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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. 

  1. 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


  1. 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. 

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