Archive for September, 2011

The Dilemma with Wearing High Heeled Shoes

September 24, 2011

History of High Heeled Shoes

High heeled shoes have been historically apart of human culture. It was first documented on ancient Egyptian murals showing both men and women of royalty wearing heels for religious ceremonies and Egyptian butchers wearing them to walk above the blood of butchered animals. In Greece and Rome, heels were worn in theatrical plays to indicate social status. Regardless of its purpose, heels have been perpetually apart of daily life since ancient civilization.

Effects of High Heeled Shoes on the Body

High heels are unique compared to other footgear due to the shoes anatomy.   The structure of heels changes the positioning of bone orientation in the foot and ankle, resulting in postural changes of the body.

1. Narrow toe box

The shoe covering over the toes is called a toe box.  In the design of most high heels, the toe box tends to be narrow, decreasing the space inside the shoe and increasing friction between the foot and shoe. This results in increased risk of blisters and corns forming on the foot. Additionally, a narrow or pointed toe box squeezes the ball of the foot causing bones in this area to be forced closer together. This pressure increases the likelihood of irritating the nerves that run in close proximity to the bones. Constant use of heels can exacerbate nerve irritation leading to inflammation of the nerve called a neuroma. This condition is associated with a numbing or throbbing sensation at the ball of the foot and may radiate to the toes.  A narrow toe box in can also aggravate bunions and hammertoe deformities.

2. Heel Cup

The covering around the heel is called a heel cup and is often very hard and rigid in high heeled shoes. Additionally, the heel cup protrudes forward into the heel resulting in friction between the back of the wearer’s heel and the shoe. This increases the pressure on the back of the heel and overtime can create a bony protrusion in the area known as a “pump bump” or Haglund’s deformity, which can be painful when walking in shoes.

3. High Heel

The increased heel height places the ball of the foot lower than the heel. This position of the foot and ankle is called plantarflexion. As plantarflexion increases, the foot loses its shock absorbing ability and creates increased shock applied to the foot when the shoe hits the ground. This shock wave is transmitted through joints in the foot, knee, and hip causing leg and back pain when wearing heels.

Increased plantarflexion of the foot and ankle also shortens the calf muscle.  This shortening decreases the ability of the calf muscle to help lift the foot off the ground. Overtime, a shorten calf muscle can create a tight Achilles tendon, which strains the tendon and causes pain to the area when transitioning back to normal shoe gear. Additionally, heels change body posture by increasing pressure on the ball of the foot and decreasing pressure on the heel.  This results in increased pressure in the knee joint and strains the knee joint tendons, leading to arthritis of the knee. Studies have shown that even moderate heel heights of 1.5 inches can significantly increase strain to the knee. By distributing body weight unevenly and causing the wearer to lean forward, heels can increase the risk of falls.

Preventing Adverse Effects of High Heeled Shoes on the Body

Statistics has shown that 35-65% of women wear heels. However, there are preventive treatments that can alleviate pain and decrease adverse effects associated with wearing heels.

1. Custom Inserts

Custom made inserts that are placed inside heels can reduce the impact force the body experiences when wearing heels. Custom inserts support the arch and heel of the foot by increasing the area of foot contact to the shoe and distributing body weight to the middle of the foot. This can relieve some of the pressure from the heel and ball of the foot. Research studies have shown that custom inserts have been clinically proven to improve comfort.

2. Stretching

As mentioned above, higher heels tend to shorten and contract muscles in the foot and shorten the Achilles tendon and calf musculature, which results in increased workload on these muscles and tendons. Therefore, stretching these areas can relieve pain and aid in more comfortable transitioning between heels to flat shoe gear. Wrapping a towel around the ball of the foot and pulling the towel towards the body stretches the bottom of the foot. It is usually recommended to hold the stretch for 30 seconds and alternating between each foot 3-4 times.  A runner’s stretch is often recommended to stretch the Achilles tendon. This stretch entails pushing against a wall while one foot is forward and bent and the other foot placed back and straight. The foot placed back is stretching the muscles and tendons in the back of the lower leg. This stretch again is held for 30 seconds and is alternated with the other foot 3-4 times.

3. Rotating types of shoes

Alternating between supportive athletic shoes, flats and heels can decrease the potential problems associated with wearing high-heeled shoes.