1. Biomechanics of Pointe Shoes
Ashley Macumber

2. Anatomy of the Foot/Ankle

3. 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

4. Foot Positions
Maximum weight-bearing plantar flexion

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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)

16. Questions?