Sports Medicine Association Singapore (SMAS) is the registered society for Sports Medicine and Sports Science professionals in Singapore. Our members represent and embody the multi-disciplinary spirit that is key to the specialty. Our integrated community includes doctors, physiotherapists, podiatrists, sports nutritionists and dieticians, exercise physiologists, sports scientists and sports psychologists. We are a non-profit organisation committed to the promotion of quality Sports Medicine and Sports Science education to the sporting community in Singapore and beyond. c/o Department of Sport & Exercise Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889
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Oh the coveted pointe shoes. After years of hard work, it is every little ballerina’s dream to be told by the teacher that they are ready to start pointe. Yet we have all heard stories the likes of Black Swan (the movie), with dancers having blisters and losing their toenails from the torture of pointe work. This article hopefully provides some insights into what exactly are these special shoes, and how do we reduce incidences of bloody toes.

Why do dancers wear pointe shoes?

The simplest answer is to look nice, but more importantly it allows them to dance on the tips of their toes. This extends the line of the legs, creates an illusion of lightness and a sense that the ballerina is floating in the air.

What are they made of?


The tip of the shoe is a rigid box made of densely packed layers of fabric, cardboard and glue (not wood or metal),  much like paper marché. The shank/sole is made of cardboard, glue and leather to provide hardness and support. The rest of the shoe is made of leather, canvas and covered in satin to give an aesthetically pleasing look. The shoe needs to be strong enough to support the dancer on pointe, yet malleable enough for the dancer to articulate the joints of the ankle and foot. Most parts of the shoe are hand-made, and no two pairs of pointe shoes are identical!

How do dancers prepare the shoes for dancing?

New shoes are pretty, but impossible to dance in as they are too rigid, thus dancers do various things to “break-in” the shoe to make them danceable. This includes sewing on ribbons and/or elastics to hold the shoe in place, with the ribbons usually being sewn at the highest point of the arch to help support the arch. They also darn the platform to create friction and protect the satin, followed by wearing and performing rises and releves to soften the box and shank in a natural way that will mould the shoe to the shape of the foot and arch.

When can dancers start dancing on pointe?

For young dancers, it is usually somewhere between the age of 11 and 13. This usually works out to about 5 years of ballet specific training, coincides with puberty, and the commencement of ossification of the soft bones in the foot. Many adult beginners or “returners” aspire to go on pointe as well, and while they are past the age of bone maturation, they should still ensure that they have a few years of good basic technique training before attempting pointe. Whether young or old, it is essential that the dancer have adequate flexibility in the ankle and foot, good strength in the lower limb and torso, good balance/proprioception, and good technique to handle the stress of dancing on her toes.

Without adequate ankle and arch flexibility, one would have problems getting up to the platform of the shoe in order to balance on pointe. This leads to either dancing on the edge of the shoe, or compensation to get on the platform. This is can be achieved by not straightening the knee, or scrunching from the toes or metatarsals. This discourages the use of the intrinsic muscles of the foot, and can lead to overuse injuries of the long toe flexors arising from the lower leg, also known as shin splints.

Without adequate strength of the plantarflexors and intrinsic foot muscles, one would find it hard to roll up onto the platform, causing one to “sit” or “sink” into the shoe. This puts excessive weight and pressure on the metatarsals, toes and toenails, which can lead to metatarsal stress fractures (usually 2nd metatarsal), blisters and blackened toenails. For dancers with very flexible ankle joint and arch, all the more they need to be strong, to prevent them from falling over the shoe. Adequate strength of the medial (tibialis posterior, flexor hallucis longus) and lateral (peroneus longus and brevis) muscles of the foot is also essential to help stabilise the foot on pointe. This helps to prevent sickling in/out, which puts excessive strain on the tendons and ligaments of the lateral ankle/foot, leading to strains and sprains.

Not getting on the platform, correct, and falling over the platform

Sickling outwards putting excessive strain on the medial ankle, correct, and sickling inwards putting excessive strain on the lateral ankle.

Biomechanics of pointe

Dancing on pointe requires complete plantarflexion of the ankle and foot to a combined minimum of 90 degrees, to create a straight line down from the hips through the knees to the tip of the toes. The ankle joint is stable in this closed packed position as the posterior lip of the tibia locks onto the posterior talus and calcaneus. The vamp and sole of the shoe provides support to the lisfranc and metatarsals joints, stabilising the mid and forefoot on pointe. The toes are in a relatively neutral to slightly flexed position, allowing the toes to be perpendicular to the floor and not curl when on pointe.

We hope you have enjoyed the article! This is the first of our two-part series on pointe shoes. Be sure to check back for the second part next week, where we talk about the importance of having your pointe shoes fitted, how long do pointe shoes last and how to increase the lifespan of your pointe shoes.