As soon as a ballerina mentions bunions (technically known as hallux valgus), everybody jumps straight to pointe shoes as the leading cause… but do our pointes really deserve such a bad rep?
This first crossed my mind when I began working as a pointe shoe fitter in a dancewear store…
I started noticing that many dancers who were coming for their FIRST pointe shoe fitting already had bunions, whilst at the same time observing how a fair few male dancers in need of ballet flats also had whopping bunions despite never having danced en pointe.
If I were a judge, I’d say that the evidence points to something besides pointe shoes as the leading cause of the crime that is bunions in ballet dancers. But what exactly?…
Cause #1 – Forced turn out
Yes your honour, I am guilty too… maybe we’re all just a little bit guilty of forcing our turn out every now and again for the aesthetics!
In ballet, the ideal turn out is, well, basically as turned out as is physically possible. As a number this would be around 180⁰, which is approximately half of the whole pizza (instead of that teeny pizza slice that was acceptable in Grade 1).
However, achieving 180⁰ turn out (which is actually totally unnecessary) requires a lot of strength in the external rotator muscles of the hips and glutes, and even then, some people just don’t have the anatomical bone structure that is needed for such extreme turn out.
This often leads to dancers ‘forcing’ their turn out, which means twisting at the knees, ankles and feet to achieve the oh so desired 180⁰, instead of working within their current range of mobility and strength.
Now this is dangerous for several reasons and often results in injury, however in terms of bunion-creation, forcing turnout can lengthen the foot and ankle tendons which support the medial (inside) and bottom of the foot (Maddocks, 2017).
This lack of support becomes especially problematic when combined with the increased force we place on the 1st metatarsophalangeal joint (bunion bone) when we jump or stand en pointe, leading to bunions (Maddocks, 2017)!
Cause #2 – Allegro
In ballet we jump A LOT, and much repertoire (especially for male roles) is very allegro-heavy.
Jumping with the correct technique involves pushing off and landing through the toes, and as touched on earlier, this can lead to increased pressure and repetitive stress to the 1st metatarsophalangeal joint (1st MTPJ), contributing to the formation of bunions (Li, Adrien and He, 2022)!
Trauma to the 1st MTPJ from repetitive jumping can also lead to poor joint alignment, exacerbating bunion formation (Li, Adrien and He, 2022).
Cause #3 – Relevé
During ballet class, I’d estimate that dancers probably spend more time en relevé than on flat feet.
This could be a leading cause of our bunions, where the relevé position requires dancers to move through the full range of motion of the 1st MTPJ joint (Li, Adrien and He, 2022).
Ordinarily, standing on our tippy toes every so often doesn’t cause a problem for most people. However, when we are doing it over and over and over again, the overuse of the 1st MTPJ through its full range of motion can result in hallux valgus (Li, Adrien and He, 2022).
Cause #4 – Ballet Flats
So ballet flats are angels and pointe shoes are the devil, right!?
Actually, our beloved ballet flats aren’t so innocent, and may be contributing to the formation of bunions…
Yes, our super tight and cozy canvas ballet flats do make our arches look GORGEOUS when we point our toes. However, when we stand on demi pointe and our toes naturally spread out, the snug fit of our ballet flats squishes them back together and restricts any expansion (Maddocks, 2017).
This squishing of our toes once again leads to more tension on the 1st MTPJ, potentially leading to bunion formation (Maddocks, 2017).
Cause #5 – Pointe Shoes
Okay, so they might not be the sole culprit, but they’re definitely up in the running for the main causes of bunions in ballerinas!
When we stand en pointe, we suspend our weight over the platform of our pointe shoes.
Now, because our big toe is (usually) the longest toe, it ends up supporting a whole lot of our body weight when we’re stood en pointe.
This body weight places a lot of pressure on the 1st MTPJ, often leading to bunion formation (Maddocks, 2017).
Finding a pair of pointes that fit properly is essential for preventing bunions. Ideally, we want the box of our pointe shoes to fit very snugly around our feet (imagine a tight hug but not so tight that the toes are squished out of a flat line).
That’s because a snug box suspends the foot off the ground so that the weight of the dancer doesn’t drive down through the big toe as heavily, reducing pressure on the 1st MTPJ.
So what can we do about it?
I know… bunions are sounding pretty unavoidable at this point. Bleak, right?
Well, fear not because there is something we can do to ward them off!
And that thing is… strengthening!
Strengthening the intrinsic muscles of the foot prevents the foot from supinating (rolling inwards) given the increased strength in the foot arch, which in turn provides greater support to the big toe, reducing the risk of bunion development (Journal of Orthopaedic & Sports Physical Therapy, 2016).
Foot doming is one of the best exercises we can do to activate and strengthen the intrinsic muscles of the foot…
When doming the foot, it’s important to lift the arch whilst remembering not to bend or scrunch up the toes. It’s this movement that activates and strengthens the intrinsic muscles, as bending the toes would make the exercise ineffective and pointless.
Step 1) Place the foot flat on a solid surface.
Step 2) Lift the arch of the foot as high off the floor as possible without bending the toes. The tips of your toes and your heels should be the only parts of the foot touching the floor, while the remaining midsection of the foot should create a dome shape.
Step 3) Repeat.
For more of my favourite exercises to strengthen the intrinsic muscles of the foot, head over to The Best Foot Strengthening Exercises for Dancers
Final Thoughts
It’s true, ballerinas are prone to bunions… but we can’t solely blame our pointe shoes!
Therefore, it’s super important that we consistently work on strengthening the intrinsic muscles of the foot to improve support in the arch and the big toe, helping to reduce pressure and tension on the 1st MTPJ to prevent bunions!
**FRIENDLY DISCLAIMER: All information, guidance or advice provided on this site is for informational and educational purposes only. Any images, including the featured image for this post, are for entertainment purposes only. The use of this information is at your own risk.**
References
- Fengfeng Li, Ntwali Adrien, Yuhuan He. (2022). Biomechanical Risks Associated with Foot and Ankle Injuries in Ballet Dancers: A Systematic Review. International Journal of Environmental Research and Public Health. 19(8), pp.1-10. [Online]. Available at: https://www.mdpi.com/1660-4601/19/8/4916 [Accessed 26 October 2024].
- Journal of Orthopaedic & Sports Physical Therapy. (2016). Bunion: Strengthening Foot Muscles to Reduce Pain and Improve Mobility. Journal of Orthopaedic & Sports Physical Therapy. 46(7), pp.500-608. [Online]. Available at: https://www.jospt.org/doi/10.2519/jospt.2016.0504 [Accessed 27 December 2024].
- Maddocks, M. (2017). Bunions in Ballerinas: it’s not really the shoes!. [Online]. International Association for Dance Medicine & Science. Last Updated: 27 February 2017. Available at: https://iadms.org/education-resources/blog/posts/2017/february/bunions-in-ballerinas-it-s-not-really-the-shoes/ [Accessed 26 October 2024].
- Some of the concepts included in this article have been clarified and informed by OpenAI’s ChatGPT (OpenAI, 2025)