CUHK Dance Medicine 中大舞蹈醫學 • Nov 11, 2020
Foot and Ankle Injuries in Ballet, Contemporary and Chinese Dancers: Are they all the same? 不同舞蹈足踝傷患
Updated: Mar 24
Foot and ankle injuries are known to be the most injured body part in dancers, and they are more often to be chronic than acute. Ankle impingement or tendinitis (inflammation of tendons) and metatarsal stress fractures due to overuse are examples of chronic conditions, while ankle sprain remains the most common acute ankle injury. Persistent pain around the foot and ankle may be a red flag which prompts dancers to seek medical attention. However, can we predict which region of the foot and ankle will be the most prone to injury in different types of dancersis it possible to predict the site of injury based on the type of dance?
A recent research study has been performed to compare foot and ankle injuries among pre-professional Ballet, Contemporary and Chinese dancers in Hong Kong based on data of one academic year collected in the span of one academic year via online questionnaire. Based on the results, as high as 96% of dancers experienced foot and ankle pain since the start of their career, with prevalence in 2018-2019 being 89% in Ballet; 79% in Chinese dance and 70% in Contemporary respectively. Different types of dancers indeed presented with different injury patterns in the foot and ankle region.
Ballet
The Achilles tendon is the most injury-prone region in ballet dancers. Classical ballet dancers performing en pointe, demi point, or plie constantly exert force on their Achilles tendon, thus overusing it. Moreover, the dancers tie the shoe ribbons at the ankle, which will impair blood flow to the tendon. These factors increase the risk of attritional injuries.
It is stated that classical ballet dancers performing en pointe, demi point, or plie exert forces that, although normal in magnitude, are increased in frequency, thus overusing the Achilles tendon. The level where dancers tie their ribbons at the ankle is also shown to have impaired blood flow. This makes the Achilles tendon prone to attritional injuries.
Contemporary
The hindfoot/ankle region is most prone to injury in Contemporary dancers are more prone to hindfoot/ankle injury. This dance style particularly emphasizes on weightbearing on extreme ankle plantarflexion (e.g. toe rise). Such movement is shown to be associated with posterior ankle impingement.
Chinese dance
The midfoot is the most injury-prone region in Chinese dancers. Like gymnastics and acrobatics, landing from unsteady bases or heights (e.g. partners, props) are common in Chinese dance and these are shown to be associated with mid-foot injuries.
The above findings provided the framework in terms of developing genre-specific foot and ankle strengthening programmes in different dancers in the future.
More interestingly, although these foot and ankle injuries resulted in partial absence or suboptimal performances, only 1/3 of these dancers would go for formal medical consultation. “No pain no gain” seems to be the mindset of many dancers, but it is just as important to realize when to seek medical attention in a timely manner if these aches persist, such that we can avoid permanent damage and enjoy dance pain-free for as long as we can.
A recent research study has been performed to compare foot and ankle injuries among pre-professional Ballet, Contemporary and Chinese dancers in Hong Kong based on data of one academic year collected in the span of one academic year via online questionnaire. Based on the results, as high as 96% of dancers experienced foot and ankle pain since the start of their career, with prevalence in 2018-2019 being 89% in Ballet; 79% in Chinese dance and 70% in Contemporary respectively. Different types of dancers indeed presented with different injury patterns in the foot and ankle region.
Ballet
The Achilles tendon is the most injury-prone region in ballet dancers. Classical ballet dancers performing en pointe, demi point, or plie constantly exert force on their Achilles tendon, thus overusing it. Moreover, the dancers tie the shoe ribbons at the ankle, which will impair blood flow to the tendon. These factors increase the risk of attritional injuries.
It is stated that classical ballet dancers performing en pointe, demi point, or plie exert forces that, although normal in magnitude, are increased in frequency, thus overusing the Achilles tendon. The level where dancers tie their ribbons at the ankle is also shown to have impaired blood flow. This makes the Achilles tendon prone to attritional injuries.
Contemporary
The hindfoot/ankle region is most prone to injury in Contemporary dancers are more prone to hindfoot/ankle injury. This dance style particularly emphasizes on weightbearing on extreme ankle plantarflexion (e.g. toe rise). Such movement is shown to be associated with posterior ankle impingement.
Chinese dance
The midfoot is the most injury-prone region in Chinese dancers. Like gymnastics and acrobatics, landing from unsteady bases or heights (e.g. partners, props) are common in Chinese dance and these are shown to be associated with mid-foot injuries.
The above findings provided the framework in terms of developing genre-specific foot and ankle strengthening programmes in different dancers in the future.
More interestingly, although these foot and ankle injuries resulted in partial absence or suboptimal performances, only 1/3 of these dancers would go for formal medical consultation. “No pain no gain” seems to be the mindset of many dancers, but it is just as important to realize when to seek medical attention in a timely manner if these aches persist, such that we can avoid permanent damage and enjoy dance pain-free for as long as we can.
足踝傷患是最常見的舞蹈傷患, 而慢性勞損比急性創傷更為普遍。 長期傷患一般包括因過度重用同一組關節而引致的足踝筋腱發炎、壓力性骨折以及後踝夾擠症候群, 急性創傷則以踝部扭傷（拗柴）最為常見。 舞者往往因為持續足踝疼痛才去求醫診治。究竟我們可否推測在不同舞種的舞者中足踝哪個部位最常受傷？
近日有本地研究嘗試解答以上問題，並透過網上問卷訪問香港準專業舞者有關足踝傷患的情況。被訪舞者分別主修芭蕾舞，現代舞以及中國舞。研究結果顯示，高達 96% 的舞者有足踝疼痛的狀況。而過去一年此情況在芭蕾舞者中最常見（芭蕾舞 89%； 中國舞 79% ；現代舞 70%） 。當中並發現各舞種最常受傷的足踝部位確有不同。
芭蕾舞
小腿後側的阿基里斯筋腱是芭蕾舞者最常見的足踝傷患。過去研究顯示，由於芭蕾舞者需要長期並重覆地處於全足踮立和半足尖踮立的位置，加上穿著足尖鞋時絲帶需要捆綁在腳腕上，影響筋腱血液循環，兩者均容易令筋腱勞損。
現代舞
後掌及腳踝傷患在現代舞者中最為常見。現代舞比其他舞種運用腳背作身體支撑點的動作較多，令腳踝不正常受壓，容易導致後踝夾擠症候群。
中國舞
中國舞者比其他舞者較常有中掌的創傷。當中原因或許和中國舞有不少與體操類似的動作有關（例如從其他舞者身上或道具上高處翻身落地）。中掌等部位容易在落地時受創，並且在已經處於長期勞損的情況下引發壓力性骨折。
總括而言，以上結果反映各舞種最常受傷的足踝部位也有不同，有助日後研究專為各舞種而設的足踝強化訓練。
另外，今次研究發現雖然有不少舞者因以上傷患而影響表現甚至需要暫停部分排練，但仍然只有約三分一的受訪舞者會主動向骨科醫生求診。或許有不少舞者從小接收訓練時老師曾教到，舞蹈如人生般沒有不勞而獲，要有血汗淚水的付出、學會吃苦忍痛才會有進步。但我們也要明白懂得聆聽自己身體的重要性。倘若身體某部位在休息過後仍持續出現痛楚，這或許是身體給我們的警號。應該及早求診，以免造成永久性的傷患，並好好讓我們可以繼續享受跳舞的樂趣。
近日有本地研究嘗試解答以上問題，並透過網上問卷訪問香港準專業舞者有關足踝傷患的情況。被訪舞者分別主修芭蕾舞，現代舞以及中國舞。研究結果顯示，高達 96% 的舞者有足踝疼痛的狀況。而過去一年此情況在芭蕾舞者中最常見（芭蕾舞 89%； 中國舞 79% ；現代舞 70%） 。當中並發現各舞種最常受傷的足踝部位確有不同。
芭蕾舞
小腿後側的阿基里斯筋腱是芭蕾舞者最常見的足踝傷患。過去研究顯示，由於芭蕾舞者需要長期並重覆地處於全足踮立和半足尖踮立的位置，加上穿著足尖鞋時絲帶需要捆綁在腳腕上，影響筋腱血液循環，兩者均容易令筋腱勞損。
現代舞
後掌及腳踝傷患在現代舞者中最為常見。現代舞比其他舞種運用腳背作身體支撑點的動作較多，令腳踝不正常受壓，容易導致後踝夾擠症候群。
中國舞
中國舞者比其他舞者較常有中掌的創傷。當中原因或許和中國舞有不少與體操類似的動作有關（例如從其他舞者身上或道具上高處翻身落地）。中掌等部位容易在落地時受創，並且在已經處於長期勞損的情況下引發壓力性骨折。
總括而言，以上結果反映各舞種最常受傷的足踝部位也有不同，有助日後研究專為各舞種而設的足踝強化訓練。
另外，今次研究發現雖然有不少舞者因以上傷患而影響表現甚至需要暫停部分排練，但仍然只有約三分一的受訪舞者會主動向骨科醫生求診。或許有不少舞者從小接收訓練時老師曾教到，舞蹈如人生般沒有不勞而獲，要有血汗淚水的付出、學會吃苦忍痛才會有進步。但我們也要明白懂得聆聽自己身體的重要性。倘若身體某部位在休息過後仍持續出現痛楚，這或許是身體給我們的警號。應該及早求診，以免造成永久性的傷患，並好好讓我們可以繼續享受跳舞的樂趣。
Dept of Orthopaedics and Traumatology, Faculty of Medicine CUHK
