Vanity, thy name is high heels. Granted, they make our legs look long and slinky, but at what cost? “Excessively high heels, especially the ones with very pointed narrow toe boxes, can lead to an exacerbation of bunions and hammertoes, and can cause corns and calluses,” says Dr. Julie Stewart, a podiatrist with the Foot and Ankle Center. She says many high heel wearers also develop low back pain from the excessive curve in the lower back needed to maintain balance. High heels can also cause plantar fasciitis and actually shorten the Achilles tendon because of the constant state of shortening, especially when they are worn most days of the week.
She is seeing a trend toward women wearing lower heels of 2 to 3 inches, instead of the stiletto 4 to 5. More rounded toe boxes are also being featured in many lines, and some shoe manufacturers are adding extra padding under the ball of the foot for cushioning. Stewart says if you add your own inserts, it can increase the problem by making the toe box even smaller. If you are planning to use inserts, take them with you when you shop for shoes to make sure they fit comfortably. Patients who need surgical correction of a foot problem should avoid high heels while they are healing.
Dr. Constantine Kyramarios at Foot Healers says that high heels worn for short periods are probably fine. It’s the all-day, everyday, wearing that creates problems. Chronic high heel wearers often get to the point where their Achilles tendons have been shortened so much that they can’t wear flat shoes like sneakers, he says.
Because all the pressure in high heels rests on the balls of the feet, a common development is Morton’s neuroma, a painful inflammation of a nerve on the bottom of the foot. “Pressure on the ball of the foot also causes weakening of some tendons and dominance of others, leading to weakening the tearing of the joint capsule and hammertoes,” Kyramarios says.
He reminds us that for every inch in heel height, the pressure on the ball of the foot increases considerably. Sticking with a heel 1.5 to 2 inches high greatly decreases the likelihood of complications. He suggests keeping two pairs of shoes at your desk. If you are walking a long distance, change into sneakers. Padded inserts don’t help much, he says. It’s the style of the shoe that’s the problem.
“A pointed toe box is not good,” Kyramarios says. “It doesn’t hold the foot, so a woman will choose a shoe that is shorter than normal. With the increased pressure against the toes, fungal nails and even loosening of the nail are real possibilities. The best shoe is one with a squared-off toe box that has room for the toes both side-to-side and lengthwise. Women with narrow heels also tend to buy a heel that’s shorter. That’s a mistake, too. Buy one with an adjustable heel strap to anchor in the heel and still leave room for the toes.” He points out another potential issue: driving in high heels. The heel can get caught in the pedal or floor mat. It’s best to have a pair of flats for driving.
Dr. John Holtzman of Missouri Foot and Ankle says high heels, especially spike heels, are basically unstable platforms that can cause a loss of balance leading to ankle sprains, ligament and tendon sprains and tears, even fractured ankles. “High heels and their narrow toe boxes also can lead to ingrown toenails and pressure on the foot bones,” he says. “When that causes inflammation at the heads of the adjoining bones, sometimes called capsulitis, it can make any walking painful.” He says high heels are fine in moderation, but recommends women choose more of a wedge heel than a stiletto to add stability to the platform for walking. It will decrease the risk of ankle twisting and falling. Even better than wedge heels, shoes with a solid bottom from heel to toe also decrease the pressure on the ball of the foot. His final recommendation: “Limit the frequency and length of time in high heels, and take the time to gently stretch the Achilles tendons after you take them off.”