The Implications of the Female Athlete Triad on the Development of Second Metatarsal Stress Fractures in Professional Classical Ballet Dancers

Shira Elana Lanyi


The professional ballet world is plagued by high injury rates that negatively impact both the ballet company and its dancers.  Female dancers between the ages of 18 and 30 are particularly prone to stress fractures of the lower extremities and of the medial forefoot.  Current research suggests that the incidence of dance injuries in women correlates with the symptoms of the female athlete triad.  This triad is characterized by disordered eating patterns, amenorrhea, and bone mineral loss.  The aesthetic nature of ballet and the desire to remain thin, lead many dancers to display the symptoms of the triad, and ultimately make them more prone to injury.  How do second metatarsal stress fractures in professional female ballet dancers correlate to the female athlete triad syndrome and in what way can education and therapy reduce the prevalence of this injury in dance companies? I viewed the triad from the perspective that bone density loss is a physiological response to menstrual dysfunction.  I reviewed primary sources that suggest menstrual dysfunction is symptomatic of nutrient deficit in females.  I also reviewed research from the perspective that caloric deficit often leads to a reduction of resting metabolic rate and bone mineral density.  Studies I found indicated that disordered eating in professional dancers is primarily a psychological and sociological response related to the extreme pressure to maintain an ideal body shape.  I also reviewed research from the perspective that injury is related to ballet footwear and faulty technique.  Results of my research suggest that the female athlete triad is a process that begins with an unhealthy body image and disordered eating patterns.  Providing dancers, teachers, and administrators with the resources to acknowledge and address the serious implication related to the female athlete triad can diminish the excessively high rate of injury observed, enhance overall performance, and lengthen a career in professional ballet.


Dance; ballet; orthopedics; stress fracture; metatarsal; female athlete triad; amenorrhea; anorexia; eating disorders

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