4 Common Ankle Injuries in Dancers

In any sport or activity that puts demands on the body, injuries can occur, and dance is no different. Some of the most common injuries seen in physical therapy clinics in regards to dancers, are injuries related to the foot and ankle. The following information serves to help educate dancers on some of the more common ankle injuries, along with techniques that could be applied to help minimize the risk of these injuries. It is important to note that only a licensed medical professional can diagnose an ankle injury.

1. Ankle Sprains

The most common type of ankle injury in all athletics, including dance, is an inversion ankle sprain. This occurs when the ankle rolls over the lateral (outside) border of the foot resulting in over stretching or tearing to the ligaments.¹ There are various grades of ankle sprains which can result in mild to severe impairments. Ankle sprains most commonly occur en pointe or in demi pointe if movement result in a rolling of the ankle.¹ Ankle sprains have also been found to occur with poor jumping and landing mechanics.¹ If you believe you have an ankle sprain, and pain has not resolved in one week’s time, it is important to seek treatment from a medical provider.

2. Tendinopathies

Tendinopathy is described as irritation to a tendon with or without inflammation being present. Tendinopathies can occur to any tendon and typically result from overuse and improper loading leading to a breakdown in mechanics.¹ In dancers, these pathologies typically occur when there is poor technique, improper jump/landing mechanics, increase in training, and overloading the tendon.¹ Most commonly this occurs at the Flexor hallucis longus and Achilles’ tendons.¹ Flexor hallucis longus is a muscle on the medial (inside) of the ankle that can help control the great toe. Tendinopathy of this muscle occurs almost exclusively in dancers and can be recognized when the dancer experiences an exacerbation of symptoms en-pointe position, jumping, plié in fifth position, tendu, or relevé with pain on the medial (inside) portion of the ankle.² Achilles’ tendinopathies can occur most commonly in dancers who force their turnout/pilé or who land jumps with poor mechanics with pain occurring at or just above the heel.¹

3. Ankle Impingement

Impingement is when there is compression of the soft tissues (muscles, tendons, ligaments, capsules). This can be due to movement issues, mechanical faults with jumping, bone issues (excessive bone growth), or inflammation.² This can occur at both the anterior (front) and posterior (back) of the ankle. Typically, with impingement, dancers will experience a painful pinching with active motion, passive motion, or with touch to the ankle.¹

4. Fractures

Fractures can occur at any time and can be the result of a trauma or overuse. Fractures from trauma can be the result of a fall when dancing. This will likely result in instant pain and loss of motion. Stress fractures occur as a result of bone remodeling being impaired when loading is increased too rapidly, weakening the bone and leaving it at risk for fracture.¹ This most often occurs with over training, hard floors, nutritional deficits, hormonal deficits, and menstrual irregularities (in women).¹ Pain with stress fractures typically occurs at night, with specific activities, or immediately following activity.¹

Injury Prevention Techniques

There are a lot of ways ankle injuries may be prevented!

• Focus on mechanics and technique
  If you do not know how to perform a skill, or you do not know if you are performing a skill correctly, ask for help. Teachers, coaches, and instructors are often trained in the mechanics of the skill you are working on and can help correct your movement patterns. If there isn’t a teacher/instructor around, make sure you are watching yourself in a mirror. If something doesn’t look right, it probably isn’t. Using external cues like mirrors are a great way to learn technique and self-correct mechanics.
• Do not force turn out
  A good turnout will come with time, practice, and good mechanics. Forcing a position your body is not ready for will only set you up for injuries.
• Land your jumps correctly
  The most common cause of injury to the ankle across all diagnoses is from bad jumping mechanics. You should be landing the jump first with the ball of your foot and then rolling through the rest of your foot to make sure forces move through the body correctly. Your knee should never be locked out in an extended or straight position when landing a jump.
• Ensure your foot and ankle are strong
  This includes working on the strength of the intrinsic (within the foot) and extrinsic (outside of the foot) muscles. These muscles can be addressed by foot doming/arch lifts, towel scrunches, and ankle band exercises into dorsiflexion, plantarflexion, inversion, and eversion. Work all these muscles in a turned out and in a neutral position to minimize the risk of overuse. A dancer’s body is not meant to be in turn out 24/7.
• Cross training is important!
  This means you need to work the body in different ways when not in dance. Swimming, cycling, and gentle weightlifting can be great ways to minimize the risk of overuse and ensure your body stays strong. The stronger the body is in a variety of activities, the better it is able to adapt to new stresses.
• Don’t push through pain
  Pain is our body’s way of telling us something is wrong. Relative rest and moving through pain-free motions will help with a lot of foot and ankle injuries. It never feels good to have to sit out, however it is sometimes necessary to allow your body to recover.

If you experience an injury or your pain lasts longer than a week, seek advice from a medical professional. Athletico Physical Therapy offers free assessments both in-clinic and virtually through our Telehealth platform with clinicians that specialize in treating dancers. Being seen by a dance-specific clinician can reduce the time away from dancing and quickly assist the dancer with their recovery needs.

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The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. Kadel, N. (2019). Foot and ankle injuries in dancers. Performing Arts Medicine, 63-76.
doi:10.1016/b978-0-323-58182-0.00008-0
2. Vosseller, J. T., Dennis, E. R., & Bronner, S. (2019). Ankle injuries in dancers. Journal of the American Academy of Orthopaedic Surgeons, 27(16), 582-589. doi:10.5435/jaaos-d-18-00596