The Problem with High Heels

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According to the American Podiatric Medical Society, 87% of women have had foot problems from footwear issues.  Yet, women continue to choose to wear heels in everyday life.  Some of the most common reasons are to increase height, make the legs seem longer, and to induce a more attractive walking pattern.  If asked, many women would know that high heel shoes are not the best shoe choice.  However, aesthetic wishes often outweigh health concerns.

Most would probably be able to list problems like cramped feet, sore legs, and calluses as side effects of wearing high heeled shoes.  There are potentially more serious complications though.  First, consider the Achilles’ Tendon.  That is the tendon that connects the calf muscle on the back of the lower leg to the heel.  That muscle’s prime function is to point the toes.  When high heel shoes are worn, the distance between the heel and the calf is shortened.  When high heel shoes are worn consistently, the body reasons that this is the new normal position and a longer tendon is not needed.  Therefore, the body starts to restructure the tendon to make it shorter.

This becomes an issue when physical exertion is necessary.  Imagine someone who wears high heel shoes to work every day of the week for months.  Then one weekend, she decides to go to the club to play tennis in athletic shoes.  The body has already started to restructure the tendon and if this particular individual started a high stress athletic activity without proper warm-up/reaccommodation, then her Achilles’ Tendon is in jeopardy.  The increased stress on a shortened tendon may cause it to snap.

Next, consider blood flow.  As we walk, the muscles in our legs contract and relax.  These contractions help return blood to the heart.  Will wearing high heels affect the venous return of blood?  A study in the Journal of Vascular Surgery examines this issue.  The authors took young women and measured their blood flow while they walked in different shoes.  They found, that while wearing high heels the amount of blood returned to the heart was decreased which left more blood remaining in the vessels of the legs.  Overtime, this will result in an increase in venous hypertension.  Left unchecked, it can cause conditions like varicose veins and venous legs ulcers.

It is not only the heel and calf that are affected by these shoes. As heel height increases, the mid-foot starts pointing towards the ground. This means that in order for the toes to be flat on the ground, the angle between the toes and the mid-foot has to increase. This increases stress and can create a “pinch point” between the mid-foot and toes. This weakens the area and can lead to injuries or the development of arthritis. Many high heel shoes come to a sharp point in the toe box. This cramps the toes and can lead to bunion formation, hammer toe, or overlapping toes. The longer this goes on, the harder it is to fix.

Finally, reflect on this study published in the Journal of Applied Biomechanics.  The authors recorded EMGs while women walked barefoot and in high heels.  They also examined joint movement using 3D inverse dynamics.  What they found was an increase in several muscle groups’ activity including the quadriceps.  They also demonstrated that there was more bone on bone forces in the knee due to increased knee extension.  These findings may partly explain why there is a higher incidence of osteoarthritis of the knee in woman when compared to men.

It would be an impossible task to convince women to stop wearing high heels altogether.  However, hopefully this article brings up some thoughtful points that will help women view their high heels a bit differently.  All that is needed is moderation in high heel wear.  Change shoe types often instead of wearing high heels every day to work.  Stay physically active to prevent problems like tendon or muscle shortening.  Finally, take care of issues right away instead of trying to tough through them.  See a chiropractor for foot, ankle, knee, or hip pain to get things correctly aligned.