Lower Extremity Injury Patterns in Elite Ballet Dancers: Ultrasound/MRI Imaging Features and an Institutional Overview of Therapeutic Ultrasound Guided Percutaneous Interventions

HSS Journal Article

Razia Rehmani, MD
Hospital for Special Surgery, New York, NY

Phillip Bauman, MD
Orthopedic Associates of New York, NY

William Hamilton, MD
Orthopedic Associates of New York, NY

R. Adler, MD, PhD
Hospital for Joint Diseases, New York University, New York, NY

Yoshimi Endo, MD
Yoshimi Endo, MD
Assistant Attending Radiologist, Hospital for Special Surgery
Assistant Attending Radiologist, New York Presbyterian Hospital
Assistant Professor of Radiology, Weill Cornell Medical College
Hollis G. Potter, MD
Hollis G. Potter, MD

Chairman, Division of Magnetic Resonance Imaging
Attending Radiologist, Hospital for Special Surgery
Professor of Radiology, Weill College of Medicine of Cornell University


Altered biomechanics from repetitive microtrauma, such as long practice hours in en pointe (tip of the toes) or demi pointe (balls of the feet) predispose ballet dancers to a multitude of musculoskeletal pathologies particularly in the lower extremities. Both ultrasound and magnetic resonance imaging (MRI) are radiation-sparing modalities which can be used to confidently evaluate these injuries, with ultrasound (US) offering the added utility of therapeutic intervention at the same time in experienced hands.

The purposes of this paper were: (1) to illustrate the US and MRI features of lower extremity injury patterns in ballet dancers, focusing on pathologies commonly encountered at a single orthopedic hospital; (2) to present complementary roles of both ultrasound and MRI in the evaluation of these injuries whenever possible; (3) to review and present our institutional approach towards therapeutic ultrasound-guided interventions by presenting explicit cases.

Online searches were performed using the search criteria of “ballet biomechanics” and “ballet injuries.” The results were then further narrowed down by limiting articles published in the past 15 years, modality (US and MRI), anatomical region (foot and ankle, hip and knee) and to major radiology, orthopedics, and sports medicine journals.

Performing ballet poses major stress to lower extremities and predisposes dancer to several musculoskeletal injuries. These can be adequately evaluated by both US and MRI. US is useful for evaluating superficial structures such as soft tissues, tendons, and ligaments, particularly in the foot and ankle. MRI provides superior resolution of deeper structures such as joints, bone marrow, and cartilage. In addition, US can be used as a therapeutic tool for providing quick symptomatic improvement in these athletes for who “time is money”.

Performing ballet may cause major stress to the lower extremities, predominantly affecting the foot and ankle, followed by the knee and hip. US and MRI play complementary roles in evaluating various orthopedic conditions in ballet dancers, with US allowing for dynamic evaluation and guidance for interventions.

This article appears in the HSS Journal: Volume 11, Issue 3.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


Back in the Game Patient Stories: