Physiotherapy intervention for toe pain in ballet dancers 

Ballet is a demanding art form that requires not only grace and strength but incredible resilience from the feet—particularly the toes. Did you know that a dancer’s toes can work under a force of up to 12 times their body weight? This can make toe pain a common complaint among ballet dancers, especially those who dance en pointe. Understanding the source of this pain and how to treat it is crucial for maintaining both performance and long-term foot health. 

 

The anatomy of the pointe shoe 

Pointe shoes are both a tool and a challenge. Designed to support the dancer while on the tips of their toes, pointe shoes feature a reinforced toe box (often made from layers of fabric, glue, and cardboard), a (generally) stiff shank for arch support, and a narrow platform that the dancer balances on. While they provide necessary structure, pointe shoes can also compress different parts of the toes and forefoot, contributing to pain and injury if not fitted properly, or if the dancer has inadequate strength through the toes. 

Here at CSSM, we work closely with our shoe fitters to determine the right shoe for our beginner dancers. This is why we undertake a highly detailed assessment of the dancer’s foot and biomechanics prior to sending them away for fittings. 

 

The anatomy of the toe 

The human toe is a complex structure made up of bones, joints, tendons, ligaments, and soft tissues. The big toe (hallux) plays a vital role in balance and propulsion. The small joints in the toes are especially vulnerable when subjected to repetitive load and unnatural positioning, as is required in ballet. Common areas affected include the metatarsophalangeal (MTP) joints, nail beds, sesamoid bones, and soft tissues at the toe pads, such as the tendons and ligaments. 

 

What causes toe pain in ballet dancers? 

Toe pain can stem from several sources: 

  • Improper footwear fit: a pointe shoe that is too tight or too loose can cause pressure points, friction, and inadequate support. 
  • Overuse injuries: repetitive strain from dancing en pointe can lead to conditions such as stress fractures, tendonitis, capsulitis, and sesamoiditis. 
  • Biomechanical issues: poor alignment, weak intrinsic foot muscles, or limited ankle mobility can increase stress on the toes. 
  • Technique faults: rolling in/out on pointe, improper weight distribution, or not fully articulating through the foot can contribute to injury. 

 

How can physiotherapy help?

As a Physiotherapist with a clinical interest in dance biomechanics and rehabilitation, my approach begins with a thorough assessment. This includes a biomechanical analysis, pointe readiness testing (if applicable), range of motion and strength evaluation, and a review of the dancer’s technique and shoe fit. 

From there, I develop a personalised treatment plan which may include: 

  • Manual therapy: to release tight structures or improve joint mobility. 
  • Strengthening exercises: especially for intrinsic foot muscles, ankle stabilizers, and core muscles. 
  • Technique correction: working closely with the dancer and their instructors to refine mechanics and reduce strain on the toes. 
  • Footwear assessment and referrals: recommending proper pointe shoe fittings or modifications, including toe pads and other accessories. If necessary, a further referral to our Podiatry team to assist with orthoses to reduce strain on the foot when not dancing. 
  • Education: helping dancers understand the importance of proper warm-ups, rest, and early recognition of symptoms. 

 

Conclusion 

Toe pain shouldn’t be a constant companion for ballet dancers. With the right Physiotherapy intervention and a holistic approach, dancers can find relief, improve performance, and continue to pursue their passion safely. If you’re a dancer struggling with toe pain, don’t wait—early assessment and targeted care can make all the difference. 

 

About the author

CSSM phsyio and Dance Program Coordinator Kelsey Thomas trained as a dancer for 17 years. “I’d always been interested in health and fitness and Physiotherapy was a great transition from Personal training into the treatment and rehabilitation of a lot of the issues I saw in the gym. It came with a stronger understanding of the human body.”

While sport is her passion, Kelsey believes that creating solid foundations of strength and rehabilitation are key components in maintaining a healthy lifestyle, whether you work in an office or as an elite athlete. “Having participated in a fair few sports over the years it’s given me a better understanding of the demands the body can be put through, the movements required to succeed and the difficult task of taking time away from the sport you love when injured.”

Kelsey employs a hands-on approach when treating muscular pains and joint dysfunction, complementing treatment outcomes with modalities such as cupping, dry needling, trigger point therapy, and taping. “I really enjoy the process of breaking down why the injury has occurred in the first place and rehabilitating the joint structures.”

 

References

Ayoub, C. (2021). Ballet Pointe Shoe Discomfort: an exploration through the use of real-time assessments while performing en pointe movements (Doctoral dissertation, Carleton University). 

Li, F., Adrien, N., & He, Y. (2022). Biomechanical Risks Associated with Foot and Ankle Injuries in Ballet Dancers: A Systematic Review. International Journal of Environmental Research and Public Health, 19(8), 4916. https://doi.org/10.3390/ijerph19084916 

Madden, K., Mayes, S., Cook, J., & Ferrar, K. (2024). The Effects of Pointe Shoes on Ballet Dancers’ Biomechanics, Muscle Activity, Movement and Symptoms: A Scoping Review. Journal of Dance Medicine & Science, 28(1), 57-71.https://doi.org/10.1177/1089313X231218305 

Parfitt, P. (2023). Do particular foot types (intrinsic factors) as well as extrinsic factors of training, flooring and footwear contribute to lower limb injuries in ballet dancers? (Doctoral dissertation, Anglia Ruskin Research Online (ARRO)).