Anatomy of the Pointe Shoe

Original Editor - Carin Hunter based on the course by Michelle Green-Smerdon
Top Contributors - Carin Hunter, Jess Bell, Kim Jackson and Ewa Jaraczewska

Introduction

• Different styles and types of pointe shoes
  • Freed
  • Capezio
  • Teplov
  • Grishko
  • Gaynor Mindens

Parts of the Pointe Shoe

• Drawstring

• Binding
• Toebox
  • Sides or wings
  • Pleats - plantar surface
  • Platform
  • inner sole
  • outer sole
  • Shank
    • how many, how thick, how long
    • goes according to the preference of your ballerina
  • waist seams on left and right
  • Back Seam
  • Accessories
    • Ribbons or elastics - used to secure shoe to foot
    • Differences in the accessories can indicate injury (how you put them on basically will give you a good understanding of the preference of the ballerina, the years of experience on the ballerina and also potential injuries or current injuries that they have)
• Accessories
  • Ribbons or elastics which are used to secure the shoe to the foot
  • They way the accessories are attached can cause injuries on their own with stitching rubbing on tendons or bony prominences. The way the accessories are attached can also give an indication of the experience and preferences of the ballerina.
  • Toe caps
    • Comfort, moldability, shock absorption, impact, sweat absorption, cushioning
    • material or silicone
      • Silicone - breathable, malleable, better compressibility, longer lasting
      • Material - hardens with sweat from dancing

Important Measurements

The Vamp which is the length of the toebox.

The Crown, or Profile, which is the height of the toebox.

• 

  Vamp Measurement

• 

  Crown Measurement

Breaking in Pointe Shoes

• This term is used when a ballet dancer:
  • Breaks or cuts off the shank of the shoe. The purpose is to help mould the shoe to the foot of the dancer for comfort. The shank strength will depend on your arch type and your arch flexibility.

• Toe box must be broken in
  • To do this they can be worn, danced in, have barre work done in them, compress the toe box with palm of hand or heel of foot or hit plantar surface of shoe on the floor
  • The toe box of the pointe shoe must be strong enough to support the dancer en pointe but also be malleable enough to allow articulation of the joints of the foot and ankle.

• The natural foot arches need to be inline with where shank has been broken in. As a basic rule of thumb if a shoe has extensive bend, the ballerina often presents with a high arch. While if the shoe is stiff, the ballerina has a low arch. This is important to be remembered when assessing a ballet shoe. The dancer needs to be comfortable on flat, en pointe and in demi pointe.
• As a Physio, we can assist with breaking in shank by marking on their shoe where their natural arches are for the dancer to align the break in the shank with these.

Foot Shape

• Square
• Tapered
• Mortons foot type or somewhat tapered

Because of the variation in feet of dancers a ballet shoe needs to be professionally fitted. There are many different variations to a shoe. For example a shoe can have different shank length, shank height, shank width, vamp length, toe box length, wing height, the height of the platform, the height of the crown.

Effect of Toe Type on Postural Stability

In this study, there were no significant differences in postural stability between the two toe types during bipedal-stance and demipointe.

During en-pointe, the dancers with Egyptian-type toes had greater COP displacement in the maximal medial-lateral and anterior-posterior directions compared to the dancers with square-type toes..

In the dancers with square-type toes, the more similar toe length allows more simultaneous loading of the toe-tips and creates a large surface area to support the body and load. This transmits balance ground reaction forces evenly through the two tips of the toes, resulting in smaller COP displacement than that of Egyptian-type toes. This result might be because dancers with a prominent hallux as in Egyptian-type toes cannot shorten their hallux appropriately inside the toe shoes, creating less floor contact and affecting the postural stability during pointe work.

Concluded that toe type affected postural stability in medial-lateral and anterior-posterior displacement during en-pointe. Therefore, dancers with square-type toes were more stable in pointe work than dancers with Egyptian-type toes.

Correct Shoe fit

• Shank strength will depend on your arch type and your arch flexibility.
• Heel height and width will have an influence on the heel section of the pointe shoe. Your
• Vamp length will be how compressability your toes are, how long your toes are, as well as your arch flexibility.
• Your shoe profile height, that's also your arch type, your arch flexibility, your box shape and width, because you can see that the boxes come in very, very different shapes. height profile of this one is slightly bigger than that one. And that will also depend on your toe length the compressibility of the toes and then the foot profile height and the arch length of that.
• Need to be broken in properly so that they mould to your foot
• Done differently depending on each individual
  • Can be done by wearing them, exercises and bar work, manual
  • Soften the box
  • Break in the shank/ soften the shank enough for your foot

Why do we want to get the right fit?

• very simply because we want to get the correct load bearing points for your feet and for your body.
• too compressed, then you're going to end up with Morton's neuromas. You're going to end up with Bunyan's and calluses and probably some deviations of that hallux

• Effect on toe type and postural stability – study by Kizawa et al

The pointe shoe is designed to assist the ballet steps executed whilst in plantarflexion, protecting the feet from impact forces and stabilising the performer

What to look out for in a pointe shoe as a physio:

• Getting “Over the box” - good indication is wear and tear on the platform on both feet
• Stiching around the platform can give proprioceptive feedback as to where they are on the toebox
• Needs to be central wear and not more to the left vs the right
• Weak ankles - DONT want a flexible shank, want a rigid shank
• Shank should curve in towards each other so there are no gaps between your feet in 5th position as shown below

Toes should be straight in the pointe shoe and not bent at all

• “Ideal” foot structure for on pointe – yes/no
  • Ankles less prone to injury
    • Toes of equal length
    • High instep
    • Flexible ankle
    • High arches, IF they are very strong
  • Ankles more prone to injury
    • Uneven toe length
    • Inflexible / rigid ankle
    • Low instep or flat arch. Flat arch requires dancer to work n flexibility, although they usually present with good strength

Assessing the Shoe new ballerina

• Indications of an inexperienced dancer:
  • Shank not “broken in”
  • Elastic on the heel to keep shoe on. more experienced dancers will either have a proper shoe fit or sew elastic along the inside seam which results in less injuries, such as an irritated Achilles.
• How long do pointe shoes last – study
  • Approximately 20 hours of dancing
  • Leather outer sole is scraped with a knife, scuffed on the floor or rubbed in rosin to prevent slipping
• How Long do pointe shoes last?
• this study was to investigate differences in foot and ankle kinetics and kinematics between new and worn pointe shoes. Fifteen professional ballet dancers completed a series of bourreés (walking en pointe) in both new and worn pointe shoes (> 20 hours wear). Force and pressure analyses determined peak ground reaction force and centre of pressure velocity. A 2D kinematic analysis determined the magnitude of mid-foot flexion and ankle plantarflexion. The worn pointe shoe caused significantly greater mid-foot flexion (P < 0.01) and ankle plantarflexion (P < 0.01) en pointe compared to the new pointe shoe. No significant changes in peak force (P = 0.855) or centre of pressure velocity (P = 0.297) were observed between conditions. The reduced structural integrity of the worn pointe shoe may be a causal factor for kinematic changes and subsequent pain and lower limb injuries in professional dancers.
• several cases, professional dancers are required to change their pointe shoes once or twice per performance, due to rapid deterioration of the shoe’s integrity
• Injuries related to pointe shoes
• A worn pointe shoe with reduced structural integrity may reduce the ability of a dancer to correct postural sway, resulting in accelerated rates of muscle fatigue, ankle sprains or falls
• during pointe work a dancer is required to maintain full plantarflexion of the ankle, extending through the mid-foot to the toes. This is achieved predominantly by movement of the talocrural joint and to lesser extent by bones of the foot . A worn pointe shoe, which has increased flexibility, may no longer be able to support the foot and ankle in the required position, and as a result, hyperplantarflexion of the talocrural joint and excessive mid-foot flexion may occur.

• Considering joints and ligaments of the foot are not designed to accept excessive loading, these changes could lead to the compression of soft tissue structures (Moser, 2011) and strains in the midfoot ligaments (Russell, Kruse, Koutedakis, McEwan, & Wyon, 2010a).
• a lack of sufficient shock absorbing material
• A new pointe shoe may contribute to the attenuation of ground reaction forces
• Take home points
  • Send a dancer to a professional fitter
  • “Too much, too soon” - applies to moving on to pointe work. Body should be ready to accept the load with correct shoe fit, adequate ROM and strength through the range
  • Need to be able to articulate through range from flat, to demi pointe, onto point, as well as reversing the movement