Rehabilitation of a Professional Ballerina Post-Traumatic Fourth Toe Fracture: A Case Report

Dance is a complex sport with a high prevalence of associated musculoskeletal injuries, especially among ballet dancers. Acute lower extremity (LE) fractures may occur in this population due to losses of balance and landing from high impact dance skills, but there is limited current evidence detailing the physical therapy rehabilitation of such injuries. The purpose of this case report is to describe the physical therapy management of a professional ballerina post-traumatic fracture of the proximal phalanx of the fourth toe. # Case Description The subject was a 27-year-old dancer employed by a professional ballet company. Ten months prior to her initial physical therapy evaluation, the subject landed from a leap on the lateral border of the left foot and flexed fourth and fifth toes. Plain film radiographic imaging revealed a nondisplaced fracture of the proximal phalanx of the fourth toe with a small section of avulsed bone. The avulsed bone was surgically resected eight months post-injury due to persistent pain with continued dance rehearsals. The subject was referred to outpatient physical therapy for post-operative rehabilitation and return to sport training. # Outcomes The subject attended 18 therapy visits over an eight-week period with documented improvements in ankle strength in all planes, fourth toe range of motion, and self-reported LE functional mobility with the Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL). The subject improved by 14 points on the OPTIMAL, with additional improvements reported in her tolerance of en pointe and demi pointe ballet positions. Upon discharge, she was cleared for return to full training and performance en pointe using a novel return to sport protocol for body-region specific rehabilitation for ballet dancers. # Conclusion This case report outlines the successful rehabilitation of a high-level dance professional post-traumatic toe fracture. Additional research is needed to further examine return to sport protocol and testing with ballet professionals after an acute traumatic ankle or foot fracture. # Level of Evidence 4.