The Low-Down on High Heels

The big fashion news last fall was the return of spike and stiletto heels. Many met this report with dread and trepidation — another season of sore feet.

High heels hurt and can cause significant health problems including bunions, heel pain, toe deformities and painful trapped nerves. Frankly, most women are tired of wearing shoes that hurt their feet. A 1993 survey of 620 women found that the majority were dissatisfied with their shoes even though most paid between $50 and $200 for dress shoes.

“Fashion shoes are expensive and come with hidden costs,” explains orthopedic surgeon Glenn B. Pfeiffer, M.D., San Francisco. “First you spend up to $200 for a pair of shoes, then you’re taking taxis all over town because you cannot walk any distance in spike heels, and finally there’s the medical cost of wearing these shoes.”

Women have about 90 percent of the 795,000 annual surgeries for bunions, hammertoes, neuromas (trapped nerves) and bunionettes — the four most common problems linked to poorly designed and poorly fitting shoes. Approximately two-thirds of these conditions requiring surgery can be attributed to the patients’ shoe wear selections.

The total estimated cost for this avoidable surgery is $2 billion annually. With an average time lost from work of four weeks per person, the cost of time lost is about $1.5 billion. That’s a total of 3.5 billion health care and workforce dollars lost each year to poorly fitting, poorly designed shoes.

People take an average of 10,000 strides per day, and high heels shift the force of these strides to place pressure on the ball of the foot and the metatarsal heads (bones at the base of the toes). A 3-inch heel creates seven times more stress on the forefoot than a 1-inch heel, thereby increasing the possibility of foot problems with each step when wearing high heels.

Minor missteps in spike or stiletto heels can have disastrous results, and women are twice as likely to suffer a sprained ankle while walking in heels than while more sensibly shod.

Frequent wearing of high heels can also shorten the achilles tendon over time and cause wearers to lose range of motion in the foot and suffer other foot problems and pain as a result.

A study by the American Orthopedic Foot and Ankle Society (AOFAS) indicates that this shortening of the achilles tendon in high-heel wearers is responsible for the disproportionate number of American women who suffer heel pain. Women make up as much as 75 percent of the two million Americans suffering heel pain, and regular stretching of the achilles tendon and calf muscles can often relieve the problem.

The AOFAS discourages wearing fashion shoes with a heel height greater than 2-1/4 inches and recommends high-heel wearers limit themselves to two or three hours in such shoes per day. “Have yourself dropped off in front of the restaurant in high heels,” advises Dr. Pfeffer, “then take them off when you get back in the car.”

While shoe design impacts foot health, proper shoe fit is equally important. A 1993 AOFAS survey of 386 women found that 88 percent wore shoes too small for their feet, 80 percent reported pain and discomfort and 72 percent had one or more foot deformities. The average woman in these studies had not had her feet measured in more than five years.

Forcing the foot into a shoe too small and subjecting it to daily pounding and pressure can cause deformities over time. Bunions, hammertoes, mallet toes and claw toes are often the result of poorly fitting shoes.

“Women should not only look for low, shock-absorbent heels, but also a rounded toe box that fits the shape of their foot,” advises Carol C. Frey, M.D., Los Angeles.

For a dramatic demonstration of the problem of poor shoe fit, stand on a piece of paper and have a friend draw a tracing of your weight-bearing bare foot. Now take the dress shoes you most commonly wear and place them over the tracing. If your forefoot is much larger and rounder than the toe box of your shoe, you may be setting yourself up for painful foot problems in the near future.