Association Between Single-Leg Heel Rise Performance and Lower Leg, Ankle, and Foot Injuries in Adolescent Ballet...

Area of Science:

• Sports Medicine
• Dance Science
• Biomechanics

Background:

• Lower leg, ankle, and foot injuries are prevalent in adolescent ballet dancers.
• Prospective evidence on performance-based risk factors for these injuries is limited.
• The single-leg heel rise (SLHR) test is used for calf muscle endurance assessment, but its injury prediction value is unclear.

Purpose of the Study:

• To investigate the association between single-leg heel rise (SLHR) performance and the incidence of lower leg, ankle, and foot injuries in vocational ballet students.
• To identify specific movement quality criteria and muscular endurance thresholds within the SLHR test that predict injury risk.
• To evaluate the predictive value of these SLHR performance metrics for both medical attention and time-loss injuries.

Main Methods:

• A prospective cohort study involving 70 vocational ballet students.
• Baseline assessment of SLHR performance, including six movement-quality criteria and a 30-repetition endurance threshold.
• Prospective recording of medical attention and time-loss injuries over a 36-week dance season.
• Analysis using random forest models, logistic regression, and receiver operating characteristic (ROC) analyses to identify predictors and evaluate model performance (Area Under the Curve - AUC).

Main Results:

• Low eccentric control and pronounced supination were identified as the strongest movement-quality predictors of injury.
• The combined model including the 30-repetition threshold achieved an AUC of 0.73 for medical attention injuries and 0.69 for time-loss injuries.
• Low eccentric control was significantly associated with injury (Odds Ratio = 4.49, p = 0.013).
• Failure to complete 30 repetitions and pronounced supination also indicated increased injury risk.

Conclusions:

• Poor eccentric control, inability to complete 30 repetitions, and pronounced supination during the SLHR test are significant performance-based indicators of lower leg, ankle, and foot injury risk in adolescent ballet dancers.
• Monitoring these specific performance deficits offers a practical and low-cost approach for injury risk screening in dance populations.
• These findings can inform targeted interventions to enhance dancer safety and performance.