The Perils of High Heels: Fashion vs. Health

For a recent mid-summer black-tie wedding, I wore four-inch stiletto heels. After several hours, my feet ached, and I noticed a small knot on the top of my right foot.  It was hard to ignore the link between the high heels and my aching feet.

“High heels, especially stilettos, force your feet into an unnatural position, leaving your toes to carry the full burden of your entire weight. Overloading the forefoot (the toe area) and bones on the bottom of your feet can, over time, lead to deformed toes, bunions and foot pain,” says Christopher HodgkinsM.D., an orthopedic surgeon who specializes in foot and ankle surgery at Doctors Hospital Center for Orthopedics & Sports Medicine. “If you don’t listen to pain’s message, it could pay you back with toe deformities and possibly other injuries.”

Foot problems can take different forms and cause pain. Here are a few:

Bunions: That bulge at the base of your big toe could be a bunion, which occurs when the tissue or bone in that area becomes inflamed at the joint. The bulge protrudes outward, and the deformity can cause your big toe to turn inward. It’s a hereditary condition, but poorly fitting shoes can be a factor, according to the American Academy of Orthopaedic Surgeons (AAOS).

Deformed toes: When you’re in high heels, you’re placing extra pressure on the ligaments around your toes. When the ligaments are weakened, your toes can drift and become deformed, Dr. Hodgkins says. Deformities include:

  • Crossover toes:  Damaged ligaments enable toes to drift out of position and cross over or under another toe. Typically, the second toe overlaps the big toe.
  • Hammer toes:  Problem shoes or poorly fitting footwear can distress toe muscles and lead to a deformity in the middle joint of your second, third or fourth toe. The deformed toe looks like a hammer.

Arthritis: In the U.S., the top cause of disability is arthritis, which occurs when you have pain or inflammation in the joints, including those in the foot or ankle, according to AAOS.

Bone and heel spurs:  Bony outgrowths on joints or on the edges of bones in the feet can cause pain or inflammation in the surrounding tissue.

If the pain does not subside after a few days, consult a foot and ankle orthopedic surgeon. Keep in mind that there are many different causes of foot pain. An orthopedic surgeon will target the source of the pain and recommend various treatments, with surgery as the last resort,” Dr. Hodgkins says.

I’ve already started shopping for my fall wardrobe—and have found great deals on some low-heeled shoes that are pretty enough for a formal wedding. But even kitten or modest heels should come with a warning, Dr. Hodgkins says.

“Anything with a heel is a high heel. Even a small one-inch heel places more stress on the front of the foot. Of course, the higher the heel, the greater the problem,” he says.

Still hooked on high heels? Here are a few guidelines:

  • Wear high heels in moderation, and save them for special occasions.
  • Avoid walking great distances in high heels.
  • Slide into sensible shoes or sneakers, and carry your heels while walking to the car or party.

“When your foot hurts, that’s when you are wearing high heels too much,” Dr. Hodgkins.


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