The Effects of Pointe Shoes on Ballet Dancers' Biomechanics, Muscle Activity, Movement and Symptoms: A Scoping Review.

This scoping review maps existing research on the effects of wearing pointe shoes on professional, pre-professional, and recreational ballet dancers, highlighting significant knowledge gaps and methodological limitations. Thirty-five heterogeneous studies, mostly cross-sectional and focused on biomechanical outcomes, were categorized into shoe factors, shoe types, ballet movements, symptoms, and intrinsic dancer factors. Findings indicate that pointe shoes can cause pain, discomfort, and skin issues, with custom toe caps potentially reducing pain, while worn ("dead") shoes may impair postural control and increase joint range of motion. However, there is insufficient evidence on functional performance outcomes, injury risk related to shoe age or treatment, and ecological validity, as many studies do not replicate real-life dance conditions or use dancers' own shoes. The review recommends future research employ rigorous, ecologically valid designs co-developed with dancers to better inform pointe shoe design and dancer education aimed at minimizing injury and enhancing comfort and performance.