Dance Injuries of the Foot and Ankle: Difference between revisions
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==== Anterior Impingement Syndrome ==== | ==== Anterior Impingement Syndrome ==== | ||
* Aggravated by repetitive forced dorsiflexion | * Aggravated by repetitive forced dorsiflexion | ||
* Symptoms are generally progressive in nature | * Symptoms are generally progressive in nature | ||
* Treatment | * Treatment | ||
| Line 71: | Line 71: | ||
** Often responsive to conservative treatment. | ** Often responsive to conservative treatment. | ||
** Surgery is effective if condition has progressed far enough<ref name=":4">Khurana A, Singh I, Singh MS. [https://jassm.org/is-anterior-and-posterior-ankle-impingement-under-diagnosed-a-review/ Is anterior and posterior ankle impingement under-diagnosed? A review]. Journal of Arthroscopic Surgery and Sports Medicine. 2021 Jan 10;2(1):58-65.</ref> | ** Surgery is effective if condition has progressed far enough<ref name=":4">Khurana A, Singh I, Singh MS. [https://jassm.org/is-anterior-and-posterior-ankle-impingement-under-diagnosed-a-review/ Is anterior and posterior ankle impingement under-diagnosed? A review]. Journal of Arthroscopic Surgery and Sports Medicine. 2021 Jan 10;2(1):58-65.</ref> | ||
* Ballet specific considerations | * '''Ballet specific considerations''' | ||
** Dance movements contributing are the plie, forcing turnout and rolling ankles | ** Dance movements contributing are the plie, forcing turnout and rolling ankles | ||
** Compensation is seen with a dancer lifting up heel earlier in a plie | ** Compensation is seen with a dancer lifting up heel earlier in a plie | ||
| Line 81: | Line 81: | ||
** The prevalence of this injury in dancers is due to releves, jumps, turns, and pointe work | ** The prevalence of this injury in dancers is due to releves, jumps, turns, and pointe work | ||
** Can be caused by tying ribbons incorrectly across achilles tendon or from hard floors. | ** Can be caused by tying ribbons incorrectly across achilles tendon or from hard floors. | ||
** A contributing factor is often changing of a choreographer, especially when they advocate for | ** A contributing factor is often changing of a choreographer, especially when they advocate for an intense jumping routine | ||
==== Posterior Ankle Impingement Syndrome ==== | ==== Posterior Ankle Impingement Syndrome ==== | ||
* Often referred to as Dancers heel | * Often referred to as Dancers heel, can be bony or soft tissue | ||
* Aggravated by forced plantarflexion and often coincides with | * Aggravated by forced plantarflexion and often coincides with Flexus Hallucis Longus [[tendinopathy]] | ||
* Symptoms are | * Symptoms are | ||
** | ** Pain and tenderness over the posterolateral aspect of the ankle | ||
** Pain with: | |||
*** Active plantar-flexion. | |||
*** Axial loading | |||
*** Great toe dorsiflexion | |||
* Treatment | * Treatment | ||
** Educate the dancer on | ** Educate the dancer on | ||
** | ** Late stage degeneration can be operated on<ref name=":4" /><ref>Grigoryev K. ''[https://www.proquest.com/openview/13aa37c86679bb28ab06a1a1d8ee37f0/1?pq-origsite=gscholar&cbl=18750&diss=y Comparison of Open and Endoscopic Surgical Procedures as a Treatment of Posterior Ankle Impingement Syndrome in Ballet Dancers: A Meta-Analysis]'' (Doctoral dissertation, California State University, Fresno).</ref> | ||
* '''Ballet specific considerations''' | |||
* Ballet specific considerations | ** '''Biomechanics check''': Plie, grand plie, releve | ||
** | ** '''Stretch''': Hamstrings, adductors, tibialis anterior, gastroc and soleus | ||
** | ** '''Strengthen''': Glutes, hamstrings, adductors, abductors | ||
** | ** '''Specific rehabilitation:''' Mobility crawls, isometric single leg heel raise, eccentric single leg heel lowering | ||
** | |||
* | * | ||
PAIS in Ballet<ref name=":3">Rietveld AB. [https://scholarlypublications.universiteitleiden.nl/access/item%3A2947375/view Performing arts medicine with a focus on Relevé in Dancers]. Leiden University; 2017 Nov 28.</ref> | '''PAIS in Ballet<ref name=":3">Rietveld AB. [https://scholarlypublications.universiteitleiden.nl/access/item%3A2947375/view Performing arts medicine with a focus on Relevé in Dancers]. Leiden University; 2017 Nov 28.</ref>''' | ||
* In some sports - required periodically and suddenly in a passive manner (by external force, e.g., soccer during certain forms of kicking) or briefly in an active manner (e.g., gymnastics and other artistic sports), | * '''In some sports - required periodically and suddenly in a passive manner (by external force, e.g., soccer during certain forms of kicking) or briefly in an active manner (e.g., gymnastics and other artistic sports),''' | ||
* In Ballet - required in a controlled, persistent, extreme, active, and fully weightbearing manner. | * '''In Ballet - required in a controlled, persistent, extreme, active, and fully weightbearing manner.''' | ||
* When kicking a ball, the talo-crural and subtalar joints are non-weightbearing; hence, there is no tendency for the talus (talo-crurally) and calcaneus (subtalarly) to slide posteriorly and add to the impingement. Second, when kicking, the calcaneus is not pulled up by the triceps surae. That this is important is biomechanically logical and is illustrated by the fact that in PAIS testing (plantar flexion test) the pain will mainly be provoked if the calcaneus is pressed up simultaneous | * '''When kicking a ball, the talo-crural and subtalar joints are non-weightbearing; hence, there is no tendency for the talus (talo-crurally) and calcaneus (subtalarly) to slide posteriorly and add to the impingement. Second, when kicking, the calcaneus is not pulled up by the triceps surae. That this is important is biomechanically logical and is illustrated by the fact that in PAIS testing (plantar flexion test) the pain will mainly be provoked if the calcaneus is pressed up simultaneous''' | ||
== Lateral Ankle Injuries == | == Lateral Ankle Injuries == | ||
* Lateral ankle sprains<ref name=":6">Bodini BD, Lucenteforte G, Serafin P, Barone L, Vitale JA, Serafin A, Sansone V, Negrini F. [https://www.mdpi.com/2076-3417/10/1/155 Do grade II ankle sprains have chronic effects on the functional ability of ballet dancers performing single-leg flat-foot stance? An observational cross-sectional study.] Applied Sciences. 2020 Jan;10(1):155.</ref> | * Lateral ankle sprains<ref name=":6">Bodini BD, Lucenteforte G, Serafin P, Barone L, Vitale JA, Serafin A, Sansone V, Negrini F. [https://www.mdpi.com/2076-3417/10/1/155 Do grade II ankle sprains have chronic effects on the functional ability of ballet dancers performing single-leg flat-foot stance? An observational cross-sectional study.] Applied Sciences. 2020 Jan;10(1):155.</ref> | ||
* Cuboid subluxation | * Cuboid subluxation | ||
** Rotational strain to bone following other issues | ** Rotational strain to bone following other issues | ||
* Sinus tarsi | * Sinus tarsi | ||
| Line 117: | Line 120: | ||
* Aggravated by weak [[Triceps Surae]] (Gastrocs and Soleus) and Posterior Tibialis strength | * Aggravated by weak [[Triceps Surae]] (Gastrocs and Soleus) and Posterior Tibialis strength | ||
* Symptoms are | * Symptoms are pain, swelling and instability | ||
* Treatment | * Treatment | ||
** | ** Ice, strapping, electrotherapy modalities, muscle strengthening | ||
* Ballet specific considerations | * '''Ballet specific considerations''' | ||
** Dancer relies on feedback and stability from lateral | ** Dancer regularly relies on feedback and stability from lateral ligament <ref name=":6" /> | ||
** | ** '''Biomechanics check''': First position pile, releve, passe, alignment in demipointe or pointe<ref name=":5" /> | ||
** | ** '''Stretch''': Hamstrings, quadriceps, adductors, iliopsoas, gastroc and soleus | ||
** Strengthen | ** '''Strengthen''': Glutes, dorsiflexors, everters | ||
** | ** '''Specific rehabilitation:''' aggressive strengthening and proprioception, side plank tbd clamshell, SLB tap front around to back, resisted PF with eversion | ||
== Toe Injuries == | == Toe Injuries == | ||
* Hallux Valgus | * Hallux Valgus<ref name=":9">Mira NO, Marulanda AF, Peña AC, Torres DC, Orrego JC. [https://www.ingentaconnect.com/content/jmrp/jdms/2019/00000023/00000004/art00003 Study of ballet dancers during cou-de-pied derrière with demi-plié to piqué arabesque]. Journal of Dance Medicine & Science. 2019 Dec 15;23(4):150-8.</ref> | ||
* Hallux | * Hallux Rigidus<ref name=":9" /> | ||
* Bunions | * Bunions<ref name=":9" /> | ||
** Strengthening intrinsic foot muscles | ** Strengthening intrinsic foot muscles | ||
** Correct alignment and toe spacers | ** Correct alignment and toe spacers | ||
* Sesmoiditis | * Sesmoiditis<ref name=":9" /> | ||
* Metatarsalgia | * Metatarsalgia<ref name=":9" /> | ||
* 5th metatarsal fracture/ Dancers fracture/ | * 5th metatarsal fracture/ Dancers fracture/ Lisfrank fracture | ||
* Hammer toe | * Hammer toe | ||
* Blisters | * Blisters | ||
* Ingrown toe nails | * Ingrown toe nails | ||
==== Hallux | ==== Hallux Rigidus ==== | ||
* Associated with the | * Associated with the Flexor Hallucis Longus<ref name=":10">Ogilvie-Harris DJ, Carr MM, Fleming PJ. [https://journals.sagepub.com/doi/abs/10.1177/107110079501600307 The foot in ballet dancers: the importance of second toe length]. Foot & ankle international. 1995 Mar;16(3):144-7.</ref><ref>Wentzell M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173219/ Conservative management of a chronic recurrent flexor hallucis longus stenosing tenosynovitis in a pre-professional ballet dancer: a case report.] The Journal of the Canadian Chiropractic Association. 2018 Aug;62(2):111.</ref> which is the primary dynamic stabiliser of the medial ankle in pointe and demi pointe positions | ||
* Aggravated by | * Aggravated by longer second toe with respect to first toe<ref name=":10" /> or excessive interphalangeal joint flexion compensation, also referred to as knuckling under | ||
* Symptoms are | * Symptoms are a stiff and painful joint<ref>Anderson MR, Ho BS, Baumhauer JF. [https://journals.sagepub.com/doi/full/10.1177/2473011418764461 Current concepts review: hallux rigidus. Foot & Ankle Orthopaedics.] 2018 Jun 7;3(2):2473011418764461.</ref> | ||
* Treatment | * Treatment | ||
** | ** Late stage treatment is a surgical debridement<ref>Carpenter B, Gentile M, Hagenbucher JR. [https://internationalfootankle.org/journal/index.php/JIFAF/article/view/1 Functional hallux rigidus in high level athletes: Arthroscopic repair by flexor hallucis longus debridement.] Journal of the International Foot & Ankle Foundation. 2022;1(1).</ref> | ||
* Ballet specific considerations | * Ballet specific considerations | ||
** Biomechanics check | ** '''Biomechanics check: F'''irst position and passe | ||
** | ** '''Stretch:''' Iliopsoas, quads, adductors, calves | ||
** Strengthen | ** '''Strengthen: G'''lutes, hamstrings, adductors, abductors | ||
** | ** '''Specific rehabilitation:''' Toe/ankle rocker with a toe spacer, big toe flexion and extension, isometric theraband toe abduction, flexion with theraband, toe abduction, toe separation | ||
==== Sesmoiditis ==== | ==== Sesmoiditis ==== | ||
Sessemoid bones are embedded within the [[Flexor Hallucis Brevis]] tendon and articulate with the plantar surface of the first metatarsal head. It helps to stabilise first metatarsal phalangeal joint and improve power of the FHB tendon | |||
* Aggravated by technical errors, such as rolling in, pronation and forcing turnout, and sollapsed arches which more pressure on sesmoids. Also aggravated by taking off and landing jumps especially without plie, rolling into Releve/demi pointe (more stressful than en pointe), walking with toe out gait/ in turn out | |||
* | |||
* Symptoms are | * Symptoms are | ||
** | ** Pain under first metatarsal head on plantar forefoot, tenderness should move distally with dorsiflexion of great toe | ||
* Treatment | * Treatment | ||
** Educate the dancer on | ** Educate the dancer on the use of stiff soled shoes outside class, which offer more support. encourage padding to off-load area, | ||
** Always assess and correct alignment, | |||
** Unfortunately the condition takes months to resolve | |||
* Ballet specific considerations | * Ballet specific considerations | ||
** stretch - hams, glutes, adductors, roll calves | ** stretch - hams, glutes, adductors, roll calves | ||
Revision as of 16:37, 13 March 2022
Original Editor - Carin Hunter based on the course by Michelle Green-Smerdon
Top Contributors - Carin Hunter, Jess Bell, Kim Jackson, Olajumoke Ogunleye and Nupur Smit Shah
Top Contributors - Carin Hunter, Jess Bell, Kim Jackson, Olajumoke Ogunleye and Nupur Smit Shah
Introduction[edit | edit source]
85% of dancers will have some form of musculoskeletal injury during career and approximately 50% occur in the ankle or foot. Even injuries higher up in the chain will have an effect on the lower limb. The foot is essential to a dancer as it it their base of support and the fundamental lever to propel in dynamic manoeuvres. It is an important shock absorber and offers the ballet dancer one of their essential forms of artistic expression.
The incidence of injuries in dancers varies from 40% to 84%. These being mostly caused by low cardiovascular conditioning, articular hyper mobility, postural deviation, alteration in the body’s center of balance[1]
“realized with amateur dancers, it shows that for each 1000 hours of training, the injuries incidence diagnosed was from 0.62 to 5.6 injuries per dancers. Bearing in mind that the technical demand for a professional dancers is even higher, it is considered that this number increases drastically into the professional contest”[1]
Acute vs Overuse Injuries[edit | edit source]
- Acute
- Often attributed to poor technique and incorrect execution of jumps and landing
- Dancer usually has an incident to report
- Many other contributing factors such as tiredness, fatigue or loss of balance
- Overuse
- Excessive use
- Repeated microtrauma
Risk Factors[edit | edit source]
- Previous injuries
- Poor rehabilitation
- Anatomical posture
- Poor training resulting in poor muscular strength[2]
- Poor lumbopelvic control[3]
- Technical mistakes[2]
- Execution speed[2]
- Choreographer
- Dance style
- Shoe fit and style
- Floor type[1][4]
Additional Contributing Factors[edit | edit source]
- Transitioning from part time to professional dancer[5]
- The foot can affect the knee, hip, core musculature and spine
- Lack of turnout
- Biomechanical requirements of pointe and demipointe which require full plantarflexion with 90 degrees metatarsal phalangeal joint extension [3]
- Floor type[1][4]
- The dancers body and their management
- Psychology and expectations of dancers
- Decreased triceps surae (Gastrocs and Soleus) and Posterior Tibialis strength[6]
- Decreased plantar flexion active range of motion [6]
Muscle weakness often results in:
- Rolling in and out of the ankles (Increased ankle inversion/eversion)
- Decreased stability en pointe
- Decreased plantar flexion range of motion
Anterior Ankle Injuries[edit | edit source]
- Anterior bone spurs
- Often found in mature or retired dancers
- Tibial stress syndrome[7]
- Tibial stress fracture
- Anterior ligament and tendon pathology
- Commonly in the Extensor Hallucus Longus tendon from trying to improve point, injuries surrounding ligaments and long-term instability
- Anterior capsule synovitis
- Anterior impingement
Anterior Impingement Syndrome[edit | edit source]
- Aggravated by repetitive forced dorsiflexion
- Symptoms are generally progressive in nature
- Treatment
- Educate the dancer on correct stretching, focus on strengthening intrinsic and extrinsic musculature
- Address biomechanical faults and look higher up for compensations or weakness
- Mulligan Mobilisation with movement, Passive Accessory Movement, Chair Ankle Rocker
- Often responsive to conservative treatment.
- Surgery is effective if condition has progressed far enough[8]
- Ballet specific considerations
- Dance movements contributing are the plie, forcing turnout and rolling ankles
- Compensation is seen with a dancer lifting up heel earlier in a plie
Posterior Ankle Injuries[edit | edit source]
- Posterior Ankle Impingement Syndrome
- Achilles tendinopathy[9]
- The prevalence of this injury in dancers is due to releves, jumps, turns, and pointe work
- Can be caused by tying ribbons incorrectly across achilles tendon or from hard floors.
- A contributing factor is often changing of a choreographer, especially when they advocate for an intense jumping routine
Posterior Ankle Impingement Syndrome[edit | edit source]
- Often referred to as Dancers heel, can be bony or soft tissue
- Aggravated by forced plantarflexion and often coincides with Flexus Hallucis Longus tendinopathy
- Symptoms are
- Pain and tenderness over the posterolateral aspect of the ankle
- Pain with:
- Active plantar-flexion.
- Axial loading
- Great toe dorsiflexion
- Treatment
- Ballet specific considerations
- Biomechanics check: Plie, grand plie, releve
- Stretch: Hamstrings, adductors, tibialis anterior, gastroc and soleus
- Strengthen: Glutes, hamstrings, adductors, abductors
- Specific rehabilitation: Mobility crawls, isometric single leg heel raise, eccentric single leg heel lowering
PAIS in Ballet[7]
- In some sports - required periodically and suddenly in a passive manner (by external force, e.g., soccer during certain forms of kicking) or briefly in an active manner (e.g., gymnastics and other artistic sports),
- In Ballet - required in a controlled, persistent, extreme, active, and fully weightbearing manner.
- When kicking a ball, the talo-crural and subtalar joints are non-weightbearing; hence, there is no tendency for the talus (talo-crurally) and calcaneus (subtalarly) to slide posteriorly and add to the impingement. Second, when kicking, the calcaneus is not pulled up by the triceps surae. That this is important is biomechanically logical and is illustrated by the fact that in PAIS testing (plantar flexion test) the pain will mainly be provoked if the calcaneus is pressed up simultaneous
Lateral Ankle Injuries[edit | edit source]
- Lateral ankle sprains[11]
- Cuboid subluxation
- Rotational strain to bone following other issues
- Sinus tarsi
- Peroneal tendon overuse and retinaculum stress
Lateral Ankle Sprain[edit | edit source]
- Aggravated by weak Triceps Surae (Gastrocs and Soleus) and Posterior Tibialis strength
- Symptoms are pain, swelling and instability
- Treatment
- Ice, strapping, electrotherapy modalities, muscle strengthening
- Ballet specific considerations
- Dancer regularly relies on feedback and stability from lateral ligament [11]
- Biomechanics check: First position pile, releve, passe, alignment in demipointe or pointe[9]
- Stretch: Hamstrings, quadriceps, adductors, iliopsoas, gastroc and soleus
- Strengthen: Glutes, dorsiflexors, everters
- Specific rehabilitation: aggressive strengthening and proprioception, side plank tbd clamshell, SLB tap front around to back, resisted PF with eversion
Toe Injuries[edit | edit source]
- Hallux Valgus[12]
- Hallux Rigidus[12]
- Bunions[12]
- Strengthening intrinsic foot muscles
- Correct alignment and toe spacers
- Sesmoiditis[12]
- Metatarsalgia[12]
- 5th metatarsal fracture/ Dancers fracture/ Lisfrank fracture
- Hammer toe
- Blisters
- Ingrown toe nails
Hallux Rigidus[edit | edit source]
- Associated with the Flexor Hallucis Longus[13][14] which is the primary dynamic stabiliser of the medial ankle in pointe and demi pointe positions
- Aggravated by longer second toe with respect to first toe[13] or excessive interphalangeal joint flexion compensation, also referred to as knuckling under
- Symptoms are a stiff and painful joint[15]
- Treatment
- Late stage treatment is a surgical debridement[16]
- Ballet specific considerations
- Biomechanics check: First position and passe
- Stretch: Iliopsoas, quads, adductors, calves
- Strengthen: Glutes, hamstrings, adductors, abductors
- Specific rehabilitation: Toe/ankle rocker with a toe spacer, big toe flexion and extension, isometric theraband toe abduction, flexion with theraband, toe abduction, toe separation
Sesmoiditis[edit | edit source]
Sessemoid bones are embedded within the Flexor Hallucis Brevis tendon and articulate with the plantar surface of the first metatarsal head. It helps to stabilise first metatarsal phalangeal joint and improve power of the FHB tendon
- Aggravated by technical errors, such as rolling in, pronation and forcing turnout, and sollapsed arches which more pressure on sesmoids. Also aggravated by taking off and landing jumps especially without plie, rolling into Releve/demi pointe (more stressful than en pointe), walking with toe out gait/ in turn out
- Symptoms are
- Pain under first metatarsal head on plantar forefoot, tenderness should move distally with dorsiflexion of great toe
- Treatment
- Educate the dancer on the use of stiff soled shoes outside class, which offer more support. encourage padding to off-load area,
- Always assess and correct alignment,
- Unfortunately the condition takes months to resolve
- Ballet specific considerations
- stretch - hams, glutes, adductors, roll calves
- Strengthen - glutes, hams, adductors, iliopsoas, intrinsic foot muscles
- rehab- tbd clamshells, foam roll ball squeeze leg lowering, prone hamstring curl to hip extension
5th Metatarsal Fracture[edit | edit source]
- Often referred to as a Dancers Fracture
- Aggravated by
- Symptoms are twisting injury, differentiate to jones fracture (occurs further down the base, repetitive stress = surgery
- Treatment
- non –operative
- Educate the dancer on
- Ballet specific considerations
- stretch -hams, glutes, iliopsoas, adductors, roll calves
- Strengthen - glutes, hams, adductors, iliopsoas
- rehab-side plank hip adduction, foam roll quadruped donkey kicks, quadruped car wheel
Plantar Fasciitis[edit | edit source]
- Aggravated by This injury is often associated with repetitive jumping which is why it has such a high prevalence in dancers[9].
- Symptoms
- Heel pain with first steps in the morning
- Heel pain after long periods of non-weight bearing
- Tenderness to the anterior medial heel
- Limited dorsiflexion and tight achilles tendon
- A limp may be present or may have a preference to toe walking
- Pain is usually worse when barefoot on hard surfaces and with stair climbing
- Treatment: Conservative measures are the first choice
- Physiotherapy
- Rest from offending activity
- Ice after activity
- Deep friction massage of the arch and insertion.
- Shoe inserts or orthotics and night splints
- Extracorporeal shock-wave therapy[17] , botulinum toxin A, autologous platelet-rich plasma, dex prolotherapy, or steroid injections.
- Advanced and invasive techniques should be combined with conservative therapy
- Surgery should be the last option if this process has become chronic and other less invasive therapies have failed
- Educate the dancer on proper stretching and rehab of the: Plantar fascia; Achilles' tendon; Gastrocnemius and Soleus.
- Ballet specific considerations
- biomechanics check - plie, developpe, gait
- stretch -iliopsoas, quads, adductors, calves
- Strengthen -glutes, abductors, deep rotators
- rehab- chair SL bridges, SL heel raises on stairs, ankle/toe rockers, strapping
For more specific physio treatment options please see Plantar Fasciitis page
Foot and Ankle Care[edit | edit source]
- POINTEWORK SHOULD BE PROGRESSED SLOWLY AND ONLY COMMENCED ONCE READY/SCREENED
- FOOT ALIGNMENT SHOULD BE MONITORED THROUGHOUT THE JUMPING SECTION WITH NO UNDUE PRONATION OF THE FOREFOOT
- SIMPLE BALANCE EXERCISES SHOULD BE INCLUDED
- INTRINSIC FOOT EXERCISES
- CALF EXERCISES AND STRETCHED
- WALK WITH NORMAL ANGLE OF GAIT TO OFFLOAD HIP ROTATORS, ie, not in turned out position
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Cardoso AA, Reis NM, Marinho AP, Vieira MD, Boing L, Guimarães AC. Injuries in professional dancers: a systematic review. Revista Brasileira de Medicina do Esporte. 2017 Nov;23:504-9.
- ↑ 2.0 2.1 2.2 Skwiot M, Śliwiński Z, Żurawski A, Śliwiński G. Effectiveness of physiotherapy interventions for injury in ballet dancers: A systematic review. PLoS one. 2021 Jun 24;16(6):e0253437.
- ↑ 3.0 3.1 Biernacki JL, Stracciolini A, Fraser J, Micheli LJ, Sugimoto D. Risk factors for lower-extremity injuries in female ballet dancers: a systematic review. Clinical journal of sport medicine. 2021 Mar 1;31(2):e64-79.
- ↑ 4.0 4.1 Campbell RS, Lehr ME, Livingston A, McCurdy M, Ware JK. Intrinsic modifiable risk factors in ballet dancers: Applying evidence based practice principles to enhance clinical applications. Physical Therapy in Sport. 2019 Jul 1;38:106-14.
- ↑ Fuller M, Moyle GM, Hunt AP, Minett GM. Ballet and contemporary dance injuries when transitioning to full-time training or professional level dance: a systematic review. Journal of Dance Medicine & Science. 2019 Sep 1;23(3):112-25.
- ↑ 6.0 6.1 En Pointe: What Ballet Dancers Should Know About Injury Prevention
- ↑ 7.0 7.1 Rietveld AB. Performing arts medicine with a focus on Relevé in Dancers. Leiden University; 2017 Nov 28.
- ↑ 8.0 8.1 Khurana A, Singh I, Singh MS. Is anterior and posterior ankle impingement under-diagnosed? A review. Journal of Arthroscopic Surgery and Sports Medicine. 2021 Jan 10;2(1):58-65.
- ↑ 9.0 9.1 9.2 Batenhorst EZ. A Dancer’s View: Analysis and Prevention of Common Dance Injuries. 2020
- ↑ Grigoryev K. Comparison of Open and Endoscopic Surgical Procedures as a Treatment of Posterior Ankle Impingement Syndrome in Ballet Dancers: A Meta-Analysis (Doctoral dissertation, California State University, Fresno).
- ↑ 11.0 11.1 Bodini BD, Lucenteforte G, Serafin P, Barone L, Vitale JA, Serafin A, Sansone V, Negrini F. Do grade II ankle sprains have chronic effects on the functional ability of ballet dancers performing single-leg flat-foot stance? An observational cross-sectional study. Applied Sciences. 2020 Jan;10(1):155.
- ↑ 12.0 12.1 12.2 12.3 12.4 Mira NO, Marulanda AF, Peña AC, Torres DC, Orrego JC. Study of ballet dancers during cou-de-pied derrière with demi-plié to piqué arabesque. Journal of Dance Medicine & Science. 2019 Dec 15;23(4):150-8.
- ↑ 13.0 13.1 Ogilvie-Harris DJ, Carr MM, Fleming PJ. The foot in ballet dancers: the importance of second toe length. Foot & ankle international. 1995 Mar;16(3):144-7.
- ↑ Wentzell M. Conservative management of a chronic recurrent flexor hallucis longus stenosing tenosynovitis in a pre-professional ballet dancer: a case report. The Journal of the Canadian Chiropractic Association. 2018 Aug;62(2):111.
- ↑ Anderson MR, Ho BS, Baumhauer JF. Current concepts review: hallux rigidus. Foot & Ankle Orthopaedics. 2018 Jun 7;3(2):2473011418764461.
- ↑ Carpenter B, Gentile M, Hagenbucher JR. Functional hallux rigidus in high level athletes: Arthroscopic repair by flexor hallucis longus debridement. Journal of the International Foot & Ankle Foundation. 2022;1(1).
- ↑ Rhim HC, Kwon J, Park J, Borg-Stein J, Tenforde AS. A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis. Life. 2021 Dec;11(12):1287.
