Posterior Ankle Pain in Dancers
A significant number of dancers will suffer from posterior ankle pain throughout their career. Symptoms may persist resulting in loss of working hours, overmedication, decreased performance and a total reduction of dance years. A number of distinct pathologies and terms have been described including posterior ankle impingement, os trigonum syndrome, stenosing tenosynovitis of the flexor halluces longus tendon, a low riding muscle belly of one of the flexor tendons, stress fractures of the posterior talar process, Haglund deformity of the calcaneous, retrocalcaneal bursitis, insertional Achilles tendinitis and mid-substance Achilles tendinopathy. Among these there is often significant overlap which may complicate the treatment and delay the return to full dancing activities. The advent of advanced imaging modalities has led to a better understanding of the different pathologies which cause posterior ankle pain and guide a multidisciplinary treatment plan. Current treatment options cover a wide spectrum, including individualized physiotherapy, ultrasound guided therapeutic injections, mesotherapy, posterior ankle arthroscopy, tenoscopy of the ankle tendons and open surgery. This presentation will review the most common disorders which cause posterior ankle pain in dancers in the absence of acute trauma. It is structured as a step by step approach to the different pathologies and overuse syndromes with a focus to diagnostic screening tests for the dance teacher.