How It Works
Pointe shoes work to support ballerinas by having a box or platform at the end to support the toes and a shank to support the arch of the foot. The pleats are on the bottom of the shoe at the toe. The pleats allow dancers to move from demi-pointe (flexed toes) to all the way through to releve (on the tips of toes) without the shoe sliding. The shoes come with drawstrings to adjust to the dancers foot size, but dancers must sew on their own elastic and ribbons. The shoes are made inside-out with no specific right or left shoe. Most shaping of the shoe is done by hand, and not with machinery.
http://www.theballetbag.com/2009/12/28/dancing-shoes/