Imaging findings of foot and ankle injuries in dancers

Dancers are performing artists and elite athletes with unique physiological and psychological demands. Many dance styles, especially classical ballet, require extraordinary flexibility and strength throughout the foot and ankle with remarkable pain tolerance. Injuries arising from biomechanical and metabolic stresses negatively impact career progression with resultant chronic pain, permanently impaired function, and financial loss. Therefore, dancers rarely seek medical attention except for genuine problems. The unique demands of dance can result in specific injuries and distinctive radiological patterns on imaging. Early and accurate recognition of these dance-specific findings is essential in diagnosing the dancer's foot and ankle. Given the dancer's unique needs and high risk of injury, this manuscript will discuss essential radiologic considerations specific to foot and ankle imaging in the dancer. Key points include the need for weightbearing radiographs, applications for weightbearing computed tomography, indications for ultrasound when magnetic resonance imaging is generally the gold standard, and the value of dancer-specific imaging techniques. An emphasis is placed on recognizing pathology that is genuinely unique to this patient cohort such as flexor hallucis longus tendinopathy, low-risk stress fractures at the second metatarsal base, and spiral fractures at the fifth metatarsal diaphysis. Understanding the degree of correlation between imaging findings with symptoms and clinical diagnoses is essential. Identifying common and uncommon injury patterns in dancers coupled with a knowledge of the implications of these injuries can facilitate improved communication with referring providers, which may help radiologists contribute to providing optimal patient care for a vulnerable patient population.