'When To Go En-Pointe
For many ballet students the transition from technique class to going up "en-pointe" is one of the most exciting and anticipated days in their life. Ballet students around the world dream of one day doing pointe work just like the professionals do. Going en-pointe is a unique position for the foot/ankle to be in with the foot/ankle tilted downwards, as far as it will go, with a pronounced arching of the foot.
Before starting pointe work it is important to know whether your body is ready. Your feet/ankles and pointe shoes will be supporting your body weight for each pointe class and they must be able to withstand the stresses this new position requires. Remember that ballet pointe shoes do not have as much support as most running/walking shoes so your feet/ankles will need to gradually strengthen to do pointe work.
Most ballet students start pointe work at around age 11 to 12. This is not a perfect hard and fast rule. A few ballet schools and instructors might start someone en-pointe at age 10, while at other programs, the instructors may start the students at a later age, perhaps age 13 or 14, to be more conservative. Not all 11 to 12 year olds are alike. Dancers vary in their foot structure, strength, flexibility, and balance skills. Additionally, dancers that have been dancing consistently since they were little (perhaps starting at age 4 or 5) have more years to develop their skills as opposed to girls that just started dancing technique class at age ten and then desire to go en-pointe at age 11. If you do not have much dance training, you may need to delay starting en-pointe to a later date than your friends that have had more dance training.
Your ballet instructors usually have a good feel for where you are in terms of your strength, flexibility, balance skills, and whether you appear ready to start pointe work.
Ballet instructors and health care providers have learned a lot over the years about which dancers may or may not begin pointe work. The first place to start is with your ballet instructor. Does the instructor think you are ready? Do they see evidence of sufficient strength, flexibility, balance, and alignment/technique to begin pointe work? In some cases, your instructor may want you to see a health care provider such as a foot and ankle specialist for a more detailed physical examination (sometimes called a pre-pointe examination) and/or foot x-rays to see whether there is any reason to delay the start of your pointe work or, in some rare cases, to not do pointe work at all.
Let's look at some of the specific factors that influence whether you should start pointe work or not.
How intense is your dance school? Is it a competition type of program where you do lots of intense dance competitions? Most large city ballet programs such as the Pacific Northwest Ballet, American Ballet Theatre, New York City Ballet, San Francisco Ballet, Boston Ballet, etc. have large numbers of ballet students competing to become professional ballerinas and, therefore, the faculty expects a high caliber of technique. Not every dancer's body is built for this level of dance. In general, dancers enrolled in ballet programs where there is less emphasis on intensity and competition have fewer foot and ankle problems. In general, the harder you push your body, the greater your chance of foot and ankle problems.
Do you have a history of foot and ankle sprains/fractures? If so, you may want to consult a foot and ankle specialist prior to attempting pointe work. The more foot and ankle sprains you have had, the greater the chance that the soft tissue ligaments (rubber band like soft tissue that holds the bones together) may be too weak to withstand the unique stresses of being en-pointe, especially the ankle ligaments on the little toe side of the ankle, where most sprains occur.
Do you have any inherited (genetic) tendency toward foot problems from your mom or dad. Do either of your parents or grandparents have a history of foot or ankle problems? If you look at your parents' feet and compare them to your own, do you see any similarities? Perhaps you have inherited a foot structure with a tendency toward ingrowing toenails (where the edge of the toenail curves downward into the skin causing pain), or other problems such as flat feet (low arch height), pronation (where the foot tilts toward the big toe side of the arch), hammertoes (crooked toes), hallux valgus (where the big toe drifts toward the second toe), bunions (a bump at the edge of the big toe joint), hypermobile joints (excessive flexibility), or perhaps corns/calluses (a build-up of thicker skin on the toes or under the balls of the feet from excessive pressure). Dancers with these foot types may require additional, professional foot and ankle specialty consultation to keep the foot healthy en-pointe. Additionally, overweight dancers have more pressure/stress on their feet and may require nutritional/ weight loss advice.
Dancers with general medical problems such as diabetes mellitus (high blood sugar) are particularly at higher risk for nerve damage (diabetic neuropathy) and poor circulation (angiopathy) depending on the length and severity of the diabetes. Diabetic dancers should have an evaluation of their feet prior to beginning pointe and at least once per year thereafter with a foot and ankle specialist, in addition to proper diabetic (blood sugar) medical management by a diabetic specialist such as an internist or endocrinologist.
If you have an experienced foot and ankle dance medicine specialist in your area, consider going in for a complete foot and ankle examination, including x-rays (called a pre-pointe examination) to spot potential problem areas early and to determine what can be done preventatively to keep your feet healthy en-pointe. X-rays can show you the details of your underlying foot structure as well as the status of the growth plates. The "growth plates" are where the bones are still growing (getting longer) and they must be sufficiently mature to withstand the stresses of pointe work (usually about 1 mm diameter at age 11 to 12). If your growth plates are not sufficiently mature on x-ray, you may need to delay starting pointe for another year.
You should not start pointe work if you have any of the following:
1. The teacher does not feel you are ready in your strength, flexibility, balance, technique/alignment as yet;
2. A current injury that has not yet healed;
3. Current limping or favoring;
4. Current swelling, bruising, redness that might indicate an underlying injury;
5. Current foot/ankle pain;
6. A foot/ankle specialist finds something on examination that he/she feels is too risky to begin pointe work.
Your pointe instructor will also be able to help you find a pointe shoe shop to have your pointe shoes properly fitted. You should try on several different models of pointe shoes under the guidance of an experienced pointe shoe fitter. If you use tape, toe spacers, pads, and/or toe covers, you will need to bring these with you to your fitting appointment as they can affect the final fit and comfort of your pointe shoes.
Remember that going en-pointe is a gradual process of developing strength, flexibility, and balance under the supervision of your pointe instructor. It is important that you communicate any problems you are having with your feet or ankles as soon as possible to your pointe instructor and parents so that they can help you. If your feet/ankles do not do well with pointe work, you may need to consider staying in ballet technique class or trying jazz dance in a more supportive shoe.