High Heels, High Risk
June 26, 2015
Story at-a-glance
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Close to half of US women wear high heels even
though 71 percent say the shoes hurt their feet
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From 2002 to 2012, more than 123,000 injuries from
wearing high heels were treated in US emergency
rooms
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High heels change the dynamics of normal human
walking, leading to an unnatural posture that adds
tremendous strain to your hips, lower back and knees
By Dr. Mercola
Close to half of US women wear high heels, and those who wear
them own an average of nine pairs each. The shoes tend to make a
regular appearance even though 71 percent of women surveyed by
the American Podiatric Medical Association (APMA) said the shoes
hurt their feet.1
When asked what they’d do if the shoes hurt, 38 percent of
women confessed they’d continue to wear them anyway if it was a
pair they liked. You might assume that the pain you’re
experiencing is temporary, and once you take the heels off to
give your feet a rub and some time to recuperate, they’ll be
back to normal.
However, over time wearing high heels can lead to chronic
problems, not only with your feet but also elsewhere in your
body.
High Heel-Related Injuries Doubled in the Last Decade
From 2002 to 2012, more than 123,000 injuries from wearing
high heels were treated in US emergency rooms. The amount of
such injuries doubled from 2002 to 2012, according to the new
research published in the Journal of Foot and Ankle Surgery.2
The majority of injuries (more than 80 percent) involved
sprains and strains to ankles and feet, although knees,
shoulders, and even heads were also injured. Most of those
injured were women between the ages of 20 and 29, and the
injuries typically occurred while in the home.
In the majority of cases, the injuries were minor, and one in
five resulted in a broken bone. The study’s lead author, Gerald
McGwin, an epidemiology professor in the University of Alabama
at Birmingham (UAB) School of Public Health, noted:3
“Although high-heeled shoes might be stylish, from a
health standpoint, it would be worthwhile for those
interested in wearing high-heeled shoes to understand the
risks and the potential harm that precarious activities in
high-heeled shoes can cause.”
High Heels Change the Dynamics of Human Walking
Even if you manage to avoid an injury such as a sprained
ankle while wearing heels, such shoes can actually change muscle
activity and the dynamics of normal walking.
High heels (generally described as a heel height of two inches
or higher) shift your foot forward into an unnatural position
with increased weight on your toes.
Your body tilts forward, so you lean backwards and overarch
your back to compensate. This posture changes the normal human
gait and adds tremendous strain to your hips, lower back, and
your knees.
Researchers found high heels increase bone-on-bone forces in
the knee joint significantly, which they said “may explain the
observed higher incidence of
osteoarthritis in the knee joint in women as compared with
men.”4
A 2015 study published in the Journal of Orthopedic
Research also found changes to knee kinematics and kinetics
during high-heel walking that may contribute to increased
osteoarthritis risk in women. The risk increased with extra
weight and as the heel height increased.5
Because of the extra stress placed on your knees, wearing
high heels increased the risk of joint degeneration and knee
osteoarthritis in yet another study as well.6
Other research suggested the use of high-heeled shoes may “alter
the natural position of the foot-ankle complex, and thereby
produce a chain reaction of (mostly negative) effects that
travels up the lower limb at least as far as the spine.”7
Additionally, according to research from the University of
Southern California, wearing 3.75-inch heels may increase stress
on your
knee joints by up to 90 percent compared to wearing a
half-inch heel!8
Generally, the higher the heel the more stress it places on
your knee joints, however even shoes with moderately high heels
(1.5 inch) “significantly increase knee torques” that may
contribute to the development and progression of knee
osteoarthritis.9
High Heels May Cause Bunions and Musculoskeletal Injuries
Indeed, yet another study revealed wearing high heels may
lead to “abnormal spine loading patterns and increases the risk
for developing musculoskeletal injuries.”10
And when worn long-term (defined as at least 40 hours a week
for a minimum of two years), high heels lead to “substantial
increases in muscle fascicle strains and muscle activation
during the stance phase compared with
barefoot walking.”
The results suggest that long-term high heel use may
“compromise muscle efficiency in walking,” which explains why
many high-heel wearers complain of discomfort and muscle
fatigue.11
Aside from altering your gait, wearing high heels may
contribute to bunions (hallux valgus). As written in the journal
Deutsches Arzteblatt International:12
“In women it is not only narrow shoes that cause
hallux valgus but also higher heels. These result in more
weight placed on the forefoot, with overstretching of the
toes and resultant splayfoot development, which in turn
triggers metatarsus primus varus deformity.”
Up to One-Third of Women May Suffer Permanent Problems
According to the American Osteopathic Association, not only
are high heels one of the major factors leading to foot problems
in women, but up to one-third of wearers suffer from permanent
problems due to long-term use.13
Natalie A. Nevins, DO, an osteopathic physician from Hollywood,
Calif. who specializes in neuromusculoskeletal medicine,
explained:14
“Extended wear of high heels and continually bending
your toes into an unnatural position can cause a range of
ailments, from ingrown toenails to irreversible damage to
leg tendons.
Additionally, cramming your toes into a narrow toe
box can cause nerve damage and bunions… High heels have also
been linked to overworked or injured leg muscles,
osteoarthritis of the knee, plantar fasciitis and low back
pain.”
The unnatural
posture that’s created from wearing high heels, which causes
you to overarch your back leading to strain on your knees, hips
and lower back, can cause even more issues. For instance, it can
put pressure on nerves in your back, leading to sciatica, a
painful condition that leads to pain and numbness that can
travel down to your feet.
Chronic pain is not uncommon with extended wear of high
heels. Due to the position of your heel (pointed upward), your
Achilles tendon can shorten and tighten. When you switch back to
flats, it will stretch again, which can be painful. According to
Dr. Nevins:15
“This tendon is designed to be flexible, so the foot can lie
flat or point. With repetitive wear, you can develop unhealthy
patterns that can persist even when you’re not wearing high
heels.”
Are There Healthier Ways to Wear High Heels?
In general, the less you wear high heels, the better. It
doesn’t matter if the heel is a stiletto or a wedge… both
wide-heeled and narrow-heeled shoes increase pressure on your
knees in the places where degenerative joint changes often
occur.16
If you do wear high-heel shoes, reserve them for occasions that
don’t involve extended periods of walking and standing. Ideally,
bring them with you to a special event, put them on when you get
there, and then change into your more comfortable shoes when you
leave.
Choosing lower heels – 1.5 inches or less – may also help to
minimize some of the strain, and it’s also important that the
shoes fit properly. Avoid shoes that cause your foot to slide
forward, which puts extra pressure on your toes, and choose
those with a toe box wide enough to wiggle your toes. Also,
consider adding a gel or foam insert to heels you already own,
which may act as a shock absorber and help to reduce some of the
strain on your knees. Overall, however, one of the easiest
changes you can make to avoid knee pain and foot problems is to
wear appropriate footwear for all of your daily activities. Opt
for comfort over style whenever possible.
It’s Not Only High Heels That Pose a Risk…
High heels are a major offender when it comes to foot pain,
but another popular style – flip flops – is also a culprit.
Flip-flops may throw off your stride and cause pain in your
lower legs and feet, according to researchers at Auburn
University in Alabama.17
Researchers recruited 39 college-age men and women and measured
how the participants walked on a special platform wearing thong
flip-flops. On another day, the same participants walked across
the platform wearing their own athletic shoes. When the
participants wore flip-flops, they took shorter strides and
their heels hit the ground with less vertical force.
When people walk in flip-flops, they apparently alter their
gait, which may explain why lower leg and foot problems can
occur in people who wear such shoes frequently. Throwing on a
pair of flip-flops to putter around your garden or walk along
the beach is an integral part of summer for many people.
However, according to Tony Bruno -- a certified Muscle
Activation Techniques Specialist -- wearing flip-flops can not
only cause dysfunctional changes and pain in your foot, these
changes can resonate all the way up to your head, neck, and jaw.18
This happens because your toes try to grip into bottom of the
flip-flop to hold them on your feet. Look at your toes in
flip-flops. The distal part of your toe is trying to flex down
(planter flex) to hold the flip-flop on while the other part of
your toe (middle) is trying to bridge up (dorsi flex).
Unfortunately, this is the opposite of what your toes should be
doing at that time. This improper toe action shortens natural
stride, prevents the natural “locking” of your foot, and forces
your hip and leg musculature to work harder, forcing some
muscles to shut down. Hammer toes are the result of years of
compensation from the intrinsic (small) foot muscles and long
term flip-flop wear can contribute to this.
So if you want to avoid hammer toes, you may want to
reconsider wearing flip-flops. In any event, taking off your
flip-flops in favor of walking barefoot on the earth will offer
benefits far beyond your foot health, as it will allow your body
to be
grounded to the earth.
© Copyright 1997-2015 Dr. Joseph Mercola. All Rights Reserved.
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