I got a great email today from a student who has been getting pain and clicking in her ankles en pointe, and she has discovered a possible cause of her pain by watching one of our videos... In this article I post a thorough response that will teach you how to deal with this and get back to dancing as soon as possible!

The video was called “The Dreaded Hooking Big Toe” and you can check it out here...



Read my response to Pamela's question, and then check out the video to test if you are doing this to!

Hi Lisa,

I was looking for some information about pointe and came upon actually by accident. I signed in and I just got the e-mail from you about the hooking of the big toe. I read it, but honestly I didn’t really thought that it could be something that is my problem. I watched the “Dreaded Hooking Big Toe” video that you made, and when I checked back of my ankle when wiggling the big toe, I was shocked...

My ankles hurts sooo much especially when I pointe but I thought that it’s normal when I dance a lot (6 days per week, 2 hours a day). I used to dance for 6 years when I was younger but I was too young to do pointe work. Now I decided to 'return to dancing' and I do it every single day, including pointe work 2 times per week. I thought my ankles hurt because it should be so when training so much. But now I realised that my teacher simply didn't tell me that I’m using the wrong muscle. It hurts a lot, even when I try to use the correct muscle (the one under my foot) so I'm wondering if I should stop dancing for a while or just stop doing pointe class or which exercises I shouldn't do? And what exercises should I do to strengthen this right muscle apart from this one you already posted? Can you please help me, because I'm really worried about my health now...

By the way it is disappointing to me that teachers (I’m at the best ballet school in my city) don't really pay attention to this because none of my colleagues from classes knew that they were doing something wrong either. Once I said it, they are visiting your site every day and it's a ballet-world-treasure really!
Thank you Lisa once more, and I hope that you will help me a bit because I don’t know what to do.

Waiting for your answer,

Hey Pamela

Thanks so much for your email, and for all your lovely comments! First of all... please don’t let anything I say get you worried about your health! It’s all just here so that you can get real information that can take your dancing to the next level, and there is always a solution to any body issue if you treat it right.
One of my favourite sayings is that “The body is in a constant state of reformation”. This means that if we give the body different messages, it will give you a different response. Please never just accept that its normal to have pain in your body because of your dancing. Yes, you may get “post exercise muscle soreness” if you are using muscles that you have not worked before (say if you are working on a new bit of choreography with different moves), however this should settle once you become stronger. Some of my girls are doing pointe work every day with no pain, so you should not expect so much pain from doing it just 2 days a week.

That being said – I do not recommend for anyone to dance every day. Your body does needs some space and time to heal, so try and arrange your classes so that you have at least 2 ‘off’ days in the week for recovery. This will actually help improve your dancing, rather than take away from it!

First things first... We need to drop your pain levels. Yes – sometimes it is a good idea if you have a lot of pain to have a little rest from full on dancing, but this dosen’t mean that you need to stop dancing. Much of the pain that dancers experience in the back of the ankle is due to inflammation and swelling in the back of the ankle. Obviously if the tendons are inflamed, they take up more room in the back of the ankle than usual, and so get even more squashed when you point your foot.

What I normally do in this situation is try and find 3 days in a row that you can back off dancing completely to drop the inflammation. Perhaps over a weekend plus a Monday where you are not dancing, not walking around too much and can really focus on getting it right.

Frequent icing of the feet and ankles in an ice bath is the first step. Get a big bucket of cold water, put both feet in it, and then start putting ice in until the water is very cold. For the first five minutes, keep the ankle on a very gentle stretch (like you are in a little plié sitting down). Then remove the feet, dry them off and let them come back to room temperature. Then place them back in the cold water for another 5 minutes, but this time, move the feet through a very slow ‘rise’ onto demipointe and ‘lower’(still sitting down) so that the ankles does not get too stiff.

You want to do this icing a minimum of 3 times during the day, and a maximum of 10 minutes every hour. In between sessions of icing, you want to put a gentle compressive bandage or ‘tubigrip’ over each foot and ankle and elevate both of them so that the feet are above the hips and knees. While an ice pack may seem easier, it does not really chill down the deep tisues as much as the ice bath as much as the ice bath method, so is just not as effective.

Treatment by acupunctureAcupuncture can also really help in reducing inflammation – but do try and get someone with the full Chinese medical training – rather than a western doctor who has done a short course in it. This does make a big difference.

Anti inflammatory gels or medications may be of benefit – but please check with your doctor before taking anything.

Over this time – try not to keep testing the foot to ‘see if it is still sore’. I know that this is hard! But it really does help in settling the inflammation. Any core, flexibility or turnout exercises are fine during this period, but do not do any foot exercises. This also means no rises, tendus or other ballet moves at all!
You can also get some gentle massage up into the top of your calf, and further up in the leg – but do not try to massage over the sore points in the tendon. This will just aggravate it more. Sometimes inserting a little heel raise into your shoes can help offload the tendon a little more if you do have to walk around.

Once the inflammation is a bit more settled, you can usually get back into class doing what I call a ‘Flat Barre’.  This means that you do not point the foot at all, or rise. So any tendus, developpé or grande battement are done with a flexed foot. You can do very small plié if there is no pain. Stay at this phase for at least a week.

ToeSwappingSmDuring this time you can start doing the “Big Toe Exercise”, “Toe Swapping” or the “Doming Exercise” from The Perfect Pointe Book, as long as there is no pain in the back of the ankle.

Sometimes, especially if you have flat feet, or rolling in arches, taping the arch or using orthotic inserts in your shoes can really help reduce the strain on the tendons. Make sure that you are wearing runners, or other supportive shoes – and absolutely NO THONGS or FLIP FLOPS!

After this week it should be starting to feel a little better, so you can start very gently performing some double leg eccentric rises. To do these, you start in standing, holding onto a barre or chair. Place one foot onto demi pointe, join it with the other one, and then slowly lower both heels together. Make sure that you do this for a good few days before you try any rises where you actually ‘rise’!
This is when you want to start working on your tendus, and making sure that there is no hooking of that big toe! After all of the effort to drop the inflammation, you don’t want to irritate it again! If you start feeling any pain with these, drop back for a couple of days and keep up the ice bathing as much as possible.
Finally, we can start with double leg rises, and slowly build back into single leg rises. How long it will take to do this will depend on how bad the inflammation was and how good you are at staying off the feet!

I know this sounds like a lot of work, but it is a great way to really change how you are working your feet, and to be able to dance pain free!

Click here to see our list of injury reports.

I hope this helps!