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Pain at the Back of Your Ankle when Dancing - Posterior Ankle Impingement Syndrome 

Dr. Raymond P. Lee - Orthopaedic Surgeon

Translation: Chloe Mo - Registered Physiotherapist (HK)

18 March 2020

Foot and ankle injuries are very commonly seen in professional dancing. Studies have shown that more than 50% of the injuries were involved in this region. It is not hard to imagine different types of dance would also put a lot of pressure on the foot and ankle. Among all dancers, the most studied one was ballet. The En Pointe (Figure 1) and Demi Relevé (Figure 2) require the ankle joint to point downwards at its maximum while dancing. This can cause a lot of discomfort and pain at the backside of the joint, hence the term “posterior ankle impingement syndrome” (PAIS).

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Figure 1: En pointe

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Figure 2: Demi releve

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Figure 3: MRI scan showing impingement at the back of ankle

Radiological studies of the ankle using MRI and CT scans allowed us to better visualize the impact during such foot and ankle maneuver. Findings include inflammation of the nearby ligaments and tendons, bony and soft tissue that is being impinged and various anatomical variations around the backside of the ankle joint which predisposes to such condition.

 

Clinical assessment by orthopedic surgeons and radiological assessment would allow us to make the diagnosis. Most of the patients can be treated with non-operative methods, such as anti-inflammatory medication, physiotherapy, and steroid injection. However, the operation would be needed if these measures failed to relieve the symptoms.

 

Recent advancements in surgical instrumentation and techniques allow us to use a minimally invasive approach if surgery is needed. We open up small holes (a few millimeters wide) at the back of the ankle and remove any soft tissue or bony structures that cause the impingement. We can correct the anatomy by removing excessive bony growth. Inflammed tendons can also be debrided to allow better gliding of the toes during dancing movements. The recovery is shorter and easier compared with the traditional open procedure. Up to 90% high patient satisfaction rate has been reported.

 

In order to prevent PAIS, proper training and supportive exercises are important. It is always useful to have stretching exercises before and after any dance practice or performance. Muscle power should be built up so that the joint is not under excessive loading. Early consultation of doctor or physiotherapist can often relieve early symptoms, and allow you to enjoy a longer dancing career.

跳舞時腳踝後方痛症 - 後踝夾擠症候群

作者:李必達醫生 - 骨科醫生

中文翻譯 : 巫柔潔 - 香港註冊身物理治療師

 

足部和腳踝受傷在專業舞蹈中很常見。研究顯示,該身體部位涉及超過50%的傷患。不難想像,不同類型的舞蹈也會給足部和腳踝施加很大壓力。在眾多舞蹈中,研究最多的是芭蕾舞。全足踮立 En Pointe(圖1)和半足尖踮立 Demi Relevé(圖2)時要求踝關節在跳舞時往下方指至最大幅度。這個動作會在關節後方引起許多不適和疼痛,因此稱為“後踝夾擠症候群”(PAIS)。

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Figure 1: En pointe

螢幕快照 2020-03-03 下午3.55.43.png

Figure 2: Demi releve

螢幕快照 2020-03-03 下午3.55.51.png

Figure 3: MRI scan showing impingement at the back of ankle

使用磁力共振和電腦掃描對腳踝進行影像研究,能讓我們能夠更清楚看見足部和腳踝活動過程中的影響。研究結果包括附近的韌帶和肌腱發炎,骨骼和軟組織也有被夾擠的現象,以及踝關節後側周圍出現的各種結構變化,以上的情況會容易導致後踝夾擠症候群。

 

骨科醫生的臨床評估以及放射學影像評估能助我們作出診斷。大多數患者可以採用非手術方法進行治療,例如消炎藥,物理治療和類固醇注射。但如果這些措施未能緩解症狀,則有機會需要進行手術。

 

現今新型發展的手術儀器和技術使我們在手術時可使用微創方法。我們只需在腳踝後部開一個小孔(幾毫米寬),並去除導致夾擠的軟組織或骨組織。我們透過移除增生骨刺來改善解剖結構,亦可以對發炎的肌腱進行清創,好讓腳趾在舞蹈時有更自如的活動。與傳統的開創手術相比,此恢復過程更短、更輕鬆,而患者滿意率更高達90%。

 

為了預防PAIS,適當的培訓和輔助鍛煉運動是不可或缺的。在每次舞蹈練習或表演之前和之後進行伸展運動能夠帶來正面作用。舞者更需要增強肌肉力量,以使關節不會承受過度負荷。儘早諮詢醫生或物理治療師意見,早期症狀一般都能夠緩解,使你享有更長的舞蹈生涯。

References:

1. JT Vosseller, ER Dennis, S Bronner. Ankle Injuries in Dancers. J Am Acad Orthop Surg 2019;27:582-589

2. KAL Peace, JC Hillier, A Hulme et al. MRI features of posterior ankle impingement syndrome in ballet dancers: a review of 25 cases. Clinical Radiology 2004;59:1025-1033

3. ABM Rietveld, FMT Hagemans, S Haitjema et al. Results of treatment of posterior ankle impingement syndrome and flexor halluces longus tendinopathy in dancers. A systemic review. J of Dance Medicine & Science 2018;22:19-32

4. F Morelli, D Mazza, P Serlorenzi et al. Endoscopic excision of symptomatic os trigonum in professional dancers. The Journal of Foot & Ankle Surgery 2017;56:22-25

5. H Funasaki, H Hayashi, K Sakamoto et al. Arthroscopic release of flexor halluces longus tendon sheath in female ballet dancers: dynamic pathology, surgical technique, and return to dancing performance. Arthrosc Tech. 2015 Nov 30;4(6):e769-74

Disclaimer Statement:

This article was accomplished by the author in his/her personal capacity. The opinions expressed in this article do not reflect the view of the official statement of CUHK and HKADMS. It is intended for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with an appropriate professional for specific advice related to your situation.

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