Hazards of High Heels

Tuesday, June 19, 2007

High heel (or high-heeled) shoes are those whose heels are 2 inches or higher. The majority of women wear high heels. In a 2003 "High Heels Survey" conducted by the American Podiatric Medical Association, 72% of women indicated that they wore high heel shoes. About 40% of those surveyed wore high heels daily. Most women who stated that they used high heels (77%) wore them for special occasions, such as weddings and funerals. Half of the respondents used high heels for parties, and half wore them out to dinner. Approximately 1/3 used high heels for dancing. In this survey, 20% of women wore high heels 1 to 4 hours per day. Approximately 10% wore high heels more than 8 hours a day. 82% of respondents stated that they wore high heel shoes for fashion or style reasons.

In this survey, 42% of women admitted to wearing uncomfortable shoes primarily for style. Thirty-one percent indicated that they wore high heels to work, even when the shoes bothered them. This study found that foot pain as a result of wearing uncomfortable shoes was common.

Although high heel shoes may look great on your feet, they may not be so great for your feet. High heels are a source of foot pain and may induce or contribute to many maladies. Heels that are over two inches in height change the way a woman normally walks. Wearing shoes with high heels can contribute to knee and back problems. Heels taller than 3 inches can place 7 times the pressure on the ball of the foot compared to flat shoes. Several foot problems have been associated with high heels. Corns and calluses are thick, hardened layers of skin that develop in areas of friction between the shoe and the foot. High heel shoes can encourage the foot to slide forward, producing sites of friction and rubbing. The narrow toe box often present with high heel shoes may produce abnormal, uncomfortable pressure points on the foot. Toenail problems can arise as a result of high heel shoes; constant pressure on toenails can lead to ingrown toenails and nail fungus. The wearing of high heel shoes can shorten the calf muscle and lead to thickening of the tendon that can connects the calf to the heel (the Achilles tendon).

Experts disagree on whether wearing pointy, high-heeled shoes can cause bunions. There is agreement that such shoes can exacerbate this condition if it already exists. High heels certainly don't help! Bunions are bony bumps that form on the inner aspect of the foot, at the base of the great toe. There is an abnormal angulation of the big toe, called a hallux valgus deformity, in which the big toe points outwards (toward the second toe). A variation of bunions can affect the little (fifth) toe. It is called a bunionette.

Bunions are often painful. Redness and swelling can develop over the site of the bony bump, as can corns or calluses. There is restricted or painful motion of the great toe. Bunions form when the normal balance of forces exerted on the foot become disrupted. Bunions tend to run in families. They are much more common in women. According to the American Orthopaedic Foot and Ankle Society, they are nine times more common in women than in men. Bunions can be associated with hammertoe deformities, which are unnatural bending of the toes, often the second through fifth toes. Hammertoes are also associated with high heel use.

A neuroma refers to a localized overgrowth of nerve tissue in the foot. Neuromas, also known as Morton's neuromas or plantar neuromas, occur most commonly between the third and fourth toes and can arise because of wearing tight-fitting shoes. Neuromas cause sharp, burning pain in the ball of the foot.

"Pump bump" is a bony enlargement along the back of the heel bone. It can be aggravated by the stiff back of high heel shoes. Pump bump is also referred to as Haglund's deformity. Redness and inflammation develop on the soft tissue overlying the bump on the back of the heel bone.

There are steps you can take to reduce the negative consequences of wearing high heels. First, only use shoes with heels two inches or taller in height occasionally, rather than regularly. Next, choose a shoe that is similar in shape to that of your foot. The shoe should be wider than your bare foot. Try on high-heeled shoes at the end of the day, when your feet are the biggest. Many people have one foot that is slightly larger than the other. Fit the shoe to the size of the larger foot. Try on both of the shoes, and walk around in them before buying. Your foot should not slip much in the shoes. Also, the shoes should feel comfortable right away; they should not require a break-in period. Remember to have your foot sized frequently. As we get older, our feet tend to get slightly longer and slightly wider -- related to changes that occur in the arch of the foot.

The American Podiatric Medical Association has awarded its Seal of Acceptance to several lines of walking shoes from various manufacturers. Visit www.apma.org for a list of shoes that bear the APMA seal.

If you have bunions, there are several measures you can take to minimize the discomfort. Use a moleskin or gel-filled pad to protect the bunion. Such pads are available at drugstores and many department stores. Make sure your shoes are large enough to accommodate the extra padding. If you have bunions, limit your use of high heels and pointed shoes. Opt for a shoe with a wider toe box that allows you to wiggle your toes. Shoes should also be flexible and allow the big toe room to flex. Athletic shoes are often good choices. If you have a prominent bunion, you can make a hole or a slit in an old athletic shoe overlying the site of the bump to help relieve pressure and discomfort. Nonsteroidal anti-inflammatory drugs (such as ibuprofen or aspirin) can help relieve pain. Icing can also help reduce inflammation and pain. See a podiatric physician or foot and ankle specialist early if pain persists. Early medical attention is important, because it can help in the management of pain and discomfort. Left untreated, bunions tend to get larger and more painful. Nonsurgical treatments are less helpful with more advanced bunions. Orthotics -- shoe inserts -- may be a good investment. Physical therapy may also be of benefit. For those who do not respond to conservative measurements, there are surgical treatments which can be offered by a podiatrist or foot and ankle surgeon. The basic surgical treatment is a bunionectomy, but there a dozens of variations of this procedure.

Surgery can reduce the pain in many, but not all, people with bunions.

Take care of your feet. High heel shoes are stylish, but you can pay a price for them, long after you buy them, if you use them too much.

• American Podiatric Medical Association: Bunions
• American Podiatric Medical Association: 2003 High Heel Survey
• American Podiatric Medical Association: Women's Feet
• MedlinePlus Medical Encyclopedia: Bunions
• American College of Foot Ankle Surgeons: Haglund's Deformity
• American College of Foot Ankle Surgeons: Bunions
• Women's Health: What to do about bunions...
• Foot Problems in Women: High Heels and Your Health