For many dancers who venture on a journey with ballet, pointe shoe dreams fill their minds; for some, it begins very young. They watch with wide eyes through an observation window as the older dancers rise higher and higher until they roll effortlessly onto the tips of their toes. From there, the magic continues to grow. Maybe a graduating senior performs a variation at the end-of-year recital, or a professional ballet company comes to town to perform Sleeping Beauty. Whatever the case, they are hooked and wish for a day when they, too, can whirl across the stage in a pair of pointe shoes as Tchaikovsky’s music floats through the air. Each dancer’s story is different, but the desire for pointe shoes among young ballet students is often palpable. Unfortunately, many students, parents, and even some dance studios fail to grasp what is truly needed for a successful pointe journey.

I had the opportunity to sit down with Dr. Aimee Martel of To The Pointe Physical Therapy to discuss what’s necessary for beginning pointework. From foot and ankle strengthening to the necessity of pre-pointe classes, read on to discover the best way to safely transition from ballet to pointe.

Though it seems self-explanatory to anyone who has spent an iota of time in ballet, pointework requires a lot of physical, mental, and emotional strength. Dr. Martel can offer a more explicit explanation. “You get up to twelve times your body weight through your foot and ankle when you’re in a pointe shoe…that really needs to be considered when we think about going en pointe. It’s not a fun kind of thing that you can do casually.” She notes that along with the increased force on the lower extremities, the dancer is also required to balance on a much smaller platform–the box of a pointe shoe is incredibly narrow compared to the somewhat wide base the foot has in a relevé on demi-pointe.

You get up to twelve times your body weight through your foot and ankle when you’re in a pointe shoe.

With these two data points highlighted, Dr. Martel further elaborates that a satisfactory range of motion, strength, and control are all necessary for a dancer to perform en pointe. “You’ve got to have enough range of motion to get you safely over the box of a pointe shoe…and you’ve got to have adequate strength and control of your balance once you get up onto the box. Otherwise, there’s no purpose. You can’t do anything once you get up there. To prepare for this arduous physical exertion, Dr. Martel advocates for pre-pointe classes–a targeted period of instruction that focuses on not just foot and ankle strengthening but also on total body preparation to dance en pointe. “Ballet class alone is not enough to adequately prepare for pointe shoes. You really have to have supplemental strengthening,” she notes, continuing, “even better if you can educate them on some basic anatomy and communicate to the students why you are focusing on certain exercises and how it will help their technique and reduce the risk of injury.” Dancers need time to build up to pointework–it is not something that can be easily taken on, even if the student has been taking ballet for years. Dr. Martel shares that the prospective pointe student should take their pre-pointe training seriously, embarking on a program that is in-depth and consistent, meeting at least twice per month for a minimum of six months to a year, depending, of course, on each dancer’s capabilities.

There is a generalized belief that once students reach twelve years old, they are decently prepared for pointework, and it is pushed as the logical next step for any quasi-serious dancer. This age-based approach is, unfortunately, somewhat arbitrary and has the negative consequence of coercing dancers who are either unready or unwilling into a pair of pointe shoes. With a concentrated preparatory program, the dancer will not only be prepared physically for the task at hand but also mentally. They had to work for the shoes–they were not just handed to them on their twelfth birthday. Strength and skill level are far more important to a successful pointe journey than one’s calendar age. “You’ve got to commit to it, and if you don’t want to, that’s okay,” says Dr. Martel. That being said, it is still recommended that a dancer be at least twelve before considering pointe classes.

young ballet student wearing ill-fitted pointe shoes
A properly fitted pointe shoe is absolutely critical. Everyone has a different foot.

Aside from the implementation of a pre-pointe program, Dr. Martel also recommends that prospective pointe students receive a screening from a qualified professional. Ideally, this would be someone in the medical field who is also familiar with what pointework entails. Dr. Martel is one such individual, and she frequently screens young dancers for pointe either at the behest of a studio or an individual parent. “The studios that do require the screening, the parents appreciate that, and it also removes some of the pressure from the studios…It’s so hard when their friends are moving up, but your dancer isn’t. As an aside, if the dancer can't receive a screening from a medical professional, a qualified dance instructor is the next best thing. There are some resources for educators, like a training program called Pointe Safe and some helpful guidelines from the International Association for Dance Medicine and Science (IADMS). Lisa Howell over at the Ballet Blog also has lots of informative advice.

After passing the screening, the next critical step in the dancer’s path is finding the right pointe shoe. “We all got Capezio Nicolinis as our first pair of pointe shoes,” quips Dr. Martel as she shares her personal experience. “They were the completely wrong shape for my foot…a properly fitted pointe shoe is absolutely critical. Everyone has a different foot.” Here is where another member of the dancer’s support team comes into play–a knowledgeable pointe shoe fitter. They can be hard to come by, especially if the student lives in a more rural setting. However, thankfully, one of the silver linings of COVID was the increasing digitization of many services. Some outstanding fitters, like The Pointe Shop, now offer virtual fitting sessions.

Many students, parents, and even some dance studios fail to grasp what is truly needed for a successful pointe journey.

It is also important to remember that dancers will need to be re-fit and have their shoes re-assessed often. As the student grows in strength, capability, or mobility, their feet and needs often change. Thus, a shoe that worked wonderfully in the beginning may no longer provide the same support. Dr. Martel also underscores the need for pointe dancers recovering from an injury to treat their bodies and feet with extra care. Their normal shoe may not be appropriate as they build back to full strength, and a different pointe shoe, sort of like a “rehab shoe,” might be in order.

Of course, pointework can come with risks and injuries, no matter how prepared a dancer is. As Dr. Martel states, “The foot is the most commonly injured area of the dancer.” Typical injuries for a pointe dancer include acute sprains and strains, tendon issues, stress fractures, bruised toenails, and, most insidious, a posterior ankle impingement. This is, essentially, pain in the back of the ankle that arises when the dancer points their foot (plantar flexion). This injury can be chronic and can adversely affect a dancer’s ability to perform en pointe. Dr. Martel shares that this impairment can potentially be prevented through competent pointe preparation. “I can tell you, anecdotally, that the dancers in my practice from local studios that have a pre-pointe or pointe-prep program in place have fewer foot and ankle injuries after they start pointework than from the studios who don’t.”

It is easy to romanticize pointe shoes, and of course, those who wear them successfully make it look breathtakingly simple. Yet, the reality is far different. Pointework is not for everybody, and that is more than okay. It is hard work that takes time and tenacity. However, with the right support team in place and careful preparation and training, it can be a gratifying experience.

Dr. Aimee Martel, DPT, PT works with recreational, pre-professional, and professional dancers in California’s Bay Area. She graduated from San Diego State University with a B.S. in Kinesiology and went on to earn her Doctorate in Physical Therapy from Samuel Merritt University. She holds a performing arts medicine certification through PAMA and ACSM. She is a member of IADMS and a certified Progressing Ballet Technique (PBT) instructor. In 2012, she opened her private practice, To The Pointe Physical Therapy, where she focuses on injury risk reduction, and rehabilitation through strengthening and technique refinement.

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