The Perfect Pointe Book

All The Tips, Tricks And Exercises You Need To Know About Starting En Pointe

How Do You Deal With Bunions En Pointe?

Many girls who start on pointe are scared that they will get bunions from doing pointe work. If a bunion is present it can cause real problems with fitting pointe shoes and dancing en pointe. Dance Physiotherapist Lisa Howell discusses the reality of dancing with bunions and offers practical solutions to workin en pointe more comfortably.

Many girls who start on pointe are scared that they will get bunions from doing pointe work. Pointe work will not ’cause’ bunions, however if you do have a family presisposition to bunions (check out your Mother and Grandmothers feet!) then wearing ill fitting shoes (whether they are street shoes or pointe shoes) may hasten their development.

People usually say that they have a bunion if they start getting a lump out at the base of the big toe. You can get a ‘pseudo’ bunion by the rubbing of the pointe shoe if the wings are too short and do not come up to the level of the big toe joint, or wear a very narrow box. This causes the toes to be squashed together, and the ball of the foot sits above the box, rather than being supported within it. Often picking a shoe with longer wings and a wider box will help reduce pressure on the area, and the irritation will subside..

A ‘real’ bunion is when the end part of the big toe begins to angle in towards the other toes, and the knuckle of the toe (head of the first metatarsal) drifts away from the second metatarsal. The protruding piece of bone thickens and often gets red and irritated. Sometimes it may feel hot.

Several things are often present in the physical examination of a dancer with bunions.

1) Often she has quite mobile feet but tends to overturn the feet in first and fifth positions.

2) She may have good turnout range, but may not have the strength to use it in standing and when dancing.

3) If this is the case, when she is standing the rolling in of the feet puts pressure on the inner edge of the big toe and this encourages the drift towards the second toe.
4) If she has good turnout range she often walks with the feet slightly turned out, and rolls off the inner edge of the big toe, rather than pushing off from the underneath part of it.

5) The muscles that support her arch are usually too weak to support the foot, and especially the one under her big toe (Flexor Hallucis Brevis) is unable to assist the movement from demi to full pointe.

6) There is often an isolated restriction in mobility between the top end of the first metatarsal and the mid foot bones (Cuneiforms).

7) If there is reduced mobility of the big joint when attempting to go onto demi pointe, this often results in either sickling in, or sickling out en demi-pointe

8) The metatarsal of the big toe is often rotated in, and angled out away from the second metatarsal.

9) She may demonstrate poor pelvic stability, with the thigh, knee and foot rotating inwards with single knee bends in parallel.

Depending on how many of the above points are true for the dancer, she should commence a series of exercises based on turnout strength, arch control and control of the intrinsic muscles of the feet. Many exercises to target these areas are described in detail, with photos in The Perfect Pointe Book.

The dancer with bunions often needs mobilization of the mid foot to help re align the toe correctly, and then taping and padding in the shoe to keep the toe in alignment. There are various taping techniques that can be used to help the dancer with bunions. Many people use toe separators, and this may help prevent the big toe from crossing the second toe, however it does not solve the real problem. It is preferable to tape under the head of the first metatarsal, before drawing the tape up and over the knuckle, de-rotating the first metatarsal. The tape is then wrapped around the big toe. This often helps align the toe more correctly in the shoe. A tape can also be used to keep the head of the first metatarsal in closer to the second, to reduce the sideways drift.

Any padding should be in a donut configuration so as to distribute the pressure to the area around the bunion, rather than to increase the pressure on the already tender area. Create custom designed shapes by cutting pieces out of a simple foam rubber shoe inner sole that you can buy from the supermarket. They are cheap, comfy, and you can even get deodorizing ones. Cut a circle larger than the inflamed area, then remove the center portion so that there is no increased pressure on the inflamed area. Adhere the padding onto the foot to keep it in place with thin hypoallergenic white tape so that it does not slide around when dancing.

Having a family history of developing bunions is not a barrier to commencing pointe work, however the dancer must take special care of her feet to avoid early development of this often painful condition.

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.

Advertisements

32 Comments»

  theresa wrote @

I have a question: should a 12 year old with severe bunions go on pointe? I am concerned about her level of pain and injury later on.

  aireline wrote @

if your daughter has severe bunions she can try to go en pointe but if it hurts she will have to stop beacause it will cause major injury and result to no more dancing.

  Lisa wrote @

Hi Theresa

If your daughter has severe bunions at teh age of 12 I would not suggest progressing onto poiunte just yet. There is still potential to revert the positioning of her toes while she is still growing, so I would fouca all attention on that initially. Engaging the appropriate muscles to sustain proper alignment, a corective orthotic device and hands on work can drastically alter the shape of her feet. Check out the photos on http://www.theballetblog.com in the gallery under “sucess stories” to see just how much young feet can change with the right guidance!

Warmest regards,

Lisa

  Raina Steinmeier wrote @

I am 37 years old with bunions since age 10 or 11. Began ballet at age 7. Parents and teachers intervened at age 12 because of very similar problems as those described in your list items 1-9 above. I was never ever en pointe. I am now, after many years of a full life with varied dance experience, making the decision to have bunion surgery.

My advice to anyone reading this, whether parents, students, or adult dance enthusiasts like myself: please consider the possibility that dancing en pointe is not necessary. Yes it can be beautiful. Yes it’s an extraordinary achievement. However, if you have the passion to dance within your heart, you will have that passion for as long as you are living, breathing, and in touch with yourself. Pushing yourself to dance in pointe shoes if your body is not made for it, can potentially rob you of enjoying a fuller life complete with a long dance career.

So if you see bunions developing in your feet, or your students feet, or your child’s feet, don’t push it to get en pointe. Work at strengthening exercises as recommended. See multipe physical therapists who are knowledgeable about dance. Realize that your ability to dance in a healthy way is hinged upon your dedication to taking good care of yourself.

At the same time, don’t quit dancing all together. Try other forms of dance! Add some support to your shoes as-needed. Understand that your bunions will probably not “reverse,” all you can do is slow them down. So enjoy living. Enjoy dancing. Within reason. When I was younger, no one exposed me to the great modern dancers, to the influence of world-dance and jazz; I just thought the world ended with ballet. Then I went to college and discovered otherwise.

If your bunion gets to a point that requires surgery, don’t put it off to a point where it damages the rest of your foot. There is life after surgery. Also, the longer you put it off, the fewer options you have with regards to surgery. That’s another topic.

Lisa, after my surgery, I will definitely want to check out the exercises from The Perfect Pointe Book. Not because I ever intend to dance en pointe; but because I truly believe that the kind of strenthening I find in my body from very basic ballet technique is more powerful than any other physical therapy I’ve ever received. Please visit my blog for more of the story, http://extremebunions.typepad.com/extreme_bunions/

  Katelyn wrote @

I know that this is an old comment.. but I would like to disagree with you in some parts.. first of, lots of young girls these days dance ballet because of pointe shoes. all those years of training, they do it for the sake of going on pointe someday.

Second of, well, actually bunions are very common among dancers. I have lots of friends from different studios that deal with bunions. and looking from the way you said it, it’s like you’re implying that bunions are a dead end for those wanting to go on pointe. but I don’t think so.. being a healthy dancer and being a dancer for the sake of art are two different things. If anyone wants to be healthy, they can just treat every dance class like an exercise. they might as well just hit the gym and take dance classes there instead of taking classes in studios or dance schools. every ballerina trains to ‘distort’ their body to perfect her art. their bodies are tuned to meet the needs of choreographers and the art of dance itself.

bunions are nothing compared to the more serious matter like eating disorders and menstrual problems (due to eating disorder). these problems are really common among professional dancers. I know, because I have friends in some professional companies. their art is perfect, but in order to achieve such great achievement, they sacrifice their health.

and these ‘unhealthy dancers’ love dance as much as healthy dancers are. it’s just which one does a dancer prefer to be most? does she want to be a healthy dancer (like you) or a perfect ballerina? whichever you choose, you always get some and lose some. in most cases (unless you are blessed to born with a perfect dancer’s body and high metabolism etc etc etc) you can’t be a ballerina with perfectly tuned body AND be a healthy dancer at the same time.

  Jeri wrote @

My daughter has recently begun turnout exercises as she has noticed that her left foot has the beginning of a bunion. It isn’t bothering her but she’s concerned and would like it to go back to normal. Her pointe work doesn’t seem to bother her either. Do you have any advice other than the turnout exercises?

  Katie wrote @

Hi Jeri,
If she has no trouble on point I do not think there is anything wrong with doing it. But, you might concider going to an orthipedix docter and maybe doing some excercises

  Alana wrote @

I am 15 years old and have been dancing en pointe for 2 years. Two months ago, I noticed a bunion growing on my foot that began hurting after pointe class. I bought a spacer to separate my big toe from the second toe, but it is not making that big of a difference. What should I do? And several of those symptoms you described are occuring in classes other than pointe. How can I prevent them?

Thanks.

  YYP wrote @

Hi Liza
I am 28 years old and I am an adult dancer. I have only discovered that my big toe knuckle is growing bigger (not necessarily sideways but rather building “upwards”) after starting pointe. I have only done pointe on and off for 3 years and never more than 25 minutes at a time and only at the barre. Nobody in my family has bunions (nobody else dances either). I am pretty confident that my placement and feet are correct in technique class and I have been taking 1-3 technique classes a week for the past 6 years. I have mainly noticed the growth of the knuckle (bunion?) by trying on old skates and my first pair of pointe shoes and realising they are very tight at the knuckle. It isn’t painful, but only feels as pressure on bone = not comfy. So do you think I should stop taking pointe classes? Do you think I’ll otherwise might end up needing surgery?

Kind Regards,

  Michelle Howe wrote @

My daughter is 18 and has a bunion on left foot. Her big toe is now shorter than the two toes next to it. The two toes are taking all the weight and is becoming painful. What should she do?

  Savanna wrote @

In the few months or so, every time I go on releve on demi-pointe, my bunion realllyyyy hurts, but only the one on my left foot hurts. Could you please help me? Thanks! 🙂

  Rachel wrote @

Hello Lisa,

My daughter is 12 1/2 years old. She does not take pointe – yet. A year ago I noticed that her big toes (both feet) were pushed over towards the next toe and a bunion formed on each foot. She has been under the care of a podiatrist since I discovered this. She has had weight bearing x-rays, plaster casts were made of her feet to make custom orthotics for each shoe and she is very diligent about wearing the orthotics. She has also worked on strengthing her feet. In the year since this discovery, there has been no more growth of either bunion. One bunion is actually slightly better. One bunion is considered very mild, the other bunion is considered mild to moderate.

The podiatrist said that genetics (shape of her foot) is the culprite and not dance or her athletic activities. He actually said that walking and poor fitting footwear probably caused this condition and not dance.

The podiatrist is allowing her to start pointe, provided that she is diligent with the care of her feet, she maintains adequate exercise to keep the muscles in her feet in shape, wears a good fitting pointe shoe and stays under the care of a podiatrist. He is also recommending a toe spacer when dancing. Outside of dance, she will always need to wear sensible shoes (this for the rest of her life!) with the orthotics. Of course, he says that if pointe hurts, she will need to stop.

What is your opinion?

  Emily wrote @

Hello!
I am 15 years old and have been dancing en pointe for a little less than a year now. Every pair of pointe shoes that I have tried have just hurt my foot to the point of not even being able to stand en pointe in class. I thought this horrible, constant pain would lessen if I found the “right pointe shoe.” Unfortunately, my hypotheseis has been proven wrong over and over again. It isn’t just the bunions that have caused me trouble…my big toe (for some reason) is in constant pain. I would greatly appreciate anyone’s advice and tips!
Thanks! =]

  Ashlynne B. wrote @

I’ve been a dancer since I was 3 and a half and I had/have bunions. I am now 20 yrs old and at age 13/14 I had surgery to fix my bunions, though they came back in the end. And before the surgery I danced en pointe and still do. I had a double hit of genetics and poorly fitting shoes that caused mine. In all the years I have dance I have never had pain because of the bunions, and I had/have them on both my big toe and baby toe. So make sure if you are getting checked for the one have them check the other.

And I will say this the surgery didnt do much for me and it could result the same for anyone else. If you are thinking of the surgery I do suggest it, but at the same time I dont. And if you do, do it over summer for the three months of healing that is needed.

  Catalina López wrote @

Hi, I am 30 years old , and have restarted ballet lessons about 4 months ago. I am happier than ever, and I wish to start point shoes soon, as my teacher sais I am ready. However, I have a big bunion on my left foot, which always makes a bigger shoe size for that foot than for the other. I am looking for the right kind of pointe shoes with a wide box and platform to purchase. Any recomendations?

  Katy wrote @

Hi Lisa,

I hope you can help. I’m a bit concerned about getting a bunnion en pointe. I just started and I have a family history with them. I want to prevent it if possible. Do bun heads toe separaters work? If so which kind? I think they may take too much space in the shoe… Do you know anything else that works? I have griskos and with a rather thck gel padding they fit well. Do you think I would have to get new shoes? I really want to get your system and I think it is great!

Thanks,
Katy

  brittany wrote @

Hi lisa,
I have been dancing on pointe for about two months and I have noticed that my toes are beginning to get very spread out. I was wondering if you might know what is causing this. I wear tennis shoes with good arches everyday and I take pretty good care of my feet. I have chacott veronese pointe shoes. Please give me some advice.

Thanks,
Brittany

  kathleen wrote @

Hi,
I have been dancing en pointe for 3 and a half years. My family has a history of bunions and i have been getting them too. Im 13. Its really hard getting fitted for pointe shoes and when i always take them off theyre dark red or bright white like theyre inflammed. What can i do to help them and ive tried the gel spacers they didnt help muchy. What kind of wrapping should i do?

Thanks

  Mandy wrote @

Hello 😀

I’m a 14-year-old ballet dancer, been dancing since I was 12 and I’m going on pointe this January. What I want to say is, I was born with bunions in both feet (they’re not really big and they didn’t hurt at all) and I have a fairly narrow heels. I’m worried, could I really get on pointe with these kind of feet? Oh, and my feet were Greek type (which means my 2nd toe is longer than all 5) if that matters.
Can anyone please help me?

Thanks before 🙂

  Stacey wrote @

Hello I definiately need some advice here. I’m 21 years old and I have had severe bunions since I can remember. I have been dancing since the age of 13 and I’m considering taking a pointe class. My bunions are severe enough that I am on a waiting list for surgery. I know pointe is not the best dance for your feet, but I was wondering if it is possible to do pointe without furthering any damage that has already been done to my feet.

  Amber wrote @

Hiyaa!
I am 12 years of age. I am considering doing pointe. I have a foot growth check with my padiatrest. Also a pointe shoe fitting. I really do NOT want a bunion! I have been dance ballet for 10 years also in those years I have also done Jazz, Hip Hop and Modern. So I have quite a bit of experience with dance. It is my life. So my question is how do I prevent a bunion from forming? Is their any way?

P.S . I need help ASAP

  Amanda wrote @

Hi Lisa

My names Amanda im 17 and im thinking about starting ballet.. Now i was born with bunions on both feet.. had sergury on my left foot about 3 years ago and as my right foot isnt as bad so they didnt operate . But now i have 2 pins in my foot and i was wondering.. if i do start ballet will i ever be able to start pointe with the pins in my left foot?

Thanks Amanda xx

please help me , asap!!!! xxx

  Sika wrote @

my second toe is longer than my big toe and it makes point abit painful and harder to get on the box of the shoe what should i do also my ouchc pouches dont feel as padded anymore

  Meg wrote @

Hi-
I’m fifteen years old and I have been taking ballet since August now. I just got the OK from my teacher to move onto pointe work, but I am TERRIFIED of bunions. I don’t know if I should not go on pointe (as much as it would pain me) or if I should give it a shot. I don’t think we have a bunion problem in our family……………. What do you think?

  Ellie wrote @

Hi I am 16 years old and I had bunion surgery four years ago. I have always wanted to do pointe and I’m enrolled to take pointe this year. Do you thnk I will be able to dance in pointe shoes?

  shelby wrote @

Hello, I’m new to this website. I feel it has been very helpful thus far but i must ask…I am developing bunions on both feet. I have been dancing en pointe for 10 years now. I would like to know if it’s time to give it up for the sake of my feet or should I just continue through the pain, and try those exercises. I feel like I’ve had a good run but I’m not sure I’m ready to give it up. Help please!

  Haruhi wrote @

Hi,
I’m 15 (I’ve been en pointe for around 3 months). I have developed a bunion from pointe work (my second pair of pointe shoes didn’t fit very well, since I had to switch brands) and I just wanted to say that bunions really aren’t that big a deal. Follow Lisa’s instructions- they’ll help. Also, a pointe shoe with flexible wings (like Capezio’s Plie II) REALLY helps make pointe more comfortable for those of us with bunions.

  Jeannie wrote @

My teacher said that when she was on pointe her foot got smaller one size then when she said I am going on pointe I am starting to freak out and I am starting to think will I walk in a unbalance way or what will happen??

  Chrystal. wrote @

Hi. I’m 14 and I’ve rated growing bunions. How can I stop them from growing too big? And do toe spacers help stop the growth of bunions?

  Elia wrote @

Hi!
I’m 15 years old and I’ve been en pointe for 2 years. I didn’t even think about the fact that I have bunions until my friend mentioned it. I’ve had them all my life. My mom has feet identical to mine (though she was never a dancer) and my dads mom has horrible bunions she had to have surgery on. Anyway, my bunions have never bothered me or been painful and I definitely want it to stay that way. So I’m wondering if I should be using any extra padding or doing anything special to prevent severe bunions and the associated pain in the long run. Thanks!

  Jemma wrote @

Hi, I’m nearly turning 14 this year and I have in got bunions form my grand mother, then are quite small and I have had them for a while and I’m technically ready for pointe I can give it a try if I want, but I wanted to know how much pain it could be in a pair of pointe shoes and what to do.

  Katey wrote @

I have a bunion on my pinki toe and and it really hurts in my pointeshoes is there any way I can prevent it hurting.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: