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. 2024 Aug 13;12(8):23259671241263593.
doi: 10.1177/23259671241263593. eCollection 2024 Aug.

Foot and Ankle MRI Findings in Asymptomatic Professional Ballet Dancers

Mai Katakura  1   2   3 , Richard Clark  4   5 , Justin C Lee  2   6 , Adam W M Mitchell  2 , Joseph W Shaw  5 , Anika I Tsuchida  2   7 , Mary Jones  2 , Shane Kelly  5 , James D F Calder  2   3
Affiliations

Foot and Ankle MRI Findings in Asymptomatic Professional Ballet Dancers

Mai Katakura et al. Orthop J Sports Med. .

Abstract

Background: Previous research in sport populations has demonstrated that abnormal magnetic resonance imaging (MRI) findings may be present in individuals without symptoms or known pathology. Extending this understanding to ballet, particularly in relation to the foot and ankle, is important to guide medical advice given to dancers.

Purpose: To assess foot and ankle MRI scans in asymptomatic ballet dancers focusing on bone marrow edema and the posterior ankle and to investigate whether these MRI findings would become symptomatic within 1 year.

Study design: Case series; Level of evidence, 4.

Methods: In total, 31 healthy dancers (62 feet/ankles; 15 male and 16 female; age, 26.5 ± 4.3 years) who were dancing in full capacity were recruited from an elite professional ballet company. Orthogonal 3-plane short tau inversion recovery imaging of both feet and ankles was obtained using 3T MRI and the images were reviewed using a standardized evaluation form by 2 musculoskeletal radiologists. Injuries in the company were recorded and positive MRI findings were assessed for correlation with any injuries requiring medical attention during the subsequent 12 months.

Results: A total of 51 (82%) of the 62 feet and ankles had ≥1 area of bone marrow edema. The most common locations of bone marrow edema were the talus (n = 41; 66%), followed by first metatarsal (n = 14; 23%). Os trigonum and Stieda process were seen in 5 (8%) and 8 (13%) ankles, respectively. Among them, 2 os trigona showed bone marrow edema. Fluid in the anterior and posterior talocrural joints and the subtalar joint was observed in 48%, 63%, and 63% of these joints, respectively. Fluid around foot and ankle tendons was observed, with the most prevalent being the flexor hallucis longus tendon (n = 13; 21%). Two dancers who had positive findings on their MRI subsequently developed symptoms during the next 12 months.

Conclusion: Positive MRI findings are commonplace in the foot and ankle of asymptomatic professional ballet dancers. The majority do not result in the development of symptoms requiring medical attention within 12 months. Careful interpretation of MRI findings with the dancer's clinical picture is required before recommending activity modification or further intervention.

Keywords: ankle; ballet; bone marrow edema; dance; foot; imaging; magnetic resonance; posterior ankle impingement syndrome; sports medicine.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by Mrs Carol Brigstocke and the Royal Opera House. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Examples of bone marrow edema (arrowheads). (A) Talar body, (B) first metatarsal head, (C) first metatarsal base, (D, E) second metatarsal base, and (F) fourth metatarsal base.
Figure 2.
Figure 2.
(A) Os trigonum with high signal intensity (white arrowhead) and synovitis (yellow arrowheads). (B) Stieda process (arrow). *, talus.
Figure 3.
Figure 3.
(A) Joint fluid around tibiotalar joint and subtalar joint (arrowheads). (B) Fluid around flexor hallucis longus tendon (arrow). *, talus.
Figure 4.
Figure 4.
(A) Bone marrow edema at the distal anterior tibia (arrowhead). (B) Stieda process (arrow). *, talus.
See this image and copyright information in PMC

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