Foot and Ankle MRI Findings in Asymptomatic Professional Ballet Dancers

Mai Katakura; Richard Clark; Justin C Lee; Adam W M Mitchell; Joseph W Shaw; Anika I Tsuchida; Mary Jones; Shane Kelly; James D F Calder

doi:10.1177/23259671241263593

Foot and Ankle MRI Findings in Asymptomatic Professional Ballet Dancers

Orthop J Sports Med. 2024 Aug 13;12(8):23259671241263593. doi: 10.1177/23259671241263593. eCollection 2024 Aug.

Authors

Mai Katakura^{1

2

3}, Richard Clark^{4

5}, Justin C Lee^{2

6}, Adam W M Mitchell², Joseph W Shaw⁵, Anika I Tsuchida^{2

7}, Mary Jones², Shane Kelly⁵, James D F Calder^{2

3}

Affiliations

¹ Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
² Fortius Clinic FIFA Medical Centre of Excellence, London, UK.
³ Department of Bioengineering, Imperial College London, London, UK.
⁴ Tottenham Hotspur Football Club, London, UK.
⁵ Ballet Healthcare, Royal Opera House, London, UK.
⁶ Division of Surgery & Interventional Science, University College London, London, UK.
⁷ Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, the Netherlands.

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.