How Ballet Affects Your Feet

From the audience’s view, a ballerina dancing seems almost effortless.

But the truth is, each step, move and position takes a great deal of effort, precision and skill. And as any dancer who’s trained in ballet will tell you, this dance style requires an immense amount of strength and coordination from your feet.

Aside from the potential for different types of injuries, years of ballet training can also cause your feet to change over time or even become malformed — often referred to as “ballerina feet.” If you’ve been dancing all your life, you may have even heard this phrase used with a sense of pride.

But years of ballet dancing come with risks, so it’s important to make sure you’re taking good care of your feet.

Sports physical therapist Jessica Waters, DPT, explains how ballet changes your feet over time, as well as how you can avoid injury or long-term damage.

What is ‘ballerina feet’?

Ballerina feet — also known as ballet dancer’s feet — isn’t an official medical diagnosis, but the term refers to the physical effects that result from the intense training and demands of ballet dancing. This can happen due to many elements involving the art of ballet, from footwear to specific techniques and positions.

Some of the common, more visual changes of ballerina feet include:

• Pronounced arches.
• Nail hardening and discoloration (mycotic nails).
• Dry, cracked soles.
• Shortened toes.
• Blisters on the toes and balls of feet.
• Ingrown toenails.
• Corns and calluses.

These changes typically happen due to poorly fitting footwear, improper training conditions and practices, and intense performances.

Can ballet cause long-term damage to the feet?

Beyond just external damage and aesthetic disfigurations, there are also severe injuries that many ballet dancers are prone to, which can also play a part in affecting your foot health long term.

Some examples of long-term damage that can be caused due to incorrect technique during ballet training include:

• Bunions: Ballet dancers may develop hallux valgus — also known as bunions — which are bony bumps that form at the base of your big toe. This can cause pain, swelling and difficulty wearing certain types of shoes.
• Hammertoes: Hammertoes occur when your toes become permanently bent, making it difficult to straighten them.
• Plantar fasciitis: Ballet dancers may develop plantar fasciitis, which is an inflammation of the tissue that runs along the bottom of your foot. This can lead to chronic pain, stiffness in your foot and difficulty walking or dancing.
• Stress fractures: Repeated stress on the bones in your feet can lead to stress fractures, which are small cracks in the bone. These usually cause a lot of pain and swelling and require rest for long periods of time to heal properly.
• Achilles tendonitis: Ballet dancers may also develop Achilles tendonitis, which is an inflammation of the tendon that connects your calf muscle to your heel bone, leading to pain, stiffness and difficulty walking.
• Sesamoiditis: Overuse of the bones in the ball of your foot can cause chronic inflammation. If left untreated, surgery may be required.

Why does this happen to ballerinas‘ feet?

The very art of ballet relies on dancers knowing proper technique, strength and balance in order to perform movements properly. Excessive stress is placed on the foot due to various positions or poor technique at the hip and knee. This in turn can lead to injuries and strains on the foot.

“If you compare across genres, ballet is documented to have predominantly foot and ankle injuries,” notes Dr. Waters.

Further, the stress that a ballet dancer’s feet can go through can happen due to either overuse or specific injuries — or a combination of both.

Overuse injuries in ballet

According to Dr. Waters, one of the biggest differences between ballet and other sports is that there’s a higher risk of overuse injuries. This is when a part of the body (in this case, the foot) gets pushed to its limit physically, without enough time to recover.

Common ballet positions that put strain on your feet include:

• Pointe work: Pointe work involves dancing on the tips of your toes while wearing pointe shoes. This requires a great deal of strength, balance and flexibility in your feet and ankles, and can put a significant amount of pressure on your toes, ball of your foot and ankle.
• Relevé: Relevé is a basic movement in which the dancer rises onto the balls of their feet, lifting their heels off the ground — essentially, putting their entire weight on the balls of their feet. This puts a lot of pressure on your toes, ball of your foot and arch, and causes a compression of the tissues behind your ankle.
• Passé: Passé, which means “to pass,” is an action of moving and holding your leg at the knee and then placing it back around. This is a fairly basic movement that many dancers use and it requires a lot of balance and control. When it’s being held for a long time, it can put a lot of pressure on your foot and ankle.
• Plié: Plié is a basic movement in which your knees bend and your heels remain on the ground. This also puts a lot of pressure on your feet and requires a great deal of strength and control.

Injury

Aside from overuse, there’s also a risk of injuries happening due to specific traumatic falls — say, a move goes wrong and a dancer takes a tumble or twists their foot in the wrong direction. A lot of times, this happens due to a dancer landing incorrectly from a move or something being wrong with their footwear.

“Placing your center of mass on a 2-inch square space can lead to ankle sprains and various injuries,” explains Dr. Waters. “There is a lot of load through the tissues in this position.”

Ballet dancers are usually at risk for an array of foot injuries, including foot fractures, ankle sprains and torn ligaments. But as Dr. Waters notes, often, these specific traumatic injuries are closely tied to problems of overuse in the foot. “Sometimes, those overuse injuries had an acute incident that wasn’t managed.”

This may happen because ballet dancers may feel pressured not to skip any practice or rehearsal, even if they’re experiencing pain. In addition, many dancers aren’t able to use braces or orthotics because of costumes, footwear and artistic requirements.

Pointe shoes

One of the most unique elements of ballet is the shoes. For dancers who specifically practice the pointe technique, they must wear pointe shoes, which are usually made of satin, leather and cotton. Compared to other dance shoes, pointe shoes provide a specific type of support for dancers to be able to do certain challenging moves because of the toe box. This is the part of the shoe that holds the dancer’s toe and provides a platform to be able to balance on their toes.

But as Dr. Waters points out, “Pointe shoes come with their own inherent risk as far as foot and ankle injury goes. The shape of your foot will determine the shape of your toe box.” So, it’s very important this is taken into account when choosing your pointe shoes. “If you have a wider foot, but select something that’s more narrow, that can have ramifications that can lead to things like bunions,” she continues.

Plus, if your shoes don’t fit right, this can cause you to lose control during routines and lead to ankle or foot injuries. Consistent stress from pointe shoes — especially if unaddressed — can lead to long-term damage and serious injury.

How to treat and prevent ballet-related foot injuries

Just like with any sport or intense physical activity, proper foot care and technique are absolutely key in making sure that your feet stay healthy and supported. A ballet dancer’s feet require a good amount of TLC and attention to avoid injuries and relieve stress and pain.

Dr. Waters lays out ways to lessen your risk of pirouetting into any foot injuries while dancing:

1. Build hip strength. Your hips are a big factor in foot health if you’re a dancer. “Hip strength provides you with significant support from the top down,” she explains. Especially when you’re doing difficult moves and turns, if your hip isn’t steady and in control of the movement, it’ll cause your foot to work extra hard.
2. Practice banded exercises. Place elastic bands around your feet and ankles while you warm up as a way to strengthen and create balance. Along with strengthening your muscles and helping you prepare for pointe, banded exercises can improve stability and control of your feet and ankles, which can help improve balance.
3. Try toe yoga. After hours and hours of dancing, your toes take on a lot of pressure as a ballet dancer. Toe yoga is a set of exercises designed to improve the strength and coordination of the intrinsic muscles of the foot.
4. Take care of your skin. It’s also important to keep the skin and nails on your feet happy and healthy. Make sure to moisturize regularly, keep your feet clean and toenails clipped after every practice. Plus, try and go easy on your feet when you’re out of the ballet studio — go for more comfortable, supportive shoes for everyday wear. “Make sure to monitor any kind of blisters or any signs of infections,” advises Dr. Waters.

When is it a sign of something serious?

If you’re a seasoned dancer, you probably have an immense amount of patience and self-discipline for performing. But it’s also incredibly important to take note when any symptoms are becoming more severe and pointing to a bigger issue. The important thing is to check in with your body after each routine or practice.

Be sure to see your healthcare provider or physical therapist if you experience any of the following symptoms:

• Severe pain. The pain is there for a reason, so don’t ignore it. If the pain in your foot is severe and doesn’t go away with rest, ice or over-the-counter pain medications, it may be a sign of a more serious injury.
• Swelling. If your foot is swollen and there’s visible redness or warmth in the affected area, it might be a sign of inflammation or infection.
• Numbness or tingling. If your foot feels numb or tingly, that’s something to take note of as well. Not being able to feel your foot may be due to nerve damage or compression.
• Limited range of motion. If your foot feels stiff or it’s difficult to move in certain directions, it may be due to a muscle or joint problem.
• Discoloration. Keep an eye on any changes in the color of your skin or nails, such as darkening or yellowing. This may be pointing toward a fungal or bacterial infection.

Here’s the bottom line: If you’re a ballet dancer, chances are your feet are going through a fair amount of stress. But it’s important to know the proper techniques and self-care practices to do so you can stay “en pointe” — both through your dance routine and with your overall foot health. Be sure to keep your healthcare provider updated with any changes, pains or concerns you may have with your feet as you continue your practice.