Biomechanics of Pointe Shoes Ashley Macumber

Anatomy of the Foot/Ankle

Anatomy of the Pointe Shoe The Box: the front of the shoe that encases and supports the dancer’s toes. The Shank: a hard material the stiffens or reinforces the sole of the shoe to support the arch of the foot while en pointe. Platform: allows the dancer to balance, appearing weightless Vamp: supports toes and metatarsals to make sure all flexible joints are encased in the box Wing: shape of the box which can be v shaped or rounded

Foot Positions Maximum weight-bearing plantar flexion

Loading A: Neutral Standing Position B: Plantar Flexion (En Pointe) Tibia, talus and calcaneus come together to form a weight bearing situation “locking” the ankle in a more stable position Simply walking in pointe shoes doubles the peak pressures acting on the foot compared to barefoot (41 N/cm2 vs 86 N/cm2).8 Rising into the relevé position from a flat footed position increases the peak pressure to 115 N/cm2.8

Injuries Not Natural 75-85% occurrence per year Overuse/Traumatic Injuries Can affect all areas of the body Hip Knee Lower Leg Ankle Foot Lumbar Spine

FHL Tendonitis Injury Risks Recovery Prevention Dancer’s tendonitis Inflammation or tear of the flexor hallucis longus tendon Risks Repetitive pushing off of the foot Plantar flexion to dorsiflexion Recovery 4-6 weeks No pointe work, grand plies or jumping until pain subsides Prevention Maintain proper foot alignment Strengthen and stretch

Posterior Ankle Impingement Injury Dancer’s Heel, Nutcracker Syndrome Compression during plantar flexion Anatomical variant in talus bone (os trigonum) Risks Pointe and demi-pointe movements Forced dorsi flexion (plies) Recovery Rest and ice Possible surgery (6 weeks recovery) Prevention Reduce ankle plantar-flexion movement by taping

Ankle Sprains Injury Risks Recovery Prevention Most common injury From forced inversion and plantar flexion Damage to anterior talofibular ligament Risks Having it before High-arched feet and flexible ankles Recovery 3-12 weeks depending on grade level Wear a boot for a few weeks Prevention Core workouts Physical Theraoy

Stress Fractures Injury Risks Recovery Prevention Found in the metatarsals 2nd metatarsal most common Risks Overactivity from preparation Weaker bones from poor nutrition Recovery At least 3 weeks No weight bearing activity Prevention Usually caused from muscle imbalance Use recovery time to determine the underlying cause

Dancer’s Fracture Injury Risks Recovery Prevention Spiral fracture of the 5th metatarsal Avulsion fracture Risks Inversion injury during landing Rolling from pointe Recovery 6-12 weeks Walking boot and limited mobilization Prevention Strong, balanced muscles

Other Common Foot Injuries Cuboid Subluxation (Cuboid Syndrome) Repetitive flexion decreases stability Can also occur from traumatic sprain Midfoot pain and inability to “work through the foot” Hallux Valgus (Bunion) Orientation of big toe in pointe shoe Plantar Fasciitis Overuse injury Band along bottom of foot from heel to toe

Foot Injuries (cont.) Sesamoiditis Metatarsalgia Cortical Hypertrophy All weight on sesamoid bones in demi-pointe (overuse injury) Pain when straightening or bending big toe Metatarsalgia Instability of the joints in the toes From forcing the foot into extreme positions Cortical Hypertrophy 1st, 2nd, and 3rd metatarsals Pain from circumferential thickening

Long Term Effects Short careers (usually end around 30 years old) Premature aging More prone to overuse injuries Artificial joints from high stress Permanent limp En pointe position is not natural, and is likely injurious. Still in use because it is important to the ballet aesthetic

Prevention Dancers should not be “en pointe” before being fully prepared Risk of growth plate injuries under age of 12 Strong lower extremities (legs, ankles, and feet) Sufficient, but not too much, flexibility and motion in ankles in feet Strong “core” muscles Good balance and alignment of the legs and torso Adequate ballet work (at least twice a week)

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