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Health

Paying a Steep Price with High Heels

If you think high heels are the height of elegance, you might be interested in the accessories that typically accompany the footwear: hammertoes, corns, calluses, bunions, ingrown toenails…the list goes on.

Research indicates a host of physical problems associated with high heels, including foot pain, foot deformities, a change in back posture, knee osteoarthritis and balance impairment, sesamoiditis (inflammation and swelling), neuromas (nerve damage), metatarsalgia (pain in the ball of the foot). Less frequent but all too common high heel-related injuries include ankle sprains and even bone fractures of the foot.

Researchers link high heels and knee osteoarthritis, a painful, degenerative joint disease.
In 1998, a team of Harvard researchers linked high heels and knee osteoarthritis, a painful, degenerative joint disease characterised by the breakdown of the cartilage surrounding the knee. In that study, D. Casey Kerrigan, MD, associate professor of physical medicine at Harvard Medical School, and her team looked at very narrow, stiletto heels.

Wide heels no better
The researchers decided to look at the chunkier heels now in fashion to determine if they too are harmful to women's knees. The latest study, which appears in the April 7, 2001, issue of The Lancet, demonstrates that wide heels increase the risk of developing osteoarthritis in the knee as much as, or more than, spindly-heeled stilettos.

"Wide-heeled shoes give you the perception of more stability when you're standing, and they feel comfortable, so women wear them all day long," Kerrigan said. "They are better for your feet than stiletto heels, but just as bad for your knees."

Low-heeled shoes or no heels are a woman's safest bet against osteoarthritic knees.
Both narrow- as well as wide-heeled shows increase knee joint pressure 26 percent more for wide-heeled shoes and 22 percent for narrow-heeled shoes. This kind of repetitive stress to the knee elevates the risk for osteoarthritis, according to physicians. Low-heeled shoes or no heels, researchers conclude, are a woman's safest bet against osteoarthritic knees.

"It takes a long time to feel the effects of knee osteoarthritis, and once you do, it's too late," said Dr. Kerrigan.

High heels also cause foot problems
High heels can also result in a variety of foot problems, including metatarsalgia, which is pain in the ball of the foot. Another condition, called Morton's neuroma, which is 10 times more common in women than men, is caused by a thickening of tissue around a nerve between the third and fourth toes. It usually develops in response to irritation and excessive pressure such as the weight burden high heels place on the ball of the foot. It is often treated with orthotics, cortisone injections and in stubborn cases, surgery.

"With higher shoes, your feet tend to slip forward," says Dr. Marlene Reid, a Fellow of the American College of Foot and Ankle Surgeons. This may amplify discomfort, especially if the shoes don't fit properly in the first place. She suggests women look for shoes with padding in the forefoot area, cushioning the toes and ball of the foot. And be sure there is sufficient shoe width to maintain comfort.

"A stable heel is also important to the well-being of the foot and ankle," she says. Stability is maintained when the heel of your foot is firmly enclosed by the shoe, with the stiffest support being the best." Dr. Reid stresses that women should walk in the high heel shoes before they make a purchase. And walk on bare floors, not just the carpeted floor in the shoe display area of the store.

Pointed toe shoes and shoes that pinch lead to other foot problems such as bunions, calluses and hammertoe.
Such common maladies as bunions or hammertoes are accelerated by ill-fitting or excessively high heels, says Dr. Reid. "Walking in these shoes will change your gait pattern, which can affect your legs and back. Poor shock absorption of the shoes can also contribute to back pain." Such longer term conditions as arthritis in the toe and ankle joints can be exacerbated by excessive wearing of high heels.

Fashion editors point to high heels as enhancing the appearance of your legs as your calf muscles contract and adjust to the angle of high heel shoes. Dr. Reid suggests women do some basic leg stretching exercises after wearing heels to avoid excessive tightening of these calf muscles and the Achilles tendon. Wearing high heels on a regular basis over the years can cause these muscles and tendons to permanently contract, making walking in flat shoes or even bare feet more difficult.

High heels can cause infertility
An expert has claimed that in their attempt to look drop-dead gorgeous in stilettos, women actually risk their fertility, as these five-inch killer heels can affect their internal organs in a condition known as visceroptosis.

"If people value their health, avoid these killer heels at all costs they're not worth the risk," The Mirror quoted Health and Fitness chief Dax Moy, as saying.

"Most important are the potential problems that high heels can cause in relation to fertility, menstrual cycles and abdominal function. When you wear high-heels, the pressure on the front of the foot causes you to compensate by excessive forward tilting of the pelvis. If left unchecked, this can lead to menstrual dysfunction and increases in period pains as well as affecting the ability to conceive," he said.

"Most women are intimately aware that the prolonged wearing of even moderate heels can cause foot, ankle and knee problems and lead to back pain. But it's not just about the feet, it affects every single function in every joint and muscle throughout the body and can seriously affect the health of women who insist on wearing them," he added.

"The forward tilting of the pelvis allows the abdominal contents to spill forward, producing that `pooch' which many women have wrongly come to think of a `fat stomach'. In doing so, they compress internal organs in a condition known as visceroptosis,'' said Dax.

"It doesn't stop there - neck, back, shoulder pain, stress headaches and even premature hair loss can ensue as a result of ignoring the way your body is designed to work," he added.

“About 80 percent of Western women report foot pain,” said Dr. Mary Ellen Franklin, an exercise physiologist and associate professor of physical therapy at the Medical College of Georgia. “Societies that don't wear shoes don't have this problem.”

With so many potential health problems, Dr. Franklin's recommendation is succinct: Don't wear high heels. She suggests that women shop for shoes very carefully. Most women's shoes, she noted, are constructed based on a man's foot. But men's feet are shaped differently than men's; women's feet tend to be more narrow at the back than the toe. Women generally use the back of the shoe to determine their fit whether or not the foot slides in the shoe. Shoes based on men's foot shape will fit in the back but be too narrow in the front, unnaturally constricting the toes.

“Make sure the shoe fits in both the front and back of the foot, and ask whether the style of shoe was made using a man's last (the mould used to construct it) or a woman's,” Dr. Franklin said.

The most healthy shoe
Surprisingly, flat shoes are not the ideal for overall foot and leg health. Low heels of one-half to three-quarters of an inch are good for both the front and back of the foot. Square-toed shoes with a roomy toe box help prevent the pinching and scrunching of the foot that can lead to lots of painful problems.

Source: Yale New Have Hospital, American Association for Women Podiatrists, Medical College of Georgia, The Hindu, Online