize a flexibility program, with attention to stretching, and an antiinflammatory medication. If symptoms become disabling, surgical excision of the bony mass is indicated.

Top Treatment Tips For Tendinitis
Although tendinitis can be an acute condition, the frequency of recurrence and the nature of dance tend to make chronic tendinitis a common occurrence in dancers.

image description image description


Post new comment

  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

More information about formatting options

Image CAPTCHA
Enter the characters shown in the image.