Today, the pointe shoe sole is constructed of a single piece of leather attached to the shoe with special glue, and stitched along the edges for reinforcement. The toe box is a hard, enclosed area that holds the dancer's toes, with the front end of the box flattened so the dancer can balance and spin on a little flat surface. Often, dancers score the bottom of the shoe with a knife (if they are not scored already) to provide traction, and less slippage.
Of course, there is a tremendous price to pay for all that flight! Most dancers have damaged feet. It's very hard to continue to put pressure and weight on such a small area without eventual, detrimental effect. But, nonetheless, if you ask a ballerina to "be careful, don't spend so much time en pointe, take care of your feet", you might as well be talking to the wall. The dance is a magnificent obsession!