title: Hyperpronation in Dancers Incidence and Relation to Calcaneal Angle.
abstract: Hyperpronation is a common finding when examining the dancer-patient and is thought to be implicated in several dance-related injuries. Little is known about the incidence of hyperpronation-related symptoms in dancers. Additionally, there is no current easy method for estimating the degree of hyperpronation. This study was designed to investigate the incidence of symptoms related to foot hyperpronation in dancer-patients and to evaluate the potential correlation between the patient's calcaneal angle and severity of hyperpronation. A retrospective study of 2,427 dancers' charts over the past 6 years was undertaken to identify dancers who presented with musculoskeletal complaints or problems related to hyperpronation. Physical exam data and diagnoses were collected. Among 24 new dancer-patients presenting to clinic with hyperpronation-related symptoms, the calcaneal angle was measured and correlated with a clinical grading scale based on the Hübscher maneuver. Per chart review, the incidence of symptomatic hyperpronation resulting in prescription for orthotics was 30% (739 dancers out of 2,427). The most common related diagnosis was retropatellar chondropathy (10%). Clinical severity of hyperpronation was linearly related to the calcaneal angle (95% CI [1.25, 4.14], p = 0.0006; Pearson's r(2) = 0.97). The calcaneal angles among mild, moderate, and severe hyperpronators differed significantly (H = 13.45, p = 0.0012). It was concluded that measuring the calcaneal angle may be a useful adjunct to the Hübscher maneuver for grading the clinical severity of a dancer's hyperpronation. Healthcare providers working with dancers should be aware of the presence of hyperpronation, its relation to compensatory turnout techniques, and association with injuries in the foot, ankle, knee, hip, and low back. A standard, time-efficient method of measuring and grading hyperpronation is still needed.
authors.affiliation: Maastricht University Medical Center, 6224 CE Maastricht, The Netherlands. r.nowacki@alumni.maastrichtuniversity.nl.
authors.forename: Rélana M E
authors.initials: RM
authors.lastname: Nowacki
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Air
authors.affiliation: Medical Centre for Dancers and Musicians, The Hague, The Netherlands.
authors.forename: A B M
authors.initials: AB
authors.lastname: Rietveld
mesh_terms: D000293:Adolescent; D000328:Adult; D002111:Calcaneus / Q000293:injuries*; D003615:Dancing / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement; D011403:Pronation; D012189:Retrospective Studies; D052256:Tendinopathy / Q000503:physiopathology* / Q000628:therapy*; D055815:Young Adult