As a Dance Educator and Dance Physiotherapist, one of the most common queries I get is… “I have ‘flat feet’. Is pointe work a no-no?”. The answer to this can be yes, or no. It really is a “that all depends” scenario. This is due to the fact that there are basically two types of ‘flat feet’.
Each foot is made up of many bones, held together by strong ligaments and then supported by the small intrinsic muscles of the feet. They are further supported and influenced by the extrinsic foot muscles that have their muscle belly further up in the calf, and tendons into the feet. The ability of a dancer to safely progress onto pointe depends more on the combined support of all of these factors, rather than the exact shape of the foot.
Some dancers (and people in general) do have anatomically ‘flat feet’. This is  usually genetically based, and often there are visible racial trends. Some girls will tend to have a flatter curve to their arch in standing due to the actual shape of the bones in their foot, and no matter how strong the small foot muscles get, the shape of the foot will not change significantly. If this is the case, pointe work is still possible, assuming all the other requirements for pointe are achieved. The foot will perhaps not have the optimal appearance en pointe that many companies desire, however, the dancer will be reasonably safe en pointe. In this situation the ligaments should be stiff enough to help stabilize the foot, and the dancer must have good control of the small muscles of the foot.
Other girls will have the appearance of a ‘flat foot’ due to the presence of very mobile ligaments and poor muscular support. This kind of mobile foot can be developed to look great en pointe when very strong, however a girl should not be allowed to progress onto pointe while the foot is so weak. This foot often looks reasonable (or even very good) in a demi-pointe position, however the arch control drops as the dancer drops her heel. Specific strengthening of the arch and isolated control of the muscles supporting and controlling the toes is essential before commencing pointe work. These dancers usually have increased mobility in many other joints in their body, and may have problems in their knees or back due to increased movement and decreased stability in these joints.
In addition, some girls have a very high arch to their foot, yet are very weak in the small muscles of the feet. While it may appear that they have good control of the arch, as it does not roll in en fondu, it must be ensured that the foot is actually strong enough. Many girls have such stiff ligaments in their feet that their arch is rigidly held in place, without any muscular support. There is little movement between the bones en fondu, and because of this they can be prone to foot, ankle and knee injuries,  due to the lack of shock absorption in allegro and pointe work. This dancer must work on the mobility and strength of the foot prior to attempting pointe work.
To assess the true nature of any ‘flat foot’ takes skill and practise, and is ideally done by a trained medical professional. Instead of simply looking at the shape of the arch, it is important to take a look at the position of the heel bone (Calcaneus) and the relative position of the next bone in the foot (the Talus). The Achilles Tendon should fall in a relatively straight line when viewed from behind, but may appear to have a significant curve at the level of the ankle, if the heel and the arch are rolling in. The dancer must be able to maintain a good position of the Talus in standing in parallel and in turnout, en fondu and with petit allegro to demonstrated adequate control of any shaped foot.
It is essential that each dancer learn the strengthening exercises relative to his or her type of foot, and be aware of the implications of their body type before progressing onto pointe. This is often difficult for dance teachers to do with each child individually, so if there is access to a Physiotherapist/Physical Therapist or Sports Doctor who is familiar with dealing with dancers, an assessment is advisable before commencing pointe work.
Lisa Howell (B.Phty) is a Physical Therapist (Physiotherapist) based in Sydney, Australia, who specialises in the assessment and treatment of dancers of all ages, from young students to professional level, and teachers. She is dedicated to the education of dancers to help prevent injury, and to develop optimal performance at every level. She produces a FREE weekly dancers newsletter with tips on all aspects of dance to help spread her knowledge to the world. To find out more about “The Perfect Pointe Book” or to receive the newsletter, go to http://www.theperfectpointebook.com.