Ballet pushes the anatomical possibilities of humans to the extreme, much like elite sports. It is a moment of wonder and awe when watching ballerinas dance an entire routine en pointe. The constant strain on the lower extremities due to pointe work- the leaping, landing, twisting, and turning- can lead to what is widely known as ‘Ballet Dancers Feet’. While pointe work looks extremely graceful, it can attribute to long term damage to the fee in some, if not most, dancers.. Ballet dancers face acute and chronic conditions such as blisters, bunions, bruised toenails, tendinitis, and degenerative joint disease. Although the grace of dancing on pointe is something so beautifully surreal, it’s important dancers are aware of the the possible damage they could be doing to their feet. This is not just to assist dancers in maintaining their feet throughout their career but long after their career as well.
Aside from superficial deformity, ballet techniques specifically places dancers at higher risks of foot and ankle injuries such as ankle sprains, torn ligaments, and stress fractures. Another offshoot of this condition is persistent ingrown toenails. Ballerinas should always keep their toenails short and clean, but cutting them too short can cause the corner or edge of the nail to grow into the surrounding skin. Furthermore, executing repetitive motions on toes results in black or broken nails. Dancing en pointe puts the foot to be maximally dorsiflexed for a prolonged time frame, placing incredible stress on the peroneus longus tendon and on the second metatarsal. Improper technique and ineffective shoes can exacerbate foot injuries while dancing. Big words we know – but in short, placing your entire body weight into your toes is far from ‘normal’. It puts a large amount of pressure on your lower extremities. Although risk of injury is high, small things can be done to prevent them.
Pointe work puts four times the body weight through the feet, thus choosing the right pointe shoes matter significantly. Typically, a pointe shoe’s basic structure comprises 5 parts- toe box, vamp, shank, ribbons, and elastic. The top of the toe box is called the vamp and it varies in length and width depending on the dancer’s forefoot length and width. The vamp should cover the entire length of the third phalanx and slightly beyond. The platform is the exterior, flat-end of the toe box, allowing the dancer to stand on pointe. The shank helps support the arch of the foot when dancing on pointe and can be reinforced by adding a layer for a dancer with a more flexible foot to slow the break down of the shoe. It is usually made of leather and is a narrow supporting spine that is glued to the back of the insole. The elastic should wrap snugly over the ankle joint. Pointe shoes should be snug but not too tight as that can lead to blister and callus formation. Dancers often fit their shoes to their foot by breaking them in, i.e. bending the shank, crushing the box, and wetting the glue.
When walking in pointe shoes, the peak pressure doubles on the foot compared to barefoot. The average pressure on the toe box while on pointe is 220 psi or 1.5 MPa.9. Each foot and ankle has 26 bones, 33 joints and more than 100 ligaments and tendons. A well-fit pointe shoe supports the alignment of these structures, but a “dead” shoe can cause these structures to collapse onto themselves. This can overload the joints and lead to long-term alignment problems like bunions or damage to the cartilage which can lead to arthritis, bone spurs and hallux rigidus. Learning how to correcrtly adjust your pointe shoes for your feet can take years to master and changes as your feet, dancing and strength levels change.
Common foot and ankle injuries:
- Blisters and calluses– These are common when dancing in pointe shoes that haven’t been broken in yet or aren’t properly fitted, or from movement and friction between the toe.
- Ingrown toenails– Ingrown toenails occur when the corner or edge of the nail grows into the surrounding skin.
- Black or broken nails– This is usually the result of the repeated impact, blisters, or overuse. Pointe dancing usually results in black or broken nails.
- Sprained ankles– Ankle sprains are common in dancers and it happens from overworking the lateral side of the ankle for long hours per day.
- Bunions– These form as a result of toes being squished together and tension on the big toe joint. Bunions can be hereditary but ballet dancers develop them as a consequence of putting torque, pressure, and weight on their feet regularly.
- Stress fractures– Stress fractures are tiny cracks in bones that occur due to overuse or repetitive force and may feel worse when jumping or turning. Stress fractures can occur due to osteoporosis as well.
- Dancer’s heel– Also known as posterior impingement syndrome, this injury is sometimes called “dancer’s ankle” because it affects the rear of the ankle. This condition can be triggered by ankle sprain or by the tissue being trapped between the ankle and heel bone.
- Morton’s neuroma– This pinched nerve causes pain between the toes and the ball of the foot. Morton’s neuro involves a thickening of the tissue around one of the nerves leading to the toes. This can cause a sharp, burning pain in the ball of the foot.
- Plantar fasciitis- This is an inflammation of the tissue that extends from the heels to the toes. Repeated stretching and tearing can irritate or inflame the fascia leading to this painful condition.
- Hallux rigidus– This injury affects the joint at the base of the big toe, eventually making it hard to move the toe. It causes pain and stiffness in the joint. Dancers with fallen arches or excessive pronation of the ankles are susceptible to developing hallux rigidus.
- Achilles tendinitis– Caused by overuse of the Achilles tendon, this injury can usually be treated at home, but in serious cases, the Achilles can tear and require surgery. Achilles tendinitis most commonly occurs in dancers who have suddenly increased the intensity or duration of their routines.
Tips to care for Ballet Dancers Feet:
- The toenail should be straight across and not curved. Curved nails or nails that are too long can lead to ingrown toenails. The length of the nail should show only a very small amount of white. It’s better to use clippers instead of scissors to get a clean, straight cut.
- Calluses should be trimmed regularly to prevent them from becoming painful. Calluses actually provide a certain degree of protection when dancing. So it’s advisable to not file them aggressively as that may lead to blisters. Use a pumice stone to gently exfoliate the soles and treat calluses.
- Even the smallest of blisters can be very painful for ballerinas. Use a sterilised needle to pop the blister and to drain out the liquid. Then cover the blister with a sterile strip as well as a strip of athletic tape.
- It’s important to keep the feet moisturised with rich, creamy foot creams, focusing on the areas of the foot that are prone to developing calluses, corns, and blisters.
- Ballet shoes must be properly padded to reduce the risk of foot and ankle injuries. Use gel toe pads or wool toe pads to protect the feet during training.
- Arch bandages are helpful as they support the feet and prevent tendonitis. Wrapping the feet with stretchable bandages before putting on ballet shoes can help stabilise the ankle and prevent injuries.
- The importance of a proper ballet shoe fit cannot be stressed enough, and the best way to make sure your shoes are a good fit is to visit a professional ballet shoe store. A well-fitted shoe that adequately accommodates your toes can reduce the risk of injuries during dancing.
- If you face persistent foot problems, have any pain or worried about your feet then we highly recommend visiting to a podiatrist, orthopaedic specialist, or foot care specialist to address the underlying issue. A doctor will be able to guide you through the healing process and prevent the condition from worsening.