Anterior Ankle Impingement in Dancers: A Pathoanatomical Review

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

INTRODUCTION: The purpose of this study is to evaluate the medical literature pertaining to anterior ankle impingement and highlight the pathoanatomical aspects of the various etiologies of anterior impingement which may affect dancers. Dancers are highly skilled aesthetic athletes who suffer a number of recalcitrant injuries because of their unique abilities and demanding training regimens; therefore, understanding this clinical entity is crucial to providing them with excellent care.

METHOD AND RESULTS: Articles from the anatomy, orthopaedic, and radiology literature since 1943 were reviewed and potential sources of anterior impingement signs and symptoms were identified therein. Several sources of impingement pathology were discovered, including the anterior inferior tibiofibular ligament, tibial and talar osteophytes, anterior soft tissue inflammation, and anterior soft tissue hypertrophy following a common lateral ankle sprain.

DISCUSSION: The repetitive ankle dorsiflexion required in dance, especially in demi-plié, may lead to chronic anterior impingement symptoms. Given the requirement for dancers to routinely force their ankles into maximum dorsiflexion, the incidence of any of the differential diagnoses could present great difficulty for the dancer. Healthcare professionals must become familiar with the extraordinary demands of dance in order to effectively care for injured dancers because 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 potential sources of anterior ankle impingement. When considering the different possible causes, this category of pathology may be more prevalent than previously thought. 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.