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Taking Care of Your Feet When Dancing En Pointe

One of the most beautiful forms of motion is dance.The choreographed movement to music using the human body can't be equaled by any other forms of motion.  It is for this reason that artistic motion is described as a "dance" even in other athletic events.  One of the key pieces to the beauty of the ballet dancer is the pointe shoe.  Being en pointe is therefore a rite of passage and a moment that a dancer looks forward to the most in their dance career.  If done correctly, pointe can also be the most rewarding form of ballet dancing for the dancer and the observer.  In hopes of facilitating the correct progression to pointe, we have created this report answering some common questions.

Why wait to get into Pointe shoes?

     As children learn and grow and their dance skills improve, getting into pointe shoes can be a very exciting moment.  However, it is important to make sure the child’s foot is properly developed before beginning pointe. 

       Although designed to facilitate dancing en pointe, pointe shoes distribute body weight very unnaturally over the foot, causing stress and strain in unusual areas.  In an immature foot or a foot without adequate strength to counteract the stress and strain, significant injury and even long-term problems can develop.  These problems could include stress fractures, tendon or ligament injury, severe ankle sprains, osteoarthritis, bunions and hammertoes.  Therefore, a dancer needs strong, developed feet in order to combat this stress and at least reduce the chance of injury or progressive deformity.  When you figure that deformities develop over time in the healthiest of pointe dancers, imagine how debilitating or limiting the injuries could be in a foot not prepared.

At what age do growth plates stop growing?

       Although complete growth plate closure is not necessary for progression to pointe, early progression can injure growth plates and even interfere with proper growth.  This is one of the main concerns about starting a child in pointe shoes too early, as their growth plates are still open and growth is still rapid.  As growth gets closer to completion, the growth plate will grow at a slower rate and become more stable.

     Growth plates or physis are an area of growing bones that allow increase in length or size. The area consists of cartilagenous tissue that expands as it is replaced at the edges of the bone.  Since cartilage is not as structurally sound as bone, there is higher risk of injury while these plates are open. Growth plate closure varies from individual to individual, but usually will not be complete until anywhere from 11 - 16 years of age.  These ages should be considered, as well as x-rays evaluated prior to progression to dancing en pointe if under the age of 16.

                Dr. Gibson does not require complete fusion of growth plates to progress to dancing en pointe.  In fact, he recommends not starting pointe shoes before the age of 11, although most dancers may need to wait longer.  Careful evaluation and testing is imperative to protect the dancer and still allow the desired progression.

What will the doctor test when you come in?

                When you come in to Mountain West Foot & Ankle Institute to be evaluated to begin using pointe shoes, the doctor will perform several tests.  These tests are designed to evaluate bone development, growth plate maturity, balance, muscle strength and overall dancing health.  Through these simple tests, each dancer can be individually evaluated to determine if dancing en pointe is appropriate at their current age.  These tests will include:

  • X-ray exam of feet and lower legs.
  • Muscle strength testing.
  • Balance testing.
  • Careful evaluation of foot and ankle structurally.
  • It will often include recommendations on exercises or other activities to improve ability to dance en pointe without problems.

Are there ways to strengthen and prepare feet and legs to dance en pointe?

                Yes.  Because dancing en pointe requires increased muscle strength and balance, there are several activities and exercises that will prepare a dancer for these new stresses.

  1. Make sure you spend adequate time on ¾ pointe or demi pointe.  You should be very comfortable on ¾ pointe before you attempt to move into full pointe. Taping the toes can also help to protect them from the strain and rubbing of wearing pointe shoes.
  2. Participate in regular balance exercises with the goal of standing in passe en releve on each leg for 30 seconds without utilizing a bar.
  3. Stretch and warm up properly to ensure joints of the feet and legs are functioning properly.  A good pointing of the foot is imperative for the ability to move into full pointe dancing.
  4. Muscle strengthening is also an imperative.  Dancers are notoriously strong and can be seen as high level athletes, but the increased stress and strain of dancing en pointe requires even greater strength of the foot and ankles.

There are some stretches and exercises that can help strengthen foot muscles and prepare ligaments and tendons to support the new weight distribution of dancing en pointe.

 

Toe resistance band - Use an elastic band as resistance when doing range of motion or other exercises of the foot or ankle.  This is a great exercise to increase the strength of the foot and ankle.

Resistant Band.jpg

 

Calf Stretching

  • Gastrocnemius muscle Stretch

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  • Soleus muscle Stretch

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Ankle Strengthening - Step Up à Stabilizes the ankle on the outside (laterally)

IMG_0562.JPGIMG_0563.JPG

 

Point and flex at the ankle

  IMG_0556.JPG IMG_0557.JPG

 

What should I watch for when my child begins dancing en pointe?

                Injury to toenails or ingrown toenails

                Blisters, new areas of pressure (redness) or callus locations

                Pain in the ankle (including ankle injury)

                Pain in the toes (toe injury)

                Change of foot shape – bunions, hammertoes, over extension

 

What are some ways to protect my feet once I am dancing en pointe?

  1. Treat blisters immediately as they form.  Popping blisters can relieve pain and pressure and keep it small.  You don’t want the blister to pop inside your shoe.  To pop a blister:
    1. Clean the area thoroughly with soap and water.
    2. Disinfect the needle with rubbing alcohol.
    3. Insert the needle at the base of the blister.  This will leave a protective covering on the vulnerable spot and reduce chances of infection.
    4. Allow the fluid to drain, applying slight pressure to help the fluid flow out.
    5. Apply a bandaid or moleskin to the area to reduce the rubbing that created the blister.
  2. Taping the toes or using moleskin patches can help to protect them from rubbing inside the shoe.
  3. Keep toenails trimmed short and straight across.
  4. Some dancer will use gel or lamb’s wool padding in their pointe shoes, but others feel it may interfere with the feel of the shoe.

How do you fit pointe shoes?

Pointe Shoes.jpg                Know that an expert at a dance store or in your studio is often the best resource for fitting pointe shoes.  Some simple pieces of information may be helpful:

  1. Toes should lie flat in the shoe (they shouldn't overlap)
  2. Just the big toe should touch the top of the box when you stand.  If it doesn’t touch, the shoe is to long, if all your toes touch the box, the shoe is too short. (If all toes slide down and touch only when en pointe, the shoe is too big.)
  3. The shoe has a strong shank.  The shank of the shoe will assist in supporting dancing en pointe, especially if you have a very flexible arch.
  4. If you can slip a finger between your foot and the drawstring, the shoe is too wide.
  5. Flex your foot.  If your heel is pinched painfully, the shoe is too tight.
Brandt R Gibson, DPM
Podiatrist, Neuropathy Doctor, Father of 11 and Founder of Mountain West Foot & Ankle Institute