Distortion of the feet through shoes that change the shape of the feet, putting strain on places that wouldn't normally have that much pressure. This forces the feet to adapt to cope with the extra strain, making joints more prominent and the feet often bony and rather ugly! The position the feet are in puts strain on the joints and bones, having to support the whole body weight on just the toes, bending the feet in a way which they were not designed for. The toes often bleed through the process of learning this ballet technique, and also can be easily broken during these steps.
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