Lower Extremity Injury Patterns in Elite Ballet Dancers: Ultrasound/MRI Imaging Features and an Institutional Overview of Therapeutic Ultrasound Guided Percutaneous Interventions
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Altered biomechanics from repetitive microtrauma, such as long practice hours in en pointe (tip of the toes) or demi pointe (balls of the feet) predispose ballet dancers to a multitude of musculoskeletal pathologies particularly in the lower extremities. Both ultrasound and magnetic resonance imaging (MRI) are radiation-sparing modalities which can be used to confidently evaluate these injuries, with ultrasound (US) offering the added utility of therapeutic intervention at the same time in experienced hands.
The purposes of this paper were: (1) to illustrate the US and MRI features of lower extremity injury patterns in ballet dancers, focusing on pathologies commonly encountered at a single orthopedic hospital; (2) to present complementary roles of both ultrasound and MRI in the evaluation of these injuries whenever possible; (3) to review and present our institutional approach towards therapeutic ultrasound-guided interventions by presenting explicit cases.
Online searches were performed using the search criteria of “ballet biomechanics” and “ballet injuries.” The results were then further narrowed down by limiting articles published in the past 15 years, modality (US and MRI), anatomical region (foot and ankle, hip and knee) and to major radiology, orthopedics, and sports medicine journals.
Performing ballet poses major stress to lower extremities and predisposes dancer to several musculoskeletal injuries. These can be adequately evaluated by both US and MRI. US is useful for evaluating superficial structures such as soft tissues, tendons, and ligaments, particularly in the foot and ankle. MRI provides superior resolution of deeper structures such as joints, bone marrow, and cartilage. In addition, US can be used as a therapeutic tool for providing quick symptomatic improvement in these athletes for who “time is money”.
Performing ballet may cause major stress to the lower extremities, predominantly affecting the foot and ankle, followed by the knee and hip. US and MRI play complementary roles in evaluating various orthopedic conditions in ballet dancers, with US allowing for dynamic evaluation and guidance for interventions.
Keywordsballet ultrasound MRI foot and ankle hip tendon ligament osseous labrum corticosteroid and PRP
Conflict of Interest
Razia Rehmani, MD, Yoshimi Endo, MD, Phillip Bauman, MD, William Hamilton, MD, Hollis Potter, MD and Ronald Adler, MD, PhD have declared that they have no conflict of interest.
This article does not contain any studies with human or animal subjects performed by the any of the authors.
- 5.Alfredson H, Ohberg L, Forsgren S. Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc. 2003; 11: 334-8.PubMedCrossRefGoogle Scholar
- 11.Blitch LE, Chaney M, Dinucci AK, et al. Diagnosis and Treatment of Forefoot Disorders. Section 3. Morton’s Intermetatarsal Neuroma. J of Foot Ankle Surg. 2009; 48(2): 1067-2516.Google Scholar
- 26.Fredberg U, Bolvig L, Pfeiffer-Jensen M, et al. Ultrasonography as a tool for diagnosis, guidance of local steroid injection and, together with pressure algometry, monitoring of the treatment of athletes with chronic jumper’s knee and Achilles tendinitis: a randomized, double-blind, placebo controlled study. Scand J Rheumatol. 2004; 33: 94-101.PubMedCrossRefGoogle Scholar
- 31.Gross CE, Hsu AR, Chahal J, et al. Injectable Treatments for Noninsertional Achilles Tendinosis: A systematic Review. Foot Ankle Int. 2013; 32: 619.Google Scholar
- 33.Hamilton WG. Foot and ankle injuries in dancers. Clin Sports Med. 1998; 7(1): 143-173.Google Scholar
- 41.Hurtwitz S, Philip EL. Image guided anesthetic injection into the painful foot or ankle as a guide to orthopedic treatment. App Radiology 2000; 29 (8).Google Scholar
- 47.Kennedy J, Hodgkins C, Colombier J, et al. Foot and Ankle Injuries n Dancers. Int Sport Med J. 2007; 8(3): 141-165.Google Scholar
- 55.Luchs JS, Sofka CM, Adler RS. Contrast effect of combined steroid and anesthetic injections: In vitro analysis. Ultrasound Med. 2007; 26(2): 227-31.Google Scholar
- 63.McLauchlan G, Handoll HHG. Interventions for treating acute and chronic Achilles tendinitis. Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group. Published Online: 21 Jan 2009 Assessed as up-to-date: 29 Dec 2000.Google Scholar
- 71.Nepple JJ, Zebala LP, Clohisy JC. Labral disease associated with cam-type femoroacetabular impingement. Radiology. 2005; 236(20): 588-92.Google Scholar
- 79.Rees D. Jonathan, Stride Mathew, Scott Alex. Tendons-time to revisit inflammation. Br. J Sports Med. 2013; 0: 1-7.Google Scholar
- 80.Robinson P, White LM. Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management. Radio-Graphics. 2002; 22(6): 1457-1469.Google Scholar
- 87.Sofka C, Adler R, Danon M. Sonography of the Acetabular Labrum. J Ultrasound. 2006; 25(10): 1321-1326.Google Scholar
- 103.Timothy WC, William SH, Darren JL. Medial Collateral Ligament “Tibial” Injuries: Indication for Acute Repair. Sports Med Update. 2004; 27(4): 389-393.Google Scholar
- 104.Wilson J, Lee K, Wang S .Platelet Rich Plasma for the Treatment of Chronic Plantar Fasciopathy in Adults A Case Series. Foot Ankle Spec Nov 2013.Google Scholar
- 106.Jin W, Kim KI, Rhyu KH, et al. Sonographic Evaluation of Anterosuperior Hip Labral Tears With Magnetic Resonance Arthrographic And Surgical Correlation. JUM. 2012; 31(3): 439-447.Google Scholar