You Can’t Run In These, Girl!

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!”

youcantruninthesegirl.jpg

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?

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13 comments to You Can’t Run In These, Girl!

  • Barbara

    pretty interesting article. I’m curious, can you speak more about “barefoot training”. Is this just walking around barefoot more often, or is there more to it.

    also, do i need to buy foam rollers to go with this DVD you mention, or is that something different?

    Thanks. I learned a lot from your article here. I think I’ve screwed myself up wearing high heels over the years, I rarely do it anymore.

    Barbara

  • I looked through the list of “recommended” shoes and I can’t say that I found anything that I am wild about. A lot of the styles are clunky and not what I consider current “fashion” at all.

    Crocs? God no *shudder*
    This is a shoe nightmare to me:
    http://www2.ecco.com/ss2007/Products/Womens/Casual.htm#articleid=16363&colourid=05202

    I don’t want that thing anywhere near my closet!

    I’m a bit snobby when it comes to fashion, so most people would probably be OK with the design of those shoes. For me to invest money in a shoe, it has to really turn me on. None of these really did. I like my shoes to be sexy… and if they are also comfortable, GREAT!

    I actually spend about 90% of my time barefoot, so the shoe issue isn’t such an issue for me. I have under 11 pairs.

  • hi Barbara,
    Here are some great barefoot exercises you can start with:
    http://wellness.ndsu.nodak.edu/fitness/Events/marathon/footDrills.pdf
    Some people also incorporate barefoot training into their workouts, but I’m not sure what kind of exercise you do.

    The Magnificent Mobility DVD is great for improving dynamic flexibility and joint mobility. You’re basically teaching your boy how to move more effectively and efficiently, using full range of motion. It is an awesome DVD.

    Foam rolling can help work out areas of tension. And actually Eric Cressey and Mike Robertson wrote an article about foam rolling that you can read here: http://www.t-nation.com/readTopic.do?id=475832

    You can also use a tennis ball or a myo release ball to get to the nooks and crannies that the foam roller can’t reach.
    http://www.power-systems.com/nav/closeup.aspx?sc=112&c=109&g=3009

    The way that it was described to me is that many people have areas of their body which they need to release tension from (through foam rolling, massage, shiatsu, active release technique, or other modalities) and areas which aren’t working properly or at full range of motion, which the DVD will help with.

    I hope this helps! Let me know if you have any more questions!

    Leslie, I’m not a fan of Crocs either… and the link was atrocious!! But you don’t like Danskos? I think they are hot as hell!!!
    http://www.dansko.com/

    I AM curious which shoes you think look nice and are also comfortable, though!

    Thanks for reading!

  • Thanks for the reminder. My sister, the Reflexologist would be so proud & hopefully, the shoe peeps can make them hotter & hotter!

  • [...] You Can’t Run in These, Girl! (great review of what high heels do to your body, by Yael Grauer) [...]

  • Rebecca

    The ‘a whole list of recognized products’ was old/broken – here is the correct link for any one Stumbling this article: http://www.apma.org/MainMenu/RecommendedProducts/SealofAcceptance/ProductsbyCategory.aspx#FOOTWEAR.

    Great article I thought – since my feet are so swollen from dancing at the club last night, I’m taking this advice to heart – I’d much rather be a little less “fashionable” than not be able to walk!! Besides I looked through every single one of those links and thought that there where quite a few really cute alternatives out there, many of which where comparatively priced to horribly uncomfortable shoes.

  • Thanks for the updated link! The only thing that surprises me is that Chaco’s are on there but not, say, Birkenstocks or Naot. I actually prefer those to Chaco’s which are more flat, so that I can keep the curve in my foot.

  • [...] You Can’t Run in These, Girl! (great review of what high heels do to your body, by Yael Grauer) [...]

  • Kate

    It is a great article. And it describes us a problem which is very modern and up-to-date. Our feet are very important part of our body and we should take care of it. But all our body is also very important if it is all right you won’t have problems with your feet and legs. Morning exercises are the first step to this. And http://www.fitness-mad.com fitness mats will help you to realize the exercises in a very convenient form. Your feet desire better life.

  • I do some weightlifting at least twice a week, weightlifting is a very good exercise and it keeps the shape of my chest and shoulder muscles in very good form.“`

  • In 2002 I discovered Active Release Techniques, ART, a medically patented technique developed by Dr. Michael Leahy. I was amazed at the ART treatment I personally received which immediately resolved my chronic shoulder, knee, and ankle problems that had responded minimally to other types of care. ART gave me my life back. I got my “game” back, I began running, cycling, swimming, etc.. I give all the credit to ART. If you are having trouble you should make an appointment with a certified ART specialist, I think he or she could help.

  • Yeah, ART is great! I just wrote an article on ART and SASTM/Graston. Good stuff.

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