Relationship between compensated turnout and lower extremity injuries in ballet dancers: A systematic review

To assess the relationship between compensated turnout (CTO) and lower extremity injuries in ballet dancers.

Systematic review.

A systematic literature search was conducted on September 17, 2025, using PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials. Observational studies written in English were included if they described CTO in ballet dancers of all ages and genders and assessed lower extremity pain, injuries, or disorders. Risk of bias was evaluated using the Revised Risk of Bias Assessment Tool for Nonrandomized Studies and the Appraisal tool for Cross-Sectional Studies.

Four studies involving 431 dancers met the inclusion criteria. Three studies reported significant associations between CTO and lower extremity injuries, whereas one study found no statistically significant relationship. The study with non-significant findings used different CTO measurement methods. Variations in measurement techniques and small sample sizes limited the strength and interpretability of the findings.

Increased CTO may be associated with a higher risk of lower extremity injuries in ballet dancers. Maintaining CTO within approximately 25°, based on findings from two included studies and previous research, may contribute to injury prevention. However, further research is needed due to methodological limitations and the small number of available studies.