Readiness for Pointe Shoes in Ballet: A Delphi Consensus Study

BACKGROUND: A ballet dancer's first pair of pointe shoes marks a significant milestone in training, allowing them to perform on the tips of their toes. Determining readiness for pointe work requires consideration of many factors, yet consensus is lacking regarding the abilities required to progress safely. Existing International Association for Dance Medicine and Science (IADMS) guidelines are broad and largely subjective. This study aimed to establish consensus on key criteria required before commencing pointe work using a scoping review and Delphi method. Secondary aims were to (i) explore differences in expert perspectives, (ii) determine expert panel agreement with the IADMS guidelines and (iii) identify reasons to conduct a pointe-readiness assessment. METHODS: A scoping review identified existing pointe-readiness criteria and informed a Delphi study with 21 experts (ballet teachers, health professionals and dance researchers). Criteria from the scoping review and first Delphi round were synthesised using inductive content analysis and presented to the expert panel for rating on a 4-point Likert scale. Consensus (defined as ≥ 80% agreement) was assessed across two additional rounds. RESULTS: Ninety-nine criteria relating to progression to pointe work were identified and grouped into three themes: (i) skill and training, (ii) physical characteristics, and (iii) health and well-being, encompassing 10 assessment categories. 48/99 criteria reached consensus, with single-leg heel-rise repetitions, balance and control and injury history receiving the highest agreement (≥ 95%). Teachers placed importance on assessing technique and posture, whereas health professionals prioritised physical capacity measures. Twenty-two reasons for conducting pointe-readiness assessments were identified, with 18 reaching consensus. Highest agreement (≥ 95%) was for establishing a baseline; informing dancer and parent decisions; assessing likelihood of success; prescribing exercises; informing the teacher; and identifying additional needs prior to commencing pointe work. CONCLUSIONS: This study established consensus-informed pointe-readiness criteria and identified differences in perceived criterion importance between teachers, health professionals and dance researchers. While panel members agreed with current IADMS guidelines, consistent assessment methodologies were lacking. Findings support the value of pointe-readiness assessments in informing progression to pointe work and provide a foundation for developing standardised, evidence-informed assessment guidelines. Further research is required to validate assessment measures and evaluate their effectiveness in reducing pointe-related injury risk.