The use of heels in an everyday setting has been a common trend amongst women for years. Work, social and personal requirements have all contributed to increasing use of high heels. Whilst most clinicians and most research all agree with consistent use as being detrimental to foot health, most people I see in a clinical setting do struggle to see the effect that wearing heels often will have on their feet, they certainly can feel it.
The use of heels has been linked to a number of different foot and lower limb ailments including:
- Sore and tight calves.
- Strained or sore Achilles tendons.
- Generally sore feet particularly underneath the balls of the feet.
- Corns and callouses.
- Clawed toes and hammertoes.
- Ankle injury due to sprains.
- Onset of osteoarthritis particularly in the knees.
- Misalignment of the hips, knees, back and spine which may contribute to altered gait and might lead to further injuries.
- Stress fractures of the metatarsal heads.
- Soft tissue injury such as ligament strains and inflammation of tendons.
The above are considering only a few of a number of different potential consequences and much of what can occur would depend on a number of factors including patient biomechanics and footwear characteristics. When you look at the science of it though, the picture does become a bit clearer as it shows that the higher the heel, the greater the pressure redistribution along the forefoot area.
As can be seen in the image, in a naturally flat plane, the pressure of the body weight is fairly equally distributed between the heel and the forefoot. However with every cm increase in heel height, the forces of pressure move away from the heel and distribute across the ball of the foot.
This can become a problem when you consider that the structure of the forefoot is made up of a bundle of bones, tendons and ligaments all holding together a very delicate system. By increasing the amount of force experienced by this region, people run the risk of disrupting this delicate system which may ultimately end in symptoms of pain and potentially dysfunction which may affect your ability to perform everyday tasks normally.
So the question I get asked is, ‘What exactly can I do?’ Whilst the ideal scenario would be patients stopping the use of high heels, most clinicians are realistic enough to know that this may not happen. So I, like many, will try to compromise and work with the patient to find a suitable solution and one of the regularly successful methods is reducing the height of the heel. By a patient opting to wear 6cm heels rather than 10cm ones, there may be as much as a 25% decrease in the forefoot pressure which reduces even further if a patient wears heels that are around 4cm high. Another approach would be to avoid heels that position the foot in a very steep angle. Heels whose midsection follows the natural shape and contours of the foot arch would be a lot more comfortable and wearable during a long day on your feet.
Ultimately though, the final note would come down to, do you really need to wear heels for 6+ hours every day? If your answer is yes, then considering a lower heel and a better contouring shoe may just help you achieve this goal as comfortably as possible.
Dr Anel Kapur (Podiatrist)