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Physio Talk With Lukas: Let’s Get To The Pointe

Lukas Hinds-Johnson, Staatsballett Berlin's resident physiotherapist and owner of PhysioX Berlin

In this installment of Physio Talk, we’re uncovering what it takes to go en pointe, how pointe shoes come into play, and why you need to know what’s going on inside your pointe shoe–and even more when choosing the right pair.

We’ll dive into the feet anatomy, their biomechanics, plus how pointe shoes allow you to balance; how they support you in movements, like jumps and landing, and the transfer of weight that occurs from your arch to your toes.

Let us follow the journey of Alice, a young dancer who has dreamt of becoming a prima ballerina ever since watching her first ballet performance, The Nutcracker, on Christmas day. She was immediately captivated by the magic of the choreography, the costumes, and the emotions she felt from watching the dancers glide across the stage. Mesmerized by ballet from the get-go, she knew ballet was for her.
Alice was particularly drawn to Clara’s duet as her character rose up onto her toes en pointe, practically floating across the stage. She had an instant enchantment and desire to pursue ballet so that she could pass that same magic onto another child. Alice was 12 years old at the time.
From then on, Alice enrolled in a local ballet school where she took her first ballet lesson, impatient and eager to go en pointe just like Clara. However, Alice’s teacher taught her otherwise. Like first learning how to master the basic technique to strengthen and prepare your body for pointe work, because like all ballet movements, ballet requires strength and a solid foundation. Pointe work adds a layer of complexity because many things are happening simultaneously in the body to achieve and sustain balance en pointe. It means that the body has to cope with the strain on the ankles.
So, what happens when a dancer goes up en pointe? To answer that, we’ll take a closer look at the foot as a whole.

What’s In A Foot?

The foot is made up of 26 bones, each interacting with one other, enabling movement while maintaining balance. The foot is divided into hindfoot, forefoot, and midfoot.

The Foot (Source: Summit Orthopedics)

1. The Hindfoot The hindfoot is made up of the talus and calcaneus, forming the ankle. It is made up of an upper part, think pulling the foot up and pointing, and the lower ankle/subtalar. The hindfoot makes the complex movement of pulling the foot into inversion/adduction and eversion/abduction possible.

The hindfoot begins at the ankle joint and stops at the transverse tarsal joint. Located between the tibia and fibular, it forms the upper ankle joint.

The Talus (Source: Ken Hub)

When you are en pointe, your upper ankle joint pulls the foot up and down and to its sides (slightly). The lower ankle joint connects the ankle bone to the tarsal bones and the calcaneus but is less mobile than the upper ankle joint. The lower ankle joint allows the foot to tilt slightly to the side and pivot inwards and outwards. Both the talus and the calcaneus connect to the bones of the midfoot.

The Ankle Joint of the Right Foot (Source: BeneFIT Physical Therapy)

2. The Midfoot

The midfoot is made up of 5 bones and lays between your two big ankle bones and the metatarsal, aka toe bones. These bones have a limited range in movement. They are responsible for more complex moves, such as adjusting your foot to uneven ground and working with the ankle to bring your foot in and outwards. Additionally, there are a lot of ligaments and tendons attached to it.

The midfoot begins at the transverse tarsal joint and ends where the metatarsals begin--at the tarsometatarsal (TMT) joint. The midfoot has several more joints than the hindfoot, and these joints have limited mobility. The five bones of the midfoot comprise the navicular, cuboid, and the three cuneiforms: medial, middle, and lateral.