The illusion of weightlessness

The Effects of Pointe Shoes on Ballet Dancers' Biomechanics, Muscle Activity, Movement and Symptoms: A Scoping Review

Introduction: Dancing en pointe requires ballet dancers to stand on the tips of their toes while wearing a structured pointe shoe. Understanding the effect of pointe shoes on ballet dancers' biomechanics, function, symptoms and skin health is essential to guide shoe development and ultimately improve dancer performance. Therefore, the purpose of this scoping review was to map the evidence and identify knowledge gaps related to the effect of wearing pointe shoes on professional and recreational ballet dancers. Method: A scoping review was conducted by searching 6 electronic databases and the International Association for Dance Medicine and Science Bibliography. Results: Thirty-five studies were grouped into 5 categories: pointe shoe factors (eg, toe box and shank, pointe shoe status; 9 studies), shoe types (eg, flat shoes vs demi pointe vs pointe; 10 studies), ballet movements (11 studies), symptoms (5 studies), and intrinsic dancer factors (eg, foot type/toe length; 7 studies). Studies were published between 1979 and 2023, with 72% (n = 23) published between 2006 and 2020. Most (86%) of the studies were cross-sectional. Most studies explored biomechanical outcomes and the most common data collection device was force plates (19 studies). Overall, there was an insufficient volume of evidence for specific research aims. Significant gaps in knowledge exist regarding functional and performance-based outcomes, injury outcomes including exploration of factors such as shoe age/usage, and pointe shoe treatment factors. Conclusions: Currently the field of research suffers from threats to ecological validity, with many study methods not reflecting ballet-specific demands or environments. The impact of pointe shoes on ballet dancers is a developing research area, and this scoping review can help guide future research decisions. Studies need to target the knowledge gaps and employ rigorous ecologically valid study designs and ensure that findings inform shoe design and dancer education to minimize injury and maximize comfort and performance.

Relationship of Extrinsic Risk Factors to Lower Extremity Injury in Collegiate Ballet Dancers

Ballet dancers are thought to be at higher risk of lower extremity injury. This objective of this study was to describe the self-reported incidence, location, and factors associated with lower extremity injury in collegiate ballet dancers. Two hundred and forty-nine female ballet dancers responded to a questionnaire that addressed their injury event/location, dance behavior over the past 2 years, and overall dance history. Behaviors assessed included the following: types and number of shoes worn (pointé shoes/ballet slippers), wear time, training time (session frequency and duration), use of warm-up/cool-down, and use of a strengthening program and lower extremity accessory. Overall dance history included age of the onset of training, total years of experience, and number of dance styles. Backward multivariable logistic regression analysis was used to determine the extent to which variables measured were associated with injury. Ankle injury was the most prevalent injury. Years of wearing pointé shoes (adjusted odds ratio = 1.21, p = 0.01) and days/weeks in pointé shoes (adjusted odds ratio = 1.26, p = 0.04) were associated with an increased risk of injury; while additional strengthening (adjusted odds ratio = 0.39, p = 0.02) and use of lower extremity accessories during classes/rehearsals (adjusted odds ratio = 0.64, p = 0.01) were protective associations. These findings suggested that the use of pointé shoes, lower extremity accessories, and additional exercise should specifically be recorded during evaluation of injured ballet dancers; and must be considered potential factors to modify during rehabilitation.