Ballet move by young girls may cause arthritis

November 30, 1999

Young ballet dancers and their parents should be aware that, along with the accolades of a professional career, often come painful and arthritic ankles, especially for dancers who go "on pointe".

A study using magnetic resonance imaging (MRI) to view the ankles of 11 female dancers with the National Ballet of Canada determined that each of them had findings of arthritis in the joints of the ankles. Research on the topic will be presented at the 85th scientific assembly and annual meeting of the Radiological Society of North America (RSNA).

"Dancers all end up with very painful ankles," said David C. Salonen, assistant professor of medical imaging at the University of Toronto and division head of musculoskeletal imaging at Toronto Western Hospital. "This is nothing new to ballet dancers, who are used to performing with pain much of the time. But perhaps the problems might be prevented, or at least alleviated, if girls waited until they were older to go on pointe, and if professional ballerinas rested more between performances."

"The ankle is one of the most injured joints," he said, noting that the same constellation of problems seen in dancers' ankles are also detected in the ankles of sprinters and mid- and long-distance runners.

Two years ago at the beginning of the fall ballet season, researchers performed MRI on both ankles of 11 female ballet dancers. All were asymptomatic, meaning none of them complained of pain or problems. All of the ankles were stable and had full range of motion. But upon analyzing the MRI examinations in the 22 ankles, osteoarthritis -- caused by stress on a joint -- was detected in 10 tibiotalar, 19 talonavicular and 7 subtalar joints.

"Ankle problems are one of the leading contributory factors in ending a dancer's career," said Dr. Salonen. "A third to half of the season, these dancers live in chronic ankle pain."

As early as age 11 or 12, some girls go on pointe, meaning they dance on the tips of their toes with special shoes. Perhaps girls shouldn't go on pointe so early, Dr. Salonen said.

It also might help if professional ballet dancers rested longer between performances, "analogous to pitcher rotation in baseball," said Dr. Salonen. "It might lengthen their careers or slow the progression of disease."

"The ankle is probably one of the most intricate and best engineered joints of the body," said Dr. Salonen. "It can support the body and transmit the forces necessary for walking and running -- it's pretty impressive."

Co-authors of the paper are Rose Lee, MD; Edna J. Becker, MD; Anthony T. Mascia MD; and Darryl Ogilvie-Harris, MB.
The RSNA is an association of 31,000 radiologists and physicists in medicine dedicated to education and research in the science of radiology. The society's headquarters are located at 820 Jorie Blvd, Oak Brook, Illinois 60523-2251.

**Copies of 1999 RSNA news releases are available online at beginning Monday Nov. 29.

(Nov. 29 to Dec. 3)
Bob Szafranski or Pam Rwankole

After Dec. 3, contact:
Steven de Sousa
U of T Public Affairs

University of Toronto

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