En Pointe: What Ballet Dancers Should Know About Injury Prevention

As students head back to school, many dancers head back to the studio and a vigorous training schedule. Regardless of preferred dance method, studies show a high incidence of ankle/foot injuries, ranging from Achilles’ Tendonitis and plantar fasciitis to everything in between. Quite often we see an increase in ankle/foot pain with young ballet dancers as they transition from demi-pointe to en pointe. During the initial physical therapy evaluation, we often find decreased triceps surae/posterior tibialis strength and/or decreased plantar flexion active range of motion. These deficits often contribute to faulty mechanics, including increased ankle inversion/eversion compensation (rolling in or out) in efforts to get en pointe and/or maintain position, decreased stability once there, knuckling under (excessive interphalangeal joint flexion compensation), and/or decreased plantar flexion rom to allow ideal positioning of body over toes. **

** Fun fact: Elite female ballet dancers average approximately 97 degrees of active ankle plantar flexion (Clippinger-robertson, 1991). Achieving at least 90 is considered desirable for optimal body placement for demi-pointe and pointe (Clippinger, 2007). For an average human, 40-50 degrees of active ankle plantar flexion is considered normal.

Outlined below are some simple strengthening and stretching exercises for the ankle-foot complex that can help those beginning pre-pointe work and those already performing pointe work away from the barre. We recommend performing strengthening exercises 2-3 times a week, and stretching exercises daily in conjunction with your dancer’s current conditioning routine. 

1. Resisted seated plantar flexion – Sit with resisted elastic/band around the ball of your foot, band pulled taut, holding elastic in hands. Push foot forward, rolling through the entire foot maintaining a neutral position. Pause at the end of your movement, and slowly return to start. Slower is better both concentrically and eccentrically during the movement. 

2. Resisted toe extension – Sit with resisted elastic/band looped around big toe. Keeping band taut, pull great toe up towards ceiling. Perform 10 repetitions on the big toe first, and then progress to remaining digits

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3. Seated plantar flexion stretch – Sit with right leg crossed over left leg, grasping heel. Slowly push right foot into plantar flexion (pointe) until a gentle stretch is felt across the top. Hold for 20-30 seconds, relax and repeat two additional times before switching sides. 

Janie Bostian, PTA, CKTP is a physical therapist with OrthoCarolina Huntersville. Janie studied under the Cecchetti method of ballet for approximately 15 years, and is certified in the Pilates Method.