MRI comparisons of ballet dancers and non-dancers found only two plantar intrinsic muscles consistently larger in dancers — the flexor digitorum brevis and the lumbricals. Both of them flex the toes. Years on pointe train your foot to curl and press, with real hypertrophy to show for it. What it never asks for is width: spreading the toes, and drawing the big toe outward. Toe-Rx is built for the direction ballet leaves out.
Fukuyama H, Maeo S, Kusagawa Y, Sugiyama T, Kanehisa H, Isaka T. Differences in the size of individual plantar intrinsic foot muscles between ballet dancers and non-dancers. Journal of Dance Medicine & Science, 2025;29(2):91–97. A cross-sectional MRI comparison, not a trial. See how we read the evidence
Every position you have ever held asks the toes to point, press or curl. None of them asks the toes to spread. Toe-Rx works that axis — opening the foot wider than pointe requires, then closing it against resistance from a position your feet are almost never in.
Open
Toe-Rx sits between the toes and draws the big toe outward, away from the second. Anatomy has a name for that motion — hallux abduction — and it is worked by the abductor hallucis.
That muscle was not among the ones found enlarged in dancers. The MRI comparison identified the flexor digitorum brevis and the lumbricals, both flexors. Years of training built the muscles that curl your toes. The one that spreads them was not part of the deal.
Grip
With the toes held apart, squeeze them closed against the foam. These are muscles you already have — you are not here to build a flexor you lack.
What changes is the position they work from. In a shoe, in relevé, on pointe, your toes are gathered and long. Held open, the same contraction runs through a range your feet meet almost nowhere else in your day.
Wearing it is not the part that works
Someone tested this directly. Twenty-four people with hallux valgus wore an orthosis for eight weeks; half of them also performed a toe-spread-out exercise. The orthosis-only group showed no significant change in anything measured. The group that added the movement improved significantly in all three measures, including the size of the abductor hallucis.
So we are not going to tell you that sitting with something between your toes will change your feet. Toe-Rx opens them wide enough to train in, and gives them something to close against. The movement is the part that counts — which is also why ten minutes of it is a real ask, not a passive one.
Kim MH, Yi CH, Weon JH, Cynn HS, Jung DY, Kwon OY. Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with hallux valgus. Journal of Physical Therapy Science, 2015;27(4):1019–1022. · Fukuyama H, Maeo S, Kusagawa Y, Sugiyama T, Kanehisa H, Isaka T. Differences in the size of individual plantar intrinsic foot muscles between ballet dancers and non-dancers. Journal of Dance Medicine & Science, 2025;29(2):91–97.Dancers get sold a lot of foot products on the premise that ballet is wrecking their feet. The literature is far less certain about that than the marketing is, and we are going to show you where it disagrees with itself rather than pick the half that suits us.
Everything here concerns adult dancers. Much of the prevalence research on dancers' feet was done in children and teenagers, and we have left it out.
Of all the muscles in the sole of the foot, only two were consistently larger in dancers — and both of them are flexors
Fukuyama and colleagues used MRI to measure individual plantar intrinsic muscles in ballet dancers and non-dancers. Across all three volume measures, only the flexor digitorum brevis and the lumbricals came out consistently larger, with large effect sizes. Both are specialised for flexing the second to fifth toes.
The authors attribute it to long-term repetitive loading during tiptoe standing. In other words, your training built exactly the muscles your training uses.
Where it stops This is a snapshot, not a trial — it measured muscle size at one moment and tested no intervention. And it does not say the other muscles are weak. It says they were not consistently larger in dancers. That is a narrower finding, and we are building on the narrower version.
Read the study (doi: 10.1177/1089313X241273887)Dancers' toe flexors measured almost twice as strong as non-dancers'
Toe flexor strength in the dancers came out at 27.0 kg absolute and 47.6% of body weight. In the non-dancers it was 14.5 kg and 27.8%. The dancers averaged nearly fifteen years of training.
We are including this because it argues against us, and because it is the reason this page does not open by telling you your feet are weak. They are not.
Where it stops One university, female dancers only, and the literature is split: some studies find no difference in toe flexor strength between dancers and non-dancers, others find dancers higher. Nobody has reported dancers coming out lower.
Read the studyThe device on its own changed nothing. Adding the movement changed everything measured.
Both groups wore an orthosis for eight weeks. Only one also performed a toe-spread-out exercise — actively drawing the big toe away from the second. The orthosis-only group showed no significant change in any of the three measures. The group that added the movement improved significantly in all three, including the cross-sectional area of the abductor hallucis.
This is the closest thing to direct evidence for what Toe-Rx asks you to do, and it is also the reason we keep saying the movement is the part that counts.
Where it stops Twenty-four people, none of them dancers, all with hallux valgus already established. Both groups wore an orthosis throughout, so this shows what adding the exercise did — not what the exercise achieves alone. The orthosis used was not Toe-Rx.
Read the study (doi: 10.1589/jpts.27.1019)Across thirteen trials, foot muscle training improved balance, strength and arch behaviour — and did nothing for pain
Jaffri and colleagues searched four databases, rated every trial for methodological quality, and pooled the thirteen that passed. Foot muscle training produced significant improvements in balance, strength, navicular drop, and what participants reported about their own foot function.
Where it stops Pain was measured and did not significantly improve. If your feet hurt, that is the number to hold on to — and a reason to see a clinician rather than buy something. The trials also used foot exercises generally, in the general population, not dancers and not any particular device.
Read the review (doi: 10.4085/1062-6050-0162.22)Whether ballet causes bunions is genuinely unresolved, and we are not going to pretend otherwise
You will find hallux valgus reported in 36.8%, 40.0% and 54.9% of dancers depending on the study. That looks damning until you read further: a radiographic study reported that hallux valgus angles in both active professional dancers and retired dancers were similar to non-dancers, and that continuing in ballet did not develop the deformity.
A 2011 review of pointe biomechanics put it bluntly: despite the unnatural loading, no study had shown that dancing on pointe raises injury risk. We have not found one since that settles it.
There is one small intervention study in dancers — four weeks of foot exercise in thirteen elite adolescent dancesport athletes who already had hallux valgus, which reduced the angle and improved their self-reported outcome. It is a pilot, in teenagers, in a discipline that trains in heels.
Why this entry exists It would be easy to quote the 54.9% and stop. Much of that prevalence data comes from dancers aged 8 to 16, the studies use different measurement methods, and at least one radiographic study points the other way entirely. We would rather you knew that than bought something because of a number we cherry-picked.
Three things we don't claim
That it will make you a better dancer. We looked for research connecting toe training to dance performance, jump height or technique and found none. A trial on toe flexor training and jumping in vocational ballet students is registered and had not reported when we wrote this. If it publishes and it goes against us, this page will say so.
That ballet is ruining your feet. The evidence is contested, most of it comes from minors, and one radiographic study found no difference at all between dancers and non-dancers. Fear is an easy thing to sell and a poor thing to be sold.
That it takes pain away. Thirteen pooled trials measured pain and found no significant improvement. Foot pain in a dancer is worth a clinician's time, not a product page's.
We sell a foot product, so read this knowing that. It is still true. There are three things that do more for a dancer's feet than anything you can do sitting on the sofa, and two of them cost nothing.
None of them is us.
Your shoes are dead long before you admit it.
Where that comes from Thirteen professional dancers were measured performing relevé, sous-sus and pirouette in new pointe shoes and in worn-out ones. Centre-of-pressure sway was significantly greater in the dead shoes across all three movements. A second study found significantly higher tibialis anterior activation during arabesque in dead shoes. Both sets of authors read it the same way: a worn shoe is a more demanding shoe, and possibly a riskier one.
Three things that matter more
Retire your shoes earlier than feels reasonable
The measurable difference between a new shoe and a dead one is not comfort — it is how much work your body does to stay stable. You feel the shank soften and adapt to it. The force plate does not care that you have adapted.
Basis Two biomechanical comparisons of new versus dead pointe shoes in professional dancers. Neither trialled a replacement schedule, so there is no evidence-based number of hours — only evidence that the difference is real and measurable.Let a fitter and a teacher make the pointe decisions
If you are returning to pointe, moving up in hours, or coming back from an injury, that is a conversation with the people who can see you dance. It is not something a foot device accelerates, and we would be uncomfortable if anyone read this page that way.
Basis Pointe-readiness screening has been through a Delphi consensus process and a scoping review, and experts converge on single-leg heel-rise repetitions, ankle range of motion and core stability. Toe spreading is not among the criteria, and we are not going to imply that it is.Take foot pain to a clinician, not a product
Thirteen pooled trials of foot muscle training measured pain and found no significant improvement. Whatever this kind of work does, relieving pain is not the thing it has been shown to do.
Basis Systematic review and meta-analysis of intrinsic foot muscle training, 2023. Dancers are also documented as reluctant to seek medical attention, which is exactly why this belongs on the list.Where we come in
After those. Toe-Rx does not change how worn your shoes are, when you go up in hours, or what is causing a pain you have been dancing through. It works one specific thing: the direction your training does not go, in the time you are not in the studio.
If your shoes are current, your hours are sensible, and nothing hurts — that is the honest place for something like this. Ten minutes, on the floor, out of shoes.
Every other day is enough. The trials that showed a measurable change ran four to eight weeks of regular sessions — nobody has found a shortcut, and nothing we have read says daily beats every other day.
You already have the habit of doing small things repeatedly for a long time before they show. This is that, for a direction you have never worked.
The session
Open
Work each toe fully into its slot and sit with them held apart. No effort needed — let the foam do it. Expect this to feel strange rather than difficult. Feet that spend their working life gathered and long have very little experience of being wide.
Circle
With Toe-Rx still in, use your hand to rotate the tips of your toes in small controlled circles, ten in each direction. Moves the toe joints through a range that neither demi-pointe nor pointe passes through.
Grip
Still wearing it, lift your toes, then press them down into the floor, squeezing against the foam as they close. The working part. Not a new strength — a strength you already have, produced from a position you are almost never in.
About ten minutes per foot, sitting down, bare feet only. Toe-Rx can be used in water, so the first two steps work in a bath or a foot soak after class. Full instructions and photos
Where it fits around class
After class, once the shoes are off
Your feet are already bare and the day's work is done. If you only ever do it at one time, do it here.
On a rest day
Nothing to work around. This is how the training was delivered in the trials — as its own session rather than something attached to a warm-up.
In the hour before class or pointe work
Two reasons, and only one of them is research. Holding a stretch for 60 seconds or more has been shown to temporarily reduce maximal force, and the effect grows with duration — a 3–5 minute spread sits well past that line. That work was done on large muscle groups, not toes, so treat it as caution rather than proof. The practical reason will be obvious to anyone who has been fitted: a foot you have just spread wide is not the foot your box was fitted around.
Nobody has tested this in dancers
The eight-week trial that showed toe-spread-out work changing the hallux valgus angle enrolled twenty-four people who were not dancers. The meta-analysis pooled thirteen trials in the general population. There is one small pilot in adolescent dancesport athletes and nothing in adult ballet at all.
So this is a reasonable protocol built on research done in other people. We think that is worth ten minutes every other day. We do not think it is worth doing through pain, doing instead of seeing someone about a foot that hurts, or doing while you are mid-transition on pointe without mentioning it to whoever is guiding that.
Two decisions: how firm, and what size. Dancers get both of these wrong in a particular way, and it is not the way you would expect — it is not that your feet are delicate. It is that you are unusually good at ignoring them.
Firm or Soft
Soft Start here
A gentler spread. We recommend this to dancers first, and not because we think your feet are weak — the strength data says otherwise. It is because a high tolerance for discomfort is an asset in the studio and a liability with an unfamiliar movement. Every instinct you have trained will tell you to push through the first week. Don't spend that instinct here.
Firm
More resistance to close against, and a wider opening. Right once the Soft feels easy rather than merely bearable. Both types cost the same, so moving up is a decision about your feet, not your budget.
Size
Do not use your pointe shoe size
You know it better than any number on your feet, and it is the wrong one here. Pointe shoes run on their own scale, vary by maker, and are fitted to a foot under load in a box — none of which describes what this has to fit. Use your street shoe size, or better, measure your bare foot.
| Toe-Rx size | Women's US | Men's US |
|---|---|---|
| Small | 4.5 – 7 | CONFIRM_BEFORE_PUBLISHING |
| Medium | 7 – 9.5 | 7 – 8.5 |
| Large | 9.5 – 12 | 8.5 – 14 |
On an iPhone or iPad, open any product page in Safari and tap the 3D image to place a full-size Toe-Rx on the floor in AR. Hold your bare foot beside it before ordering — it is the closest thing to trying one on.
If you land on a boundary, or your toes aren't average
Shoe size measures length. What has to fit here is the width and thickness of your toes, and you already know more about your own toe shape than most people ever learn about theirs.
Women's 7 and 9.5, and men's 8.5, sit on the line between two sizes. If that is you, let your toe shape decide.
Wrong size? We'll swap it
Sizing from a shoe size is an estimate, not a guarantee. If your Toe-Rx pinches or slips once you try it, get in touch and we will exchange it for the size that fits.
Please do that rather than adapting to it. Wearing the wrong size is uncomfortable and can cause injury — and adapting to footwear that does not fit is a habit worth leaving in the studio. Contact us about an exchange
Your feet are not the problem. MRI puts two plantar muscles consistently larger in dancers than non-dancers, and toe flexor strength has measured almost twice as high. Years of training built exactly what years of training uses. What it never built is width.
Spreading the toes and drawing the big toe outward is a direction class does not go. It is also the movement that changed the numbers in the one trial that isolated it. Ten minutes, every other day, out of shoes — after your shoes are current, your hours are sensible, and nothing hurts.
References
Every figure on this page comes from one of these. Where a study's findings run out, we have said so in the section that cites it.
About these claims
No study on this page tested Toe-Rx, and none of the intervention research was done in adult ballet dancers. The MRI and strength work describes what ballet builds. The treatment trials tested opening and gripping the toes in people who were not dancing. We have joined those two ends together because we think it is reasonable, and we have said clearly where that reasoning starts.
Toe-Rx is not a medical device. Nothing here is intended to diagnose, treat, cure or prevent any condition, and nothing here is guidance on pointe readiness — that belongs to your teacher and a clinician who can see you dance. If your feet hurt, if the big toe is visibly drifting, or if you have reduced sensation in your feet, speak to someone qualified before using anything that presses between your toes.
