Pointe Readiness: What's the Debate All About?

by Cindy Lugo

(Note from Opus Artistic Director Brooke Evans: The following is one of the best articles I've found online that deals with the topic of pointe readiness - it really covers all the bases!)

The age range is wide and heavily debated. Some teachers say a child should start pointe work at eight, others twelve, and still others even older or younger. But how do you know the right answer for your child, your student or yourself? One of the major considerations is bone ossification, which is the natural process where soft tissue hardens or calcifies to form bonelike material.

There is wide and very well documented research on bone ossification. At ages 10-11 the ossification of the bones of the feet, in girls, is normally only 50-60% complete. By age 11½-12 it is approximately 75% complete, and by age 13-14 the fusion is usually at 100%. But, the development of the bones in the feet continues up until 20-25 years of age. In boys this process is usually a year later than girls. 

So, what does this mean? One should not start a child on pointe before a minimum of 75% ossification, and then only 10-15 minutes at the barre for 6-8 months. At that point, you can work up to 30 minutes at the barre only. Then at age 13-14, with normal development, if the fusion is 100% then you can start to work in the center and gradually over another year work up to 1 hour on pointe.

How Can I Be Sure?

The only way to know if your child is at the correct stage of ossification is to have x-rays. After these are complete a radiologist can tell you whether the bones are at this 75% minimum level. No one, no teacher, can tell you this. Yes, some children develop more quickly, and some less. So, your child's bones may well be ready for this beginning work, or they may be even less ready. Some do not have the necessary level of ossification until they are 14.

The point that I and others are making is that children should not be put at risk like this. The chances increase dramatically of bone malformations, bunions, hammertoes, and crippling effects in old age when these guidelines are not adhered to. Though many will tell you that they've been on pointe for several years with no problems, these problems are not necessarily seen until later, often much later, unless you examine the bones under x-ray.

What are the Effects?

It may help for you to understand that, at least as I understand it, dancing on pointe can put up to 10 times a dancer's body weight on her feet/toes/ankles. This is IF she is perfectly aligned while dancing, which is not usual until a dancer has actually been on pointe for quite a few years, and even then they aren't always perfect.

I believe if there is only a 2 degree difference of placement on pointe - you can add another approximately 35% of her weight. In other words, as i understand this - if she weighs 100 pounds, that is equivalent to - up to 1000 pounds of pressure on her foot/toes/ankle. With another 2 degrees of imperfect alignment this would be the equivalent of another 35 pounds of pressure. So if the bones are not finished developing and ossification is not sufficient this will malform bones and cause other completely unnecessary problems that can be very serious and even crippling.

Also, this information was based on a study of pressure primarily to the ankle, which is a wider area than the tips of the toes. So, that figure will be less than the actual pressure coming to bear on an even smaller area of the toes/platform of the pointe shoe. In other words more than 10 times the body weight may be the case. (And those of you that have to replace pointe shoes often because of soft boxes can relate!)

Ok, that gives you a clearer picture of why many of us are so concerned about this early pointe work that is all too prevalent in the world of ballet. Most children who are started too early can, and often do, suffer from bone deformity in their toes, joints, etc. In some cases these are quite serious problems.

Often these problems do not show-up or cause trouble until they are older. Additional problems other than damage to the feet, are impairments to knees, hips, ankles etc.. Many of my former teachers - some of whom are no longer living, had horrible problems that they blamed on this very practice. And they were instrumental in helping educate teachers, parents, etc. along with the medical community regarding this.

Won't that Put My Dancer at a Disadvantage?

This practice of starting children on pointe so early should be considered irresponsible, as the bones are entirely too malleable. These teachers need to be educated so they understand and stop this practice. The bones in a childs feet have not finished the ossification process. Their time would be much better spent strengthening their muscles and working on proper technique. With concentration in those areas, the musculoskeletal structure can better handle the demands of beginning pointe work without causing such damage. It should be noted however that some children's bones and muscles in the feet are not ready even at 12-14 and that they should wait an additional 1-3 years before commencing pointe work.

A good teacher will not necessarily put an entire class on pointe at once; it should be done on an individual basis. The children can all participate in the pointe exercises on flat, until their time comes. It is well worth the wait - they will catch up quickly with the ones who started earlier, as their technique on flat will have matured at the same, or quicker rate

Explaining this all to your daughter will help her understand the reasons why. So, along with the natural feelings of disappointment, she will know that when she does start, it will be better for her, her bones, and her dancing career if she decides to pursue this.

References

There is so much research available regarding bone ossification, and too many teachers putting children on pointe prior to a minimum 75% ossification. At age 10-11 this is between 50-60 percent in most children. This information has been available for many years - one of the first, and in my opinion best, writings on this was in 1949 Anatomy and Ballet by Celia Sparger.

First Reference from Anatomy and Ballet by Celia Sparger (fifth edition-1976):

"AT WHAT AGE SHOULD A CHILD BEGIN POINTE WORK?

This question has already been touched upon in the previous chapter, but it is of such paramount importance that it is worth while to enlarge further on the subject. Although the recognition of the danger of too early pointe work is far more widely accepted than a few years ago, it is still possible to buy blocked shoes to fit a six-year-old and to find classes where they are allowed to wear them.

It cannot be too strongly stressed that pointe work is the end result of slow and gradual training of the whole body, back, hips, thighs, legs, feet, co-ordination of movement and the "placing" of the body, so that the weight is lifted upwards off the feet, with straight knees, perfect balance, with a perfect demi-pointe, and without any tendency on the part of the feet to sickle either in or out or the toes to curl or clutch.

This movement will arrive at different times in different children, not only by virtue of previous training but according to their physical type, and in this may be included the growth of the bones. All the bones of the body begin as a relatively soft material known as cartilage which becomes progressively ossified into "true" bone at different times, being completed as late as twenty-five years.

During this period there is a gradual hardening from the centre outward. In the long bones, such as those of the leg, forefoot and toes, the shaft ossifies first, the ends known as the epiphyses remaining connected to the shaft only by cartilage until the early teens, with considerable variation between one child and another as to the exact time at which the cartilage becomes bony. Ideally, if pointe work could be delayed until this time in children...no doubt their feet would be safeguarded, but this is a counsel of perfection, the most that can be done is to prepare the whole body as perfectly as possible, and to ensure that the introduction of the work on pointe is slow and gradual, rarely earlier than twelve years of age and preferably later.

The fact that some feet can be found to have survived the abuse of tottering around on blocked shoes from the age of six onward is no criterion as to its safety. The author has met at least one case of a child whose strong feet were unharmed by "dancing" on pointe at six years old, but who succumbed later with knee trouble. There is little doubt that the strain had been resisted by the feet but had been transferred to the knee joints.

The further question is, however, should a child do any pointe work unless she is taking her dancing professionally? The once-a-week class can never be a suitable preparation for pointe work, and what is gained by including it? On the other hand, a risk is being taken which may result in lifelong disability. The teacher does not see the results. The child gives up her lessons as other things claim her and if, maybe years later (for damage does not always show at once), she has foot, knee or back trouble, she goes to a doctor for advice, not to her one-time teacher. The doctor, then, rightly enough, condemns ballet and is unable to do much to repair the damage.

With the child who is going to train professionally it is different. Her training will be systematic and concentrated, and, just as every profession has its risks, this is one which has to be taken. In honesty one must say there is a fair amount of enlargement of the big toe in ballet dancers, but only in a slight degree and not to cause any great trouble;..."

I'm not saying I agree with the part of the quote regarding whether a child should completely forego pointe work if they are not intending to dance professionally, because many times children may not have those professional aspirations until they are 15-16 years old, so if they are interested really want to go on pointe and are attending at least 3-4 classes a week, then personally I would not discourage this.

Note: Celia Sparger uses many references, radiology photographs of differing types of bone ages and ossification in this book. This is a wonderful book for any teacher and is actually meant to be "A Handbook for Teachers of Ballet". If you can locate a copy of this book, even an older edition, it would be well worth the search. The 1970, 1972 and 1976 printing of the fifth edition includes 43 x-rays and photographs and 51 drawings.

Second Reference: Both Sides of the Mirror - The Science and Art of Ballet by Anna Paskevska (first edition 1981 -second edition 1992):

"Bones have varying rates of ossification. Epiphyses are layers of cartilage whose presence in the bone indicates that it has not completed its growth. As growth ceases the cartilage gradually becomes ossified; when closure is completed no more growth can occur. Some epiphyses do not completely ossify until the twentieth or even the twenty-fifth year. The bones that concern us here are in the lower extremities and bear the burden of supporting the body's weight. The femoral head, the lower end of the tibia, as well as the numerous bones of the foot, normally begin the process of ossification in the fourteenth year. This process is not completed until the twenty-first year (a little earlier in females).

From these figures, we can deduce that putting girls on their toes is a fairly hazardous undertaking unless the musculature has been developed enough to protect the integrity and alignment of the joints all the way down the leg. We should remember that the force of gravity always acts in a vertical direction. If the body is aligned from head to foot, the dancer will experience the force in one vertical plane. But if the body is misaligned, gravity will pull on it in several different places, and various extraneous muscular contractions will be necessary to maintain balance. 

Thus, it is that malformation and permanent damage can result if a child is put on pointe too early or with insufficient preparation.It takes approximately four years to develop the proper musculature to rise on the toes. If a child begins dancing at the age of eight, she will be ready to don pointe shoes around her eleventh or twelfth year. Even if the child starts dancing earlier (which is not a good idea), she should not begin pointe work much before that time if damage to her skeletal structure and internal organs is to be avoided. 

We only have to think of the old Chinese custom of binding the foot, which stopped its natural growth, to realize how malleable and vulnerable a young body is and how carefully it must therefore be nurtured in its growth and development."

Anna Paskevsa also sites many, many references and has done extensive research on this subject. This book is incredible, and she goes on to describe very precisely what needs to be accomplished with the dancer prior to pointe work. This one is good not only for teachers but also for parents and eventually students with more advanced reading skills.

Third reference: Anatomy by Gardener, Gray, and O'Rahilly - this is primarily for medical students - but it charts the ossification in the "Median Times of Appearance of Postnatal Ossification Centers in the Lower Limb".

"The metatarsals: 50% ossification appears at age 10 in females and age 12 in males. Fusion is complete radiographically (however bones continue the ossification process). In females age 13 for the tuberosity of the metatarsals, and age 15 for the Heads or Base of the metatarsals. In males this would be ages 14 and 16 respectively."

Last Reference: Inside Ballet Technique - Separating Anatomical Fact from Fiction in the Ballet Class by Valerie Grieg:

"The dangers of putting young children on pointe before the bones of their feet have begun to ossify have been so well documented that it hardly seems necessary to mention it here...."

Dr. William Hamilton, writing in Dance Magazine (Feb 1978), relays to us the delightfully commonsense viewpoint of Balanchine, who remarked that, children should not be put on pointe until they have the strength and training to do something when they get up there. This would usually be after about 3-4 years of quite intensive work, so the dancer would necessarily be at least eleven or twelve years of age. A delay of several more years would do no harm, provided the training has not been interrupted during that time and necessary strength has been developed.

Capezio/Ballet Makers, as one of this firm's many services to teachers and dancers, has printed a brochure entitled: "Why Can't I Go On My Toes?". The last information I had for getting that pamphlet by Capezio was: "Teachers in the U.S. can obtain these free brochures by calling 1-800-234-4858.

Overseas teachers can write: Capezio/Ballet makers Inc., 1 Campus Drive, Totowa, New Jersey, 07512, U.S.A."

So the research backs the notion that one should not start pointe work before the ossification process is at least 75% complete and then that work should be a gradual process. There is a serious need for education of parents, teachers and summer intensive programs that tend to do it as it has always been done. Just like many other things in our world today, we must rethink our ways when we have better knowledge and recognize that our dancers of today are doing more spectacular things than dancers of the past. We have an obligation to use this knowledge responsibly.

​