Pointe shoe fitting is a moving target.
As dancers grow and their skill and technique change, dancers will require different shoes. As you solve one problem, you may create a new one (for example: choosing a wider width to relieve pressure off a bunion may lead to more pressure on the big toe).
There isn’t a shoe that will solve every problem. Sometimes 2 problems may be opposing issues. For example, a dancer may be weak in the ankles and sink in their shoes. Their ankles may require a wider platform for more stability but will result in even more sinking. The fitter must figure out what is the highest priority for the dancer and solve one problem at a time.
Even the same problem will require different solutions for each dancer because they have different levels of strength, flexibility, weight and shape. At times, the dancer will come in asking for a specific solution (a shorter vamp), but it is more helpful to know the problem (not getting over the shoe), because the solution may be different (needs a wider box). Ask the dancer and the instructor to come in with specific problems rather than solutions.
Most problems dancers encounter en pointe are multifaceted and may not be solved by the shoe alone. The pointe shoe can only do so much so the dancer must be committed to putting in the work as well. Pointe shoe fitting is a dynamic process and as the dancer improves, the shoe may as well. It is important to kindly explain both sides so the dancer knows what to work on as well as continuing the conversation with their instructor, cross training coach and medical professional (if they have one).
Troubleshooting common problems:
If the dancer is having trouble getting over the box:
Curved crown - gradually slopes up from the tip of the platform to the throat of the shoe
Higher crown - more room in the box to push up and over the platform. A shoe with a lower crown may not give the dancer enough space for leverage and pull them back
Wider box - if the shoe is too narrow, the dancer may be “floating” inside the shoe and not able to articulate enough to get over en pointe
Wider platform - if the platform is too narrow, sometimes the dancer is not able to find the center of the platform to get over en pointe
Softer shank - a softer shank will bend easier for those who lack flexibility
¾ shank - a shank that bands under the arch may help give support for the heel and push the arch over the box
Pre arched shank - the curve of a pre arched shank will give more support to the foot and help push over the box
Shorter vamp - a longer vamp may restrict the dancer from pushing forward
Harder shank - a shoe that is too soft may not give enough support for a weaker dancer to get over on the platform
Flatter platform - a rounded platform is more susceptible to roll the dancer back towards the heel. A flat platform will allow the dancer to find the center and stay there
*Some solutions are opposite of each other (softer shank vs harder shank). That is because some dancers have the range of motion in their ankles but not the strength in their feet so they require a harder shank and others do not have enough range of motion but more strength in their feet so they require a softer shank.
If the dancer complains of not being able to roll through demi:
Shorter vamp - for dancers with shorter toes, a longer vamp may prevent the dancer from reaching full demi
Softer shank - a shank that is too hard may be too stiff to bend
Lighter shoe - some dancers do not weigh enough or do not have enough strength to control a shoe that is too heavy. This type of shoe is generally harder as well but certain manufacturers use heavier glue and materials
Rounded platform - some dancers describe a feeling of getting “stuck” when rolling through a shoe that has a sharp edge around the platform. A rounded platform will allow a smoother transition
If a dancer feels pain (surface level pain):
Big toe pain (bruised toe nail):
If the dancer feels big toe pain when standing flat but less en pointe, try a longer shoe
If the dancer feels big toe pain when en pointe but not standing flat, try a narrower width or tapered box
If the dancer feels big toe pain both standing flat and even more en pointe, try a longer shoe with a narrower width or tapered box
Bunion pain:
try a wider width or rounded wings
If there is a lot of space between the first and second toe, add a super spacer
If their toe pad is too short to cover the bunion, try toe pads with extra long wings
This may be an indicator that the muscle that runs from the big toe along medial arch (abductor hallucis) may be weaker.
Pinky toe pain:
Less tapered box or wider width to give more space around the pinky
Add a pinky pad if the width and taper fits but needs a bit more cushion
This may be an indication of curling toes
Heel pain:
If the dancer feels where the back of the shoe meets the heel, try a longer shoe or a wider width
Everything hurts:
Skin type - just as there are some skin types that burn easier than others, there are certain types of skin that are more sensitive and easily injured than others (common but not limited to very fair skin types like those with Irish backgrounds). Those with this type of skin may suffer more en pointe due to pain. Suggest lambswool and other padding options to help prevent excessive pain.
If the shoes die in less than 10 hours:
Synthetic material - If the studio allows untraditional pointe shoes, a shoe made of a polymer shank such as a Gaynor Minden may last longer
Harder shank - a harder shank may bend less when the dancer goes en pointe and keep its integrity longer
Softer shank - in rare cases, dancers with flexible feet may snap harder shanks faster and softer shanks will last longer because it will bend instead of snap
¾ shank - ¾ shank will give more support and last longer for those who have enough strength in their feet and ankles. If the dancer is not strong enough, a ¾ will break faster.
Pre arched shank - Pre arched shanks will give more support for those with high arches and flexible feet. However, if the dancer is flexible but not strong enough, a pre arched shoe may push the dancer too far over the box
Different fit - the shoe may die faster if the shoe is not fitted correctly. Make sure that the dancer is in the right length, width and shape.
If the shoe has excessive twisting:
Wider width - shoes twist in certain foot shapes because there isn’t enough space in the box
Less tapered - the dancer may not be sitting straight inside the shoe if the box is too tapered
Higher crown - if the crown is too low, the dancer may not have enough space inside the box
Softer shank - If the dancer is struggling to control the shoe, a softer shank may be easier to control
Some foot types will twist regardless of the pointe shoe - Those with an unusually high instep, high arch and wide width are more prone to twisting in pointe shoes but there are shoes that will twist less in others. However, C-shaped feet may twist regardless of the shoe or training. A C-shaped foot is a condition where the metatarsals are positioned to the inside of the foot curving into a C shape. As the dancer builds more strength and flexibility, their feet are more likely to straighten.
If the dancer is sickling:
Wider width - if the dancer doesn’t have enough space inside the box, their feet may spill over towards the outside of the shoe
Less tapered - if the shoe is too tapered, the dancer may not be all the way inside the box and have less control of the shoe
Longer wings - if the dancer doesn’t have enough support on the sides of the foot, longer wings may help stabilize the foot
Harder shank - a shank that is too soft may not give enough support to the foot for those who have weaker lateral muscles
Flat platform - the sharp edge of the platform will help the dancer find the center of the platform
If the dancer complains of the shoe slipping off the heels:
Higher heel - if the shoe doesn’t have enough fabric in the back to cling to the heel, it will likely slip off
Cushioned heel - a cushioned heel or a double satin is more stiff and will stay on the heel better
Stretch satin - for those who have a “disappearing heel” a strength satin will cling to the heel better than a traditional satin shoe
Shorter length - if the shoe is too long, the shoe will be too baggy and more likely to slip off
Longer length - if the shoe is too short, the shoe will not have enough fabric in the back to cling to the heel
If the dancer is knuckling or breaking the shoe too low towards the toes:
Wider width - if the shoe is too narrow, the dancer may be too lifted inside the box and the vamp may be too short
Narrower width - if the shoe is too wide, the dancer may be sinking into the shoe and breaking the shoe too low
Too much padding - if the dancer is wearing too much padding, the box may not be long enough to cover the toes
Less tapered box - if the shoe is too tapered, the dancer may be hovering inside the box and the vamp may not be long enough
Longer vamp - if the vamp is too short, it will not give the dancer enough support on the top of the foot and break too low
Harder shank - if the shank is not hard enough to give the dancer support, it may collapse too low
¾ shank - if the foot cannot control where the shoe breaks, a ¾ shank may force the break to be higher
If the shoe looks too bulky:
Though this is more of an aesthetic choice, if the dancer likes a more streamlined look, try a smaller, narrower or tapered shoe. We don’t recommend going smaller or narrower than their size, but if the dancer feels they can control the shoes, they can go a bit tighter
Common injuries
A tremendous amount of dance related injuries go unnoticed and untreated because dancers do not oftentimes recognize their pain as an injury. Because so many pointe related injuries are overuse injuries, it can slowly build up over the years through bad habits and go unnoticed. The longer the dancer is building the injury, the longer it will take to treat and even longer to reverse the habit that caused it in the first place.
It is just as important to catch and treat injuries quickly as it is to build it back with proper technique.
Dancers suffer more injuries than most other athletes because of a variety of reasons: biomechanical deficits (example: knee complaints are more common with those with limited hip rotation and forced turn out), improper technique, incorrectly fitted shoes, hard floors with no shock absorption, poor nutrition, excessive training and culture of competition.
Though as fitters, we can only offer one solution to a myriad of problems, if we can recognize certain injuries and emphasize the necessity of going to see a dance specialist, we can help elongate their career.
If the dancer has obvious biomechanical deficiencies that may cause future injuries but do not feel any pain, recommend going to a prehab specialist (this could be a physical therapist or someone who specializes in cross training dancers (pilates, PBT, Feldenkrais, coach):
Overturning out the feet and knees pointing inward
Pronating or supinating of feet
Severely lacking range of motion to get over en pointe
Landing jumps with heels off the floor
Lacking core muscles for balance
If the dancer has biomechanical deficiencies with pain, recommend going to a medical professional that specializes in dancers (this could be a physical therapist, sports medicine doctor, foot and ankle specialist).
We recommend always finding someone who is familiar with ballet dancers because the mechanics are drastically different than other athletes. We have seen many dancers being treated for the wrong injuries for extended periods of time without any improvements before sending them to someone who understands ballet dancers.
See DanseMedica Members to connect with those who can help prevent, treat and rehab dance injuries.
Rehab Shoe
Once the medical professional clears them for pointe work, the fitter should first recommend a shoe that will be the easiest to rise onto pointe and feels the most stable when en pointe. Sometimes the dancer may be able to tell that certain shoes irritate the injured area right away. If they express immediate pain in the same area they were injured, switch to another shoe.
Depending on the dancer, this may be a harder shoe (for more support), a softer shoe (for more articulation), wider platform (for more stability) or a shoe made of polymer (for spring).
You can also try supportive devices such as compression socks (Apolla Shocks) or tape (Non stretch tape for more support and less stretch or Kinesiology Tape for more stretch and less support).
Gradual Overload
As the dancer recovers, you can start the overloading process with a more challenging shoe (if the dancer first needed a hard shank, go to a medium shank) or by taking off supportive devices.
Common dance injuries
Achilles Tendonitis
Achilles Tendonitis is an inflammation of the long tendon in the back of the ankle. It is largely responsible for pointing the foot. This tendon may become inflamed, inflexible and painful in the heel and lower calf when overused. The dancer may have more difficulty getting over on the box.
Ankle Sprain
Ankle sprains are the most common traumatic injury for dancers that may be caused by overstretching or tearing of ligaments when the ankle moves outside the normal range of motion especially during directional changes, turns and jumps. Swelling and bruising may be present in the inside or outside of the ankle.
Shin Splints
Shin splints are characterized by pain and swelling in the tibia and fibula (bones at the front of the leg that runs from ankle to knees) caused when the lining of the bone is stripped away.
Stress Fracture
Stress fractures can occur when the muscles around the bones become too tired to support the bones. These are tiny breaks in the bone which may be caused by repeated exercises, vitamin deficiencies or increased intensity among others.
Ankle Impingement (Dancer's Heel)
Ankle impingement can come in 2 forms: Posterior Impingement (back of the ankle) and Anterior Impingement (front of the ankle). This will result in pain in the back or front of the ankles. Usually non surgical treatment is sufficient but some Posterior Impingement exacerbated by an “extra bone” called an Os Trigonum in the back of the ankle may call for surgery to remove the bone.
Hammertoe
Hammertoe is when the toes are contracted due to an imbalance between the tendons on the top and bottom of the toes. This may cause corns to develop on the top of the toes from rubbing on the shoe. It could be flexible or rigid in nature. Though rigid hammertoe may be hard to fix, stretching and exercising both intrinsic and extrinsic muscles of the feet and ankle as well as properly fitted pointe shoes may help treat flexible hammertoes.
Ingrown Toenail
Ingrown toenail is caused by the skin growing over the toenail and could be very painful en pointe. Usually cutting the toe nail straight across and taking pressure off the toe with more padding or a more tapered or narrower shoe can help relieve the pain.
Bunions
Bunion is an enlargement of the joint at the base of the big toe that may cause pain and inflammation in the area. Properly fitting pointe shoes, sufficient amount of padding and strengthening muscles in the feet may help relieve the pain and prevent bunions from growing.
Neuroma
Neuroma is a condition when a nerve is being pinched and may be characterized by a burning pain in the forefoot (usually between the third and fourth metatarsals) and numbness in the toes. May be caused by shoes that are too narrow.
Plantar Fasciitis
Plantar fasciitis is an inflammation of the tissue (fascia) on the bottom of the foot that connects the toes to the heel. Dancer may feel pain in the bottom of the foot, especially in the morning and may be caused by hard floors and excessive training.
Sesamoiditis
Sesamoiditis is the inflammation of the two sesamoid bones where the big toe joint is. It is marked by pain on the ball of the foot and may feel like the dancer is walking on a rock.
Metatarsalgia
Metatarsalgia is marked by the pain on the ball of the foot.
Patellofemoral Pain Syndrome
Patellofemoral Pain Syndrome is caused by misalignment, muscle imbalance and/or repetitive forces on the knee causing soreness around and under the kneecap.
Conclusion
Dancers have a tendency to dance through pain. But this can lead to a more serious problem. Injuries build upon one another so no injury should be taken lightly. Sometimes being the best fitter means you are sending the dancer home with a medical referral rather than a pointe shoe.
This concludes your Basic Training. Please review all previous lessons for the final test next week.
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