Open Access Highly Accessed Research article

Bone stress injury of the ankle in professional ballet dancers seen on MRI

Ilan Elias1*, Adam C Zoga2, Steven M Raikin1, Judith R Peterson2, Marcus P Besser3, William B Morrison2 and Mark E Schweitzer4

Author Affiliations

1 Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA

2 Department of Radiology, Thomas Jefferson University Hospital, 111 S. 11th Street, Philadelphia, PA 19107, USA

3 Department of Physical Therapy, Human Performance Laboratory, Thomas Jefferson University, 130 S. 9th Street, Philadelphia, PA 19107, USA

4 Department of Radiology, Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA

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BMC Musculoskeletal Disorders 2008, 9:39  doi:10.1186/1471-2474-9-39

Published: 28 March 2008



Ballet Dancers have been shown to have a relatively high incidence of stress fractures of the foot and ankle. It was our objective to examine MR imaging patterns of bone marrow edema (BME) in the ankles of high performance professional ballet dancers, to evaluate clinical relevance.


MR Imaging was performed on 12 ankles of 11 active professional ballet dancers (6 female, 5 male; mean age 24 years, range 19 to 32). Individuals were imaged on a 0.2 T or 1.5 T MRI units. Images were evaluated by two musculoskeletal radiologists and one orthopaedic surgeon in consensus for location and pattern of bone marrow edema. In order to control for recognized sources of bone marrow edema, images were also reviewed for presence of osseous, ligamentous, tendinous and cartilage injuries. Statistical analysis was performed to assess the strength of the correlation between bone marrow edema and ankle pain.


Bone marrow edema was seen only in the talus, and was a common finding, observed in nine of the twelve ankles imaged (75%) and was associated with pain in all cases. On fluid-sensitive sequences, bone marrow edema was ill-defined and centered in the talar neck or body, although in three cases it extended to the talar dome. No apparent gender predilection was noted. No occult stress fracture could be diagnosed. A moderately strong correlation (phi = 0.77, p= 0.0054) was found between edema and pain in the study population.


Bone marrow edema seems to be a specific MRI finding in the talus of professional ballet dancers, likely related to biomechanical stress reactions, due to their frequently performed unique maneuvers. Clinically, this condition may indicate a sign of a bone stress injury of the ankle.