Pointe Ballet dancers and posterior ankle pain
A common complaint in ballet dancers, particularly those in ‘pointe’ shoes, is posterior ankle pain (around the Achilles/back of ankle area). When any of us picture a ballet dancer, right up on their toes, it is not hard to visualise how much compression may occur in the posterior ankle. Combined with hours and hours of practice and performance, again it is not hard to see how overload and excessive compression of the structures in the posterior ankle can easily occur. This is known as Posterior impingement syndrome and the structures affected can vary from soft issue to actual bony impingement.
Soft tissues- including the joint capsule, synovium, Kagers fat pad, tendons and ligaments, are most often the source of the pain, inflammation and impingement. When bony impingement is diagnosed through X-ray, there is sometimes an ‘os trigonum’ (oval shaped ossicle) that is presumed to be the cause. However, Susan Mayes, the principal physiotherapist for the Australian Ballet, reports that even when the ossicle is present, more often she finds the soft tissues between these bony prominences are the cause, and surgical removal doesn’t always result in resolution of symptoms for this reason. Susan Mayes, through her years with the ballet has found that posterior impingement “can be managed conservatively with early and appropriate intervention”.
So what should you do if you suspect that yourself, or someone you know may be suffering from Posterior ankle impingement? Correct and specific diagnosis is absolutely vital. With so many structures in the small region referred to as the ‘posterior ankle’, without correct diagnosis management can be ineffective. At Kinetic Sports Physiotherapy, we pride ourselves on accurate diagnosis and provision of world class treatment.