Washington - Freshly pedicured toes in high-heeled sandals or open-toed pumps look fabulous but sometimes feel like the masochistic torture tools that many podiatrists insist they are.
Michael Liebow, a podiatrist in Bethesda, Maryland, pulls out a wince-inducing photograph of a foot X-rayed in a high-heeled shoe: It reveals the ball of the foot at a nearly 90-degree angle to the bones in the rest of the foot. It does not look good.
The X-ray is a prop that Liebow says he shows to patients who “walk into the office in six-inch heels and say, ‘My feet are killing me! Why?’ “ He says he tells them, “That is not how your foot has evolved to walk.”
To sum up his brief and frequently futile plea for foot health: humans are meant to walk heel-to-toe, with the leg at about a 90-degree angle to the foot and the ankle joint employing a 60-degree range of motion during normal daily activities. By wearing a high heel, “you’re altering the position of the foot and how the foot is to function, therefore, lots of bad things happen”.
Shall we count the ways?
Among the more common problems podiatrists say they see in women are calluses and, more painfully, corns, hard nuggets of keratin build-up caused by pressure on the skin. With high heels, corns develop up under the balls of the foot where the weight of your body presses down, and they feel like small rocks underfoot when you walk.
Liebow also sees capsulitis, a painful inflammation of the joints where the toes attach to the foot, and neuromas, or pinched nerves, where pointy high heels squeeze the toes. And when the heel is frequently in a high-heeled shoe, it can cause the Achilles tendon (which connects the calf muscle to the heel bone) to tighten. When you kick off your shoes and the heel comes down to the floor, the extra stretching of the tendon can lead to a condition called Achilles tendinitis.
Wearing high heels can also cause inflammation of the connective tissue at the bottom of the foot, the plantar fascia. That can result in severe heel pain and the need for aggressive treatments such as anti-inflammatories, steroids, cortisone injections, walking boots and crutches.
All of these conditions can be incredibly painful, requiring corticosteroid shots and, ideally, flatter and wider shoes. His patients will take the shots, but give up the shoes?
Women, Liebow says, “will wear their high-heeled shoes until their feet are bloody stumps”.
Take Danielle Pletka, vice-president for foreign and defence policy studies at the American Enterprise Institute. She wears 10- or 12-centimetre heels to work most days; just the other day, she towered in 12cm stiletto-heeled Sergio Rossi booties.
“There are lots of things that impact on the way you look that aren’t necessarily optimal for every muscle in your body,” says Pletka, who admits that she has some high pairs “that are uncomfortable, no question”.
But, she adds, “you want to look nice. I always get nice comments on my shoes. And I like it.”
Erika Schwartz, a podiatrist who practises in Washington, says when she asks her patients to stick with heels less than five centimetres high, “some say, ‘Oh, you’re so cute. No, I’m not going to wear under two inches, but it’s very cute of you to say that’.”
Schwartz says she understands that many are in professions that demand a more fashionable shoe than the comfy, orthopaedically correct footwear she wears to work. So she tells them to at least “walk in something else. Put those dress shoes on when you get to the office. Minimising the amount of time you’re standing or walking will minimise the issues that come along with such an unnatural position of the foot”.
Did we mention that walking too long in high-heeled shoes can also result in stress fractures, or cracks in the bones of the feet?
Schwartz also suggests that women avoid the thin, stiletto-style heel:
“If it’s chunky or a wedge, it seems to be better because the shoe has a wider base of stability. A skinnier heel and you’re more likely to have ankle spraining.”
You can also break your ankle or injure the ligaments on the side of your ankle, among other body parts, when you fall from wobbly high shoes – thus becoming “fashion roadkill” like Carrie Bradshaw of Sex And The City, who in one episode fell face first while walking the runway in sky-high heels.
Podiatrist Franklin Polun – his website is Mydamnfoothurts.com – estimates that at least a quarter of his women patients come in with issues related to high heels. Like Schwartz’s patients, many of them aren’t willing to throw out their Manolo Blahniks.
“A high-heeled shoe is sexier-looking,” he says. “I get that.” So he tries to give them “an action plan that’s actually doable”.
This includes choosing a rubber-soled shoe over leather, because rubber is better able to absorb pressure on nerves in the feet.
He suggests shopping for shoes at the end of the day, when your foot is most swollen, rather than in the morning.
Liebow, too, has a “short list of things you can do to minimise the problems” if you insist on wearing high heels. The list includes buying only shoes with good padding at the balls of the foot and a gradual slope, so “the force is more evenly distributed” over the foot.
As for how high you can safely go with heels, Liebow says, “there’s no height that’s good”.
But “most women can handle a heel of an inch or two with minimal side effects.”
Liebow adds that some people have problems with slip-on woolly boots which often have little or no support for the arches of the feet.
Ditto for that other summertime favourite, flip-flops. – Washington Post-Bloomberg