Comfort, posture and functionality of the feet in classical ballet practitioners: pointe shoe and demi-pointe

BACKGROUND: Ballet shoes are potential extrinsic risk factors for changes in foot posture and the magnitude of the plantar load, as well as the appearance of lesions in the knee, ankle, and feet. In professional dance training, a workout in a demi-pointe shoe allows for the gradual adaptation of the feet during the transition to a pointe shoe, which enhances the performance, balance, and ability of movement during dance. Although the type of ballet shoe is an important risk factor for the comfort and functionality of dancers' feet, only four studies have investigated this risk factor and their results have been inconclusive, especially when it comes to comparing pointe and demi-pointe shoes. The aim is to verify the effect of pointe and demi-pointe shoes on the pain, comfort, posture, functionality, and health of classical ballet dancers' feet.METHODS: A total of fifty classical ballet practitioners participated in the study and were divided in two groups. The group with demi-pointe shoes (GDPS) contained 25 beginner dancers who practiced for 3.6±1.4 hours weekly and had a practice time of 2.3±0.7 years. The group with pointe shoes (GPS) had 25 advanced dancers who practiced for 4.6±0.8 hours and had a practice time of 6.5±2.7 years. The pain, comfort, posture, functionality, and health of the dancers' feet were evaluated, post-workout, using a visual analogue scale, the foot posture index, the foot function index, and the foot health status questionnaire, respectively. A statistical analysis was performed using the independent student t-test with a level of significance of 5%.RESULTS: The GPS dancers had a higher pain intensity (5.8±2.0 cm, P<0.001) and a lower comfort (total score 3.0±1.4, P=0.001) compared with the GDPS dancers who reported a pain intensity of 1.0±0.4 cm and a comfort score of 7.3±0.8. Foot functionality was lower in the GSP dancers (10.0±6.6, P<0.001) than in the GSDP dancers (4.4±2.9, P<0.001). Both groups experienced poor foot health and had a neutral static foot posture.CONCLUSIONS: Classical advanced ballet dancers who used pointe shoes presented with a greater intensity of pain and discomfort, and had less functionality of the feet compared with dancers who used demi-pointe shoes. Both groups exhibited poor foot health and a neutral static foot posture. Therefore, both types of ballet shoes caused painful changes in the feet and interfered with functionality; the changes in the dancers with the pointe shoes were more pronounced.