Do you really want to wear those high heels?

Those who wear high heels risk foot injury, muscle imbalance, bone deformities, knee and ankle joint problems, bunions, hammer toes and more.

by Chung-Li Wang — 

For years, orthopedic surgeons have been warning women about the perils of wearing high heels. Those who wear high heels risk foot injury, muscle imbalance, bone deformities, knee and ankle joint problems, bunions, hammer toes and more.

A new study featured in the November 2009 issue of Foot & Ankle International details the biomechanical changes that occur in feet during high heel wear, and the correlation between heel height and the amount of pain, pressure and strain it puts on the feet.

The study measured plantar pressure and soft-tissue thickness simultaneously, using a load cell, a device that detects foot pressure, and a linear-array ultrasound transducer. Participants in the study included 21 healthy men and women who had measurements  taken while standing barefoot on wooden blocks placed below the heel — in heights of 2 cm (.78 inch), 3 cm (1.18 inch) and 4 cm (1.57 inch).

The results showed a significant increase in pressure on the metatarsal heads (the ends of the metatarsal bones that connect to the toes) as the heel height was raised. Such increased pressure contributes to pain, calluses and bony deformities. The authors of the study suggest limiting heel height to no greater than 2 cm (.8 inches), along with the use of padding at the ball of the foot, which can significantly reduce discomfort and risk of injury to the metatarsal heads.

The study demonstrates a close association between heel height, plantar pressure and soft tissue compressibility. This is helpful in the prevention of pain and damage to your feet from improper heel height.

For those who like to wear high heels, discomfort can be lessened by choosing shoes with a wide toe box, adding a pad under the metatarsal heads and removing your shoes frequently.

Following the tips listed here, as well as the study data, will go a long way toward reducing foot discomfort. Remember that however appealing high-heel, high-fashion shoes might be, your feet need to carry you around for a lifetime. Treat them kindly.

Tips for wearing high heels

• Wear a lower heel. A 2-inch heel causes fewer problems than a 4-inch heel. A lower heel will give an elongated appearance if it is a thin stiletto type rather than a thick or chunky heel.
• Try to save the use of high-heeled shoes for functions where you will not be on your feet for extended periods of time; treat them as a limited, special-occasion accessory.
• Take your designer shoes to a pedorthist to have them custom-fit to your feet. They may be able to stretch the toe box to better accommodate your feet.
• Try wearing a larger size and insert heel cups into the backs for a more comfortable fit.
• Wear open-toe shoes so as not to crowd your toes.

Chung-Li Wang, M.D., Ph.D., EMBA, is professor of orthopaedic surgery at the National Taiwan University College of Medicine. He specializes in foot and ankle surgery, biomechanics, musculoskeletal ultrasonography and hospital management, and has published more than 75 articles in medical and scientific journals related to the care of the foot and ankle. www.aofas.org.

Reprinted from AzNetNews, Volume 29, Number 1, Feb/Mar 2010.