Dancer Health

Is pain a necessary evil for dancing en pointe? Or is there another way?

EnPointe Orthotics Pointe Inserts

There’s nothing quite like the feeling of dancing en pointe. For many aspiring young dancers, and even for adults who start dance late, the idea of dancing en pointe is viewed as the pinnacle of being a ballerina.

The long-term consequences of pointe work.

The only problem is, dancing en pointe can hurt. A lot! And the damage can be serious and potentially irreversible. For me, the problem was toenails that turned black and fell off. Another common problem is blisters. But it can be much worse, and serious foot deformities are some of the most sinister. Let me lay them out for you, so you fully appreciate the love-hate relationship dancers have with their pointe shoes.


Bunions are an enlargement of the inner portion of the metatarsophalangeal joint at the base of your big toe, which looks like a lump on the side of the big toe. It is caused by changes in the framework of bones at the front of your foot, as your big toe starts to lean into your second toe, throwing the bones out of alignment.

Pointe shoe paddingHammertoe

This is a toe deformity caused by a downward bend at the middle joint. If left untreated, it can result in complete inflexibility in the toe, requiring surgery to restore mobility.


Inflammation of the flexor hallucis longus tendon makes it painful and virtually impossible to flex the big toe. It also causes sharp pain when lowering from pointe to a flat position. The toe can lock up, and the dancer might feel a clicking sensation when trying to move the toe.


If you feel pain in the ball of your foot under the big toe joint, it may mean you have damaged the sesamoid bones located under the big toe joint.

Stress fractures

Stress fractures are overuse injuries. When dancing en pointe, the repeated pressure on your toes can cause a small crack in the toe bones.

An accident that led to a solution.

But it doesn’t have to be this way, thanks to a neat invention by Myfwany Fish, known as an EPO, short for En Pointe Orthotics.

The story of Fish and the EPO follows the pattern of many who create something unique and useful, which began when an injury forced her to abandon her own dream job.

“I’d always wanted to be a nurse since I was four years of age,” explains Fish. “I also wanted to dance. So I did all my dance training over the years until I finished school, and then I went straight into nursing. I was a nurse for 20-odd years and had four children in the meantime. It was an accident at work that left my hand deformed and months in hospital and many operations. And I was no longer able to do nursing.”

Myfwany Fish. Photo courtesy of Fish.

Myfwany Fish. Photo courtesy of Fish.

As a dance lover herself, Fish had enrolled her own children in dance school, and spent many hours sitting in the waiting room with other parents while her kids were in class, which is where inspiration first tapped her on the shoulder.

“There were lots of people asking me to borrow my child’s dancewear and other mothers asking if they could borrow their dance costumes for solos,” she recalls. “So while I was sitting outside the studio, I thought, ‘Maybe this is something I can do to take my mind off my hand, and the fact that I can’t be a nurse anymore.’ It wasn’t that I planned to open a business. It just flowed on from that first decision to collect up costumes, put them into a database, photograph them, and promote the costumes for hire. It all came to me one afternoon waiting for my children to finish their dance class.”

This was where Fish’s first business venture with dance gear started. Initially, a home-based business taking costumes on consignment and hiring them out, Dance Desire ( soon expanded to provide dance costumes, dancewear, dance shoes, dance accessories and dance training tools.   

The mix of having been a dancer herself and the mother of dancers, owning a dance supply shop, where she regular did pointe shoe fittings, and having a nursing background created the unique circumstances that lead the creation of the En Pointe Orthotic.

“I’d see all these feet and toes that weren’t conducive to wearing pointe shoes or being on pointe,” Fish says. “I’d see the deformities they would get, so I started looking for a solution, trialling and testing many things to see how I could help, and that’s where I developed the En Pointe Orthotic.”

Since every dancer has a unique foot, a one-size-fits-all solution wasn’t going to work.

“It isn’t a product that anyone can fit themselves,” Fish explains. “They need to be fitted correctly for the individual. So then I had to develop training so others could fit the orthotic. They’ve now been fitted in the UK, in Panama, the US and around Australia, and we travel to those places who don’t have trained fitters.”

Fish drew on her nursing background and experience fitting pointe shoes, but she also consulted with physiotherapists, a pilates instructor and many dancers. The product is endorsed by renowned foot surgeon, Dr Aneel Nihal (

What makes the EPO unique?

Using some kind of insert to protect the toes and feet is nothing new. Dancers have used all sorts of things, from wrapping their toes in lamb’s wool, plastering their toes with band-aids, using synthetic pouches, gel or silicone inserts, athletic tape, even paper towel or toilet paper. But the EPO is different.

Each EPO is made by an accredited fitter who creates the orthotic around and through the dancer’s toes to the extent that they actually mould to the dancer’s toes.

“The process takes about an hour, and it’s trimmed and made to fit that individual foot,” Fish explains. “No one else can fit into that EPO. I’ve fitted girls who’ve had very short big toes, toes that have been amputated, and they want to get back into pointe. It’s fully customisable to the point of even making an artificial toe, or a silicon band around their forefoot so their toes are free to hold them in their pointe shoe better.”

EnPointe Orthotics Pointe Inserts

En Pointe Orthotic

She continues, “The pouch covers the front of the toes, and goes underneath, but if you are on demi at the barre, you don’t see the back of them, so it doesn’t interfere with feeling the floor. When you look inside, it has an area for each toe. It is flexible so it moves with the toes. If they had a second toe that was longer, instead of the toe knuckling up, we add more silicon to the other toes so it distributes the weight more evenly.”

The EPO works by distributing weight evenly through the foot, regardless of the dancer’s foot shape or variations in toe lengths.

“When the weight is distributed evenly, you don’t get that knuckling, holding the toes in a supported position,” Fish describes. “It also divides the pressure across all the toes rather than one or two toes. It also has a spacer between the big and second toes so it holds the big toe in better alignment. This means the pressure goes straight down the foot rather than out through the metatarsal, so you don’t get that bunion forming.”

Prevention and recovery of injuries aside, Fish reports that it is the comfort her clients love about their EPOs.

“I give them a money-back guarantee after they’ve danced in them for three to four weeks,” Fish assures. “None of them give them back or want to give them up because they are so much more comfortable. They also say they no longer get blisters or lost toenails once they use them. People with stress fractures in their feet recover.”

Now, you might worry that with a fully individualised orthotic, that a young dancer may grow out of it when her foot grows, but apparently this is not a problem.

“Girls go up in size, and their EPOs still fit like a glove,” Fish says. “Foot length changes but not toe shape. It’s a good investment, and the mothers are the first ones to say they don’t want their daughter’s toes damaged. We give them options for toe padding – we don’t say you have to have the EPO, because it’s not the cheapest option out there, but most undoubtedly say they want the EPOs for their daughters.”

From pain, to comfort, to longevity.

Having seen first-hand the damage and pain that dancing en pointe causes, I asked Fish about her view on pointe shoes. I thought perhaps she would be against them. But she understands the allure of pointe shoes.

Myfwany Fish. Photo courtesy of Fish.

“From my perspective, I think it’s something to aspire to as a young ballet dancer,” she shares. “And to see the looks on their faces when they come in for their first pointe shoes … I’ve fitted teachers as well so they can demonstrate to their students. They’ve gone through so many foot surgeries, and to be able to get en pointe when they weren’t able to, that’s why I do it.”

It sounds like a miracle, right? But surprisingly, Fish reports that there is some resistance to the EPO from some dance teachers. 

“Some of the old school teachers believe in nothing in pointe shoes, and that I feel is a real shame to see those girls coming in with blisters, callouses and nails falling off, and red sore bunion areas and they’re 12-13 years of age,” says Fish. “So it may take a generation to change some of those teachers’ minds.”

She adds, “I would fit any teachers in EPOs complimentary – and give lots of fittings out free of charge just to let them feel what it could be like, and for the teachers to know they are not a bad alternative. Of course, some teachers are set in their ways and don’t want to know it at all, and that all those problems are just part and parcel of dancing – but they don’t have to be, and until that generation moves on, I’ll be blocked by some of those students, but others are quite happy with the EPO.”

So from dancer, to nurse, to dance mum, to dancewear shop owner, to scientific innovator… Fish is an example of how adversity can lead to something amazing. She is on a mission to help more young dancers experience the joy of pointe work without the pain, to enhance the longevity of the ballet dancer’s career, and to help people enjoy dancing en pointe for longer.

For more information on En Pointe Orthotics, visit

By Jo McDonald of Dance Informa.

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