Dancing and bunions
BALLET – Will dancing in pointe shoes give me bunions?
Often, many dancers (and their parents) are concerned that dancing en pointe will cause a permanent foot deformity in the shape of a bunion. Let me preface this blog by firstly saying, no – pointe shoes do not have to give you bunions, however they can certainly increase your chances of gaining one. This article will discuss in more detail what bunions are, factors that can cause them, how to prevent them and how to treat them.
What is a bunion 
A bunion, otherwise called “Hallux valgus” is a common foot deformity that occurs both in dancers and in non-dancers. Hallux valgus is a progressive deformation of the first MTP joint (the bone that attaches to your big toe). The joint is gradually pushed outwards away from the foot whilst the toe point inwards – this results in a bony prominence on the inside of the foot. The formation of bunions can lead to foot pain and problems with wearing some footwear.
What causes them
Genetics play a role in the formation of bunions –if your parents have bunions, this increases your risk of developing one. Footwear, biomechanics and loading are the other factors which lead to bunions which we will discuss in more detail below.
Anatomy and biomechanics of the feet
“The human foot is a masterpiece of engineering and a work of art” – Leonardo Da Vinci.
The foot is not rigid, it is mobile and dynamic which allows it to absorb elastic energy stored from the ground. The structure of the foot has enabled us to perform all sorts of athletic feats – however dancing on your toes is not a natural movement that anyone can do safely without proper training.
The dome of the talus is wider anteriorly than posteriorly (wider at the front than at the back) which is relevant as it is more stable in standing in dorsi-flexion than in plantar-flexion which is the position you are in on point. This highlights the extra importance of having strong feet before going on pointe.
Foot strength
“The evolutionary development of the arch of the foot was coincident with the greater demands placed on the foot as humans began to run” – McKeon et al, 2015). The movement and stability of the arch is controlled by intrinsic and extrinsic muscles. When you start dancing en point, the amount of pressure on the toes does substantially increase the risk of toe deformities if your feet are not strong enough to hold correct placement within the shoe to avoid the shoe twisting on the big toe joint. Optimal foot placement is only possible with strong feet, good technique and careful selection of shoes specifically selected for the individual dancer.
Common problems which increase bunion formation:
Technique in Turnout “Forcing” your turnout though pronation of the foot or rolling the arches of your feet and “Screwing your feet around” in turnout position which over stretches the joint of the big toe.
Toe crunching – Leaning on the toes during a tendu or moving from second or derrière. This can easily happen in flat shoes as well as pointe shoes and will increase your risk of developing a bunion.
Walking – Walking in a turnout position is a common sight I see in many Dancers. This is not a good habit to get into as it causes you to roll off your big toe when walking turned out rather than pushing off the big toe.
Shoe fit – It is extremely important to have pointe shoes which fit correctly – never borrow another girls pointe shoes or let another girl borrow yours as they will eventually mould to the dancers foot with time. Things to look out for in pointe shoes is that the “wings” come up high enough, the toe box is not too wide or too narrow and is the right shape. If the wings are too short the big toe will be squeezed towards the other little toes and the joint will get over stretched. If the toe box is too big, then your foot will slide down and this will crush your toes. If the box is too narrow then your toes will be squashed in, even in standing you will feel this. If the box itself is the wrong shape then this can compress the foot sideways whilst leaving too much room at the top. Make sure you have a professional fitting – it will make your ballet performance much better as well as make your feet more comfortable
Once a bunion is there:
It is possible to reverse a bunion if you are child and it has only recently developed. As we get older it is more difficult to reverse a bunion formation. Careful taping in a donut shape around the bunion can help to relieve the pressure pain during dancing. Do not tape directly over the bunion as this can often be very tender and may worsen the situation. If you are developing foot pain, it is important to address it early as there are many factors which can play into the causation of sudden foot pain, foot deformities and other long-term foot problems.
Take home message:
Before starting on pointe, make sure that your feet are strong, you have purchased the right footwear and you have completed a pre-pointe assessment by a trained professional to help address any weakness or potential causes for future injury. We are lucky to live in a time where there is in depth knowledge about injury prevention and training so that dancers now can dance their whole lives, injury free with beautiful feet for life.
Ref: McKeon PO, Hertel J, Bramble D, et al. The foot core system: a new paradigm for understanding intrinsic foot muscle function. British Journal of Sports Medicine 2015;49:290.