The Ankle and Foot 339dancers, based on many factors including femoral
torsion, tibial torsion, and forefoot abduction.
Thus, although this cue is often helpful in a class
setting, the individual dancer may need to adjust it
slightly for his or her body. Furthermore, in dance
forms that require the feet to face almost directly to
the side, dancers should realize that this will tend to
produce pronation of the foot and internal rotation
of the tibia if hip external rotation is not sufficient.
Focusing on using the external rotators of the hip
and knee to maximize turnout at the hip and pro-
hibit internal rotation of the tibia can help reduce
the tendency toward or degree of foot pronation.
Beginning Pointe
Beginning pointe is a major and often highly antici-
pated step in the training of a female classical ballet
dancer. With rising technical demands in profes-
sional dance, teachers and parents frequently have
questions regarding the appropriate timing to begin
pointe. The goal is to avoid injury in dancers who are
still maturing while still allowing them to develop the
proficiency on pointe that is necessary to be competi-
tive in the ballet world. Unfortunately, the answer
to this question is not simple; it encompasses many
individual factors such as skeletal maturity, mental
maturity, technical proficiency, and years of training.
Considering all of these factors, several orthopedists
who are noted for their expertise with dancers have
recommended that dancers begin pointe at a mini-
mum of 11 years of age if they have undergone three
to four years of disciplined ballet training and exhibit
sufficient strength, technical proficiency, and skeletal
and mental maturity (Hamilton, 1988; Sammarco,
1982; Weiker, 1988).
However, these age guidelines were in part based
on the concern for injury of structures still in the
growth process. And the limited number of injuries
reported that appear to be related to premature
pointe has led to some less conservative recommen-
dations and a greater emphasis on functional readi-
ness. In terms of age, two dance medicine groups
suggest that if other criteria are met, with select
individuals a minimum of 10 years of age may be
appropriate (Solomon, Micheli, and Ireland, 1993),
at least to begin pointe work at the barre (Ryan and
Stephens, 1987). In terms of functional concerns,
there is an increasing awareness of the varied age at
which dancers reach adequate strength, flexibility, and
technical proficiency. Hence, a greater emphasis on
individual readiness may be appropriate. Suggested
functional tests include the ability to plantar flex the
foot in a line parallel to the line of the tibia (Solomon,
Micheli, and Ireland, 1993) when measured with a
goniometer or as evidenced in a tendu and relevé.
Another commonly used test is the ability to maintain
balance in retiré on demi-pointe with good alignment
of the ankle, a straight knee, maintenance of turnout
at the hip, and good pelvic and spinal alignment
(Khan et al., 1995). The author also recommends use
of a pirouette, noting the alignment just described
with the retiré, with particular attention paid to the
ability to prevent excessive rolling out on the foot.
The ability to go on pointe without knuckling or
sickling is another commonly held criterion.
While in general agreement with these sugges-
tions, from a kinesiological perspective the author“Point From the Top of the Foot”
T
he instruction to “point from the top of the foot,” often in conjunction with “and don’t use your
Achilles,” is sometimes used by teachers in an effort to achieve a greater point of the foot without
causing discomfort under the Achilles (posterior impingement). However, from an anatomical perspec-
tive, this cue can be confusing in that the muscles on top of the foot do not point the foot (they are
dorsiflexors), and the Achilles and associated gastrocnemius and soleus are prime movers for plantar
flexion. A more anatomically sound cue could focus on creating a stretch across the top of the foot by
reaching the foot “out and down,” focusing on articulating each of the joints that can contribute to
plantar flexion/flexion (talocrural, subtalar, intertarsal, tarsometatarsal, and MTP joints) rather than
just the ankle joint. In addition, focusing on using the stirrup muscles and the intrinsic muscles of the
feet to pull the bottom of the metatarsals back toward the heel can increase the point of the foot with
less tendency for impingement.