Pathoanatomy and Pathomechanics of Posterior Impingement of the Ankle in Dancers

Russell, Jeff MS, ATC, University of Wolverhampton, Walsall, United Kingdom

INTRODUCTION: Dancers are highly skilled aesthetic athletes who suffer a number of recalcitrant injuries because of their unique abilities and demanding training regimens. Dancers place their ankles into a greater amount of plantar flexion?when en demi-pointe and en pointe?than participants in any other activity, and this may lead to posterior impingement syndromes that significantly compromise their ability to dance.  The purpose of this presentation is to examine the posterior impingement of the ankle in dancers and focus on the anatomical and biomechanical aspects of its multitude of etiologies. 

METHOD AND RESULTS: Articles from the anatomy, orthopaedic, and radiology literature since 1882 were reviewed in order to identify potential sources of posterior impingement signs and symptoms. A wide variety of contributors to impingement pathology were discovered, including os trigonum, extended lateral talar tubercle, posterior intermalleolar ligament, posteromedial talar ossicle, os post peronei, superior calcaneal tuberosity, downward sloping posterior malleolus, and posterior soft tissue inflammation. These can be categorized generally into bony or soft tissue sources of impingement.

DISCUSSION: Given the nature of ankle motion in dance, the incidence of any of the differential diagnoses could present great difficulty for the dancer. These are among the most complicated conditions to manage in dancers because the mechanism of this class of injury involves repetitive movements that are fundamental to dance performance. Often healthcare professionals? relative unfamiliarity with the extraordinary demands of ballet and other types of dance results in inadequate care for dancers. But, dancers who suffer an impingement syndrome cannot perform at full capacity unless the pathology is accurately identified and treated. 

CONCLUSIONS AND CLINICAL RELEVANCE: This paper broadens the understanding of dancers, dance educators, dance scientists, and dance medicine clinicians about the wide variety of potential sources of posterior ankle impingement. The condition may greatly limit dance performance if it is not recognized or is left untreated. This paper also highlights the need for practitioners interested in dance medicine to obtain specialized knowledge in managing injuries that are primarily seen in dancers and which can be rather problematic.