I have a confession to make. I own way too many shoes for my own good. I have hiking boots, running shoes and weightlifting shoes. I have work shoes and play shoes. I live in Arizona, so sandals are a necessity. I have at least three pairs of shoes that I only wear for job interviews, and I currently have my eyes on two pairs of Danskos and some Chacos. I even have a shoe organizer in my tiny little closet. As a dedicated non-shopper, this type of activity is a bit unusual for me. According to a survey for Mervyn’s, the majority of women own 11 or more shoes, so at least I know I am in good company.
Although half of the women surveyed say they wear fewer than half their shoes for a regular basis, the primary reason given was that the shoes do not match their current wardrobe.
My primary reason for not wearing many of my shoes is that they hurt.
While I definitely buy shoes that are comfortable in the store, or when I first put them on, I have noticed that even a 1” heel can stress my ankles, knees and hips, causing pelvic tilt and lower back pain.
According to a series of articles in the Washington Post, heels are even worse than I’d imagined. The long list of heel-related ailments include corns, callouses, bunions, stress fractures, joint pain in the ball of the foot, Morton’s neuroma, hammertoe, tight Achilles tendons and more. Heels cause instability and push the foot too far forward, which increases pressure on toes and joints, throws your natural alignment out of whack and can cause low back pain and osteoarthritis of the knee. Heels also increase the possibility of ankle sprains. The higher the heels, the higher the risk. The American Academy of Podiatric Sports Medicine reports that a 3” heel creates seven times more stress than a 1” heel. Pointed-toe shoes can cause hammertoes and bunions. Open-backed shoes can inflame the tendon connecting the calf muscles to the heel.
The American Orthopaedic Foot and Ankle Society released a position statement on women’s shoes, stating that “foot problems from poorly fitting poorly fitting shoes have reached epidemic proportions and pose a major health risk for women in America. “ According to a 1991 footwear survey they took, 90% of women wore shoes that were too small and about 80% had foot problems Elsewhere on their website, the Society writes, “Remember that however appealing those high-heel, high-fashion shoes are, your feet need to carry you around for a lifetime. Treat them kindly!”
I spoke with chiropractor Ken Cooper about heels, and he pointed out that the heel forces the weight of the body to be transferred to the ball of the foot, forcing the knee to come forward. This misaligns the knees from the hips, from the shoulder point to the tip of the ear. This causes unnecessary wear and tear on the joints–not only of the knees, hips and ankles but of the spinal column as well.
“Long term wear and tear will result in degenerative changes in the spine, such as foraminal narrowing, disc degeneration and lipping and spurring on the vertebral bodies,” Dr. Cooper said. “Continuing the narrowing of the foramen will result in pressure on the nerve roots,” he continued, “resulting in a myriad of problems ranging from the musculoskeletal to organ malfunction.”
While researching these various aches and pains, which can sometimes become serious enough to warrant foot surgery (around $3.5 billion annually is spent on women’s foot surgeries in the U.S. alone, and women account for 90% of foot surgeries in this country), one begins to wonder why women put themselves through this. According to Elizabeth Semmelhack, a curator at Toronto’s Bata Shoe Museum, enduring discomfort for the sake of fashion is an age-old trend. In a Washington Post article, Semmelhack was quoted as saying that impracticality was one of the primary features among people of privilege. Semmelhack believes that women have historically worn high heels to express what it is they do not have to do—activities including strenuous work or walking long distances.
For those of us that do need to walk long distances or even just stand all day (and want to look good doing it), take heart. There are shoes available that are comfortable and stylish. The American Society of Podiatric Sports Medicine has a whole list of recognized products. My absolute favorite for both fashion and comfort are Danskos–and now you have an excuse to go shoe shopping. You’re welcome!
Say you absolutely have to wear high heels, or worse, you have to break the American Academy of Orthopaedic Surgeon’s rule of thumb of no more than three hours in 3 inches. I can certainly relate to this, as I recently had to wear shoes that hurt for eleven hours straight for work (with a lot of walking on concrete). I was already pushing the dress code by wearing wedges instead of stilettos. Aside from bubble baths and massage, I’m sure you’re asking what you can do for quicker recovery. My ankles, knees, hips and lower back were killing me afterwards, and so I turned to Magnificent Mobility. The DVD is sensibly reviewed on the Performance Menu forums and has helped me a lot in improving my mobility and watching aches and pains disappear. The DVD is easy to understand, straightforward and extremely effective. It is the product of strength coach/corrective exercise specialist Mike Robertson (who recommends glute activation, foam rolling and soft tissue work on plantar fascia, calves and hamstrings for post-high heel recovery) and competitive powerlifter/strength and conditioning coach Eric Cressey, who recommends posterior chain work, barefoot training, ankle mobilizations and dedicated dorsiflexion work and directed me towards an interview previously published in his newsletter. (reprinted with permission.)
EL: You’ve mentioned to me in the past the issues with the ever popular Nike Shox training shoe as well as high heels in women. What’s are the potential problems?
EC: When you elevate the heels chronically – via certain sneakers, high-heels, or any other footwear – you lose range of motion in dorsiflexion (think toe-to-shin range of motion). When you lack mobility at a joint, your body tries to compensate by looking anywhere it can to find range of motion. In the case of restricted ankle mobility, you turn the foot outward and internally rotate your lower and upper legs to make up for the deficit. This occurs as torque is “converted” through subtalar joint pronation.
As the leg rotates inward (think of the upper leg swiveling in your hip joint socket), you lose range of motion in external rotation at your hip. This is one of several reasons why females have a tendency to let their knees fall inward when they squat, lunge, deadlift, etc. And, it can relate to anterior/lateral knee pain (think of the term patellofemoral pain … you’ve got restriction on things pulling on the patella, and on the things controlling the femur … it’s no wonder that they’re out of whack relative to one another). And, by tightening up at the ankle and the hip, you’ve taken a joint (knee) that should be stable (it’s just a hinge) and made it mobile/unstable. You can also get problems at the hip and lower back because …
Just as losing range of motion at the ankle messes with how your leg is aligned, losing range of motion at your hip – both in external rotation and hip extension – leads to extra range of motion at your lumbar spine (lower back). We want our lower back to be completely stable so that it can transfer force from our lower body to our upper body and vice versa; if you have a lot of range of motion at your lower back, you don’t transfer force effectively, and the vertebrae themselves can get irritated. This can lead to bone problems (think stress fractures in gymnasts), nerve issues (vertebrae impinge on discs/nerve roots), or muscular troubles (basic strains).
So, the take-home message is that crappy ankle mobility – as caused by high-top shoes, excessive ankle taping, poor footwear (heel lifts) – can cause any of a number of problems further up the kinetic chain. Sure, we see plantar fasciitis, Achilles tendinosis, and shin splints, but that’s just the tip of the iceberg in terms of what can happen.
How do we fix the problems? First, get out of the bad footwear and pick up a shoe that puts you closer in contact with the ground. Second, go barefoot more often (we do it for all our dynamic flexibility warm-ups and about 50% of the volume of our lifting sessions). Third, incorporate specific ankle (and hip) mobility drills – as featured in our Magnificent Mobility DVD.
Oh, I should mention that elevating the heels in women is also problematic simply because it shifts the weight so far forward. If we’re dealing with a population that needs to increase recruitment of the glutes and hamstrings, why are we throwing more stress on the quads?
So there you have it. Plenty of valid reasons not to wear high heels, some ways to fix post-heel damage you may have already caused, a list of shoes that are sexy and comfortable and an excuse to go shopping. What more could you ask for?