The Lowdown On Stilettos
	The Stresses High Heels Place On The Body
	How To Prevent These Problems
	Shoes For Day Wear

Before you fall head over heels for another pair of heels, you might have problems in your joints the heels can worsen.

Trina Lee
Physiotherapist

The Lowdown On Stilettos
Stilettos are sexy and they may make your legs look like they stretch for miles, but is it really worth all the pain in your feet or the risk of an ankle injury? When you're young, you may think that it is all worth it, but when you are old and crippled with bunions, claw toes, calluses and ugly feet, you might understand the price of beauty.

They look harmless and quite attractive when you try them on, but they can be quite dangerous. Apart from stepping on your partner's toes while you are doing the salsa and breaking them, they can cause you to slip, fall down the stairs and make it difficult for you to brake while driving.

The Stresses High Heels Place On The Body

1. Instability
   The smaller the heel, the harder the muscles around the ankle have to work to prevent side-to-side movements and maintain stability. When the muscles are caught off-guard, the ankle is very prone to going over on the side and spraining the ligaments that support and protect it. A weak ankle is at risk of recurring sprains.
   
   
2. Heel pain
   There is a fibrous band of connective tissue (the plantar fascia) that spans the sole of the foot from the heel to the ball of the foot. Its bowstring effect plays an important role in maintaining the integrity of the arch of the foot and stabilising the foot just before the foot lifts off the ground to take a step during walking.
   
   Wearing high heels all day causes the plantar fascia to be in a continuous state of tension as in this position where the heel is substantially raised, it is maximally stretched. Coupled with the stresses of walking, its attachment at the heel can become inflamed, causing heel pain.
   
   
3. Foot deformities
   According to a consultant podiatrist, shoes with a tight, pointy toe box can compress and cramp the toes, causing a number of foot disorders and deformities, some of which may require surgery.
   
   Some of these include corns calluses, bunions (a turning of the big toe towards the other toes leading to a prominent bump on the inner side of the foot), hammer toes (a claw-like deformity in which usually the big or second toe is permanently bent).
   
   The higher the heel, the more pressure is exerted on the ball of the foot. Forces equivalent to as much as twice the body weight can be concentrated on the ball of the foot, causing chronic pain and sometimes, stress fractures.
   
   
4. Achilles tendinitis
   Wearing high heels over a period of 5 to 10 years causes the calf muscle to adaptively shorten. When this happens, it becomes difficult and often impossible to squat or walk barefoot without walking on your toes.
   
   In time, overuse of a tight calf muscle causes tendinitis of the Achilles tendon located in the back of the ankle. This tightness produces all kinds of other stresses to the foot, the knee, hip and even the lower back due to an alteration in the biomechanics of the lower leg.
   
   
5. Knee pain
   A Harvard Study has implicated high heels as a possible contributor to osteoarthritis of the knee. This may support the fact that women are twice as likely to suffer from knee pain than men. An explanation of this might be that having the heels raised causes the body to be pitched forward.
   
   In order to counteract this, the knees bend slightly to prevent the body from falling forward. Keeping the knees bent while walking increases the pressure and friction between the joint surfaces, causing more wear and tear.
   
   
6. Back pain
   A sway back posture is created as the body arches back to counteract the forward pitching of the body. This may look sexy as the buttocks stick out and the chest is thrown forward, but it actually places a lot of stress on the joints and ligaments of the spine, resulting eventually in back pain.
   
   
7. Forces of impact
   The smaller the surface area of the heel in contact with the ground, the more pressure and hence, the greater the force exerted by the ground on the heel and transmitted to the rest of the body. These forces are multiplied when walking speed is increased and while running (if that is physically possible). These jarring forces can exacerbate problems of the heel, knee, hip and back.

How To Prevent These Problems
If you are wearing five centimetre heels or higher all day, everyday, you are putting extreme amount of stress on your feet. You are better off wearing flat shoes or shoes with a wider heel no higher than three centimetres during the day while on your feet and saving the high heels for the weekend or at night when you are doing more sitting.

Don't fret because you think you should quit wearing high heels altogether. As with everything, moderation is good, excessive is bad.

Shoes For Day Wear
Shoes that have a square or rounded toe box high enough to allow your toes to wiggle are strongly recommended. It should have a fairly wide heel no more than 3 centimetres high with a sturdy heel counter (support behind the heel). To prevent slipping, a rubber base is preferred to a plastic or wooden one. Platform shoes are a potential disaster.

Date reviewed: 26 April 2005