Do You Have to Give Up Your High Heels?

Peter Wishnie, D.P.M.
Owner of Family Foot & Ankle Specialists in Piscataway & Hillsborough, NJ

Do you wear high-heeled shoes despite the pain and discomfort that you may have?  Or are you used to wearing heels so much that you have no pain?  Regardless, high heels are often a staple for a lot of women as they are very fashionable and the standard in many settings. Women will go through great lengths and sacrifice comfort for sake of beauty.  Social pressures are also very strong and lead women to wear high heels even when they should not. 

Admittedly, they do look nice. However, there is a time and a place for every type of shoe.  The problem is that a lot of women wear high heels up to 5 or 6 inches all the time! How uncomfortable is this?  One might wonder how anyone can even walk in these uncomfortable and sometimes very awkward-looking shoes.  We’ve all seen women who when walking down the street in 6 inched heels, walk  VERY slowly and holding on to their friend or loved one for dear life.  But don’t ever, ever tell them they don’t look good!  Or how about the 80-year-old lady who wore heels for most of her adult life but now she has bunions and hammertoes and really cannot fit into heels any longer but does so anyway.  I see this type of situation a lot in my office.  Their pain will go away by simply wearing a wider shoe with a lower heel to accommodate their feet.  This is how ingrained the use of heels are for many women.

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Ever wonder why your feet hurt when wearing flats if you are accustomed to wearing heels?  This is because when you wear heels this causes your ankle to go down (plantar flexion) and there is NO stress or pull of your Achilles tendon, which is the strongest tendon in your body.  So your Achilles becomes used to this shorted position and develops a contracture.  This is a condition called ankle equines.  When this person wears flats, all of a sudden the Achilles is being stressed or pulled up (dorsiflexion).  The Achilles is used to these very high heels and is tight, so now wearing flats causes the Achilles to actually work and it pulls causing the pain.  If this same very fashion-conscious lady continues wearing very high heels, it could eventually lead to the development of Achilles tendonitis or inflammation of the tendon which can lead to tendinosis or degeneration and finally a tear or rupture of the Achilles tendon.  A tear or rupture of the tendon for an active, healthy person means they will need immediate surgical repair to maintain proper foot and ankle function.

Also heels are usually very narrow in the front.  If you are prone to bunions and hammertoes and you wear these types of shoes, you are NOT going to be comfortable.  Bunions and hammertoes are an inherited condition and will happen regardless of the type of shoes you wear.  However, bunions and hammertoes are not always painful.  The condition can be managed by wearing a regular shoe with a low heel and a round or even squared toe-box.  Wearing narrow shoes will accelerate and aggravate the condition.

Pain in the balls of the feet called metatarsal is another problem associated with high heels.  Heels put a lot of pressure on the balls of the feet or the heads of the metatarsal bones.  This can lead to inflammation of the joint capsule called capsulitis, neuromas and even stress fractures.  Also high heels can lead to other types of tendonitis, contractures, stress fractures, ankle sprains and a whole host of other problems. 

Wearing heels should not be banned.  High heels up to 2 inches high are fine for certain occasions such as a wedding, special event, or interview but even at the wedding you should take those heels off and change into a flat to dance.  Kitten heels, which are about 1” high, are great as they offer a low heel but even then you shouldn't’t walk too far in them.  If you are going out for a long walk around the city or mall, then you should not wear a heel rather you should have comfortable sneakers or casual shoes on.  If you must wear a heel especially if you are short and want more height, platform heels are not bad on your feet.  Platforms are high in the front and the back providing the elevation but not causing the ankle to go down (plantar flexion) and not allowing the Achilles to rest and contract.  Remember there is a time and a place for every shoe, but high heels should and cannot be worn for prolonged periods.  As with everything moderation is the key.

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