Foot & Health Clinic - Chiropodist-Foot Care-Diabetic Neuropathy-Orthotics-Burlington Oakville Ontario

For several years, chiropodists have been warning women that wearing shoes with high heels and narrow toes can lead to painful and often permanent foot deformities. Now, a study has found the first evidence that high heeled shoes may also contribute to knee arthritis in women.

For many women, painful and misshapen feet are the ultimate cost of a long term love affair with high heeled shoes. In the United States, women visit orthopedic surgeons for foot problems four times as often as men, and they undergo about 87 percent of operations performed to correct acquired foot deformities, such as bunions and hammer toes. In societies where people go barefoot or wear flat sandals, acquired foot deformities in adults are rare and their frequency is the same in both sexes.

The deformities that often develop after years of wearing high fashion pumps are similar to foot problems that were formerly seen in Chinese women whose feet had been bound by their parents, said Michael J. Coughlin, a clinical professor of orthopedics at Oregon Health Sciences University who practices in Boise, Idaho.

When the feet of such Chinese women were X rayed, "the deformities were not in the bones at all. They're just in the joint," Coughlin said. "Women of today . . . are achieving the same thing. They're causing these joint deformities by binding their feet in constricting footwear."

Problems tend to develop in the front half of the foot (the forefoot) and include bunions, hammer toes or claw toes and bunionettes, conditions common in middle aged or older women that often require corrective surgery. A bunion is a bump or enlargement on the inner side of the foot, at the base of the big toe. A bunionette is a similar enlargement on the outer side, at the base of the smallest toe. Hammer toes and claw toes are deformities in which the toe curls and its joints protrude upward, often rubbing against a shoe and causing painful corns.

Foot structure, heredity and the elasticity of ligaments can predispose some people to such deformities. But narrow, pointed shoes and high heels also contribute, by compressing the toes and increasing forces on the forefoot during standing and walking. With a 3 1/4 inch heel, pressure on the forefoot is more than seven times greater than with a flat shoe.

Coughlin analyzed 3,000 surgeries for forefoot deformities performed in his Boise practice over a15 year period and found that 87 percent were done on women's feet. Women had 94 percent of the bunion surgeries, 90 percent of bunionette surgeries, 81 percent of hammer toe surgeries, and 89 percent of surgeries for neuromas, a painful thickening of a nerve that runs between two toes.

Surgery can improve such foot deformities but usually can't restore the foot completely to normal, said Michael W. Bowman, a foot and ankle surgeon who chairs the AOFAS (American Orthopaedic Foot and Ankle Society) Orthosis and Footwear Committee. "I tell patients up front, 'You can't expect to have surgery and go back and wear this type of shoe,' " he said.

In addition to choosing unhealthy shoe styles, women frequently buy shoes that are too narrow for their feet, according to a 1993 survey by the AOFAS. Of 356 women who responded to the survey and had their feet measured, 88 percent were wearing shoes that were too narrow, by an average of one half inch. Most women's feet are between 3 1/4 inches and 3 3/4 inches wide, Coughlin said, but fashion shoes are usually only three inches wide.

PROBLEMS WITH KNEES

New evidence, published in the British medical journal The Lancet, suggests that high heels are also bad for women's knees. D. Casey Kerrigan, an assistant professor at Harvard Medical School who specializes in physical medicine and rehabilitation, used special laboratory equipment to analyze the forces that were generated in the knees of 20 healthy women while walking in high heeled shoes. The research subjects, whose average age was 35, habitually wore high heels.

Kerrigan found that rotational forces compressing the inner part of the knee joint were 23 percent higher when the women walked in high heels than when they walked barefoot. High heels also prolonged the strain and pressure on the smaller joint between the kneecap and the underlying thigh bone, the patellofemoral joint. Both joints are common sites of osteoarthritis in women.

No one had previously suggested that high heeled shoes might contribute to knee arthritis. "This is a completely new direction," said Kerrigan. She said the shoes prevent the ankle from working as it should to absorb part of the force of walking, so she suspected they might result in abnormal rotational forces on the knee joint. Walking in high heels tends to rotate a woman's knees outward into a more bowlegged position.

She added that high heels also make older women less stable and contribute to falls. "I'm telling anybody who has knee arthritis, 'Just don't wear them!' "

CHOOSING SHOES THAT FIT

Poorly fitting shoes are painful and can promote foot problems. To make sure new shoes fit properly, follow this advice:

Sizes vary among brands and styles. Judge the shoe by how it fits your foot, not by the size marked on the box.
Select a shoe that conforms as nearly as possible to the shape of your foot.
Have your feet measured regularly. Foot size changes as you grow older.
One foot is usually bigger than the other. Measure both, and fit shoes to the larger foot.
Fit shoes at the end of the day when your feet are largest.
Stand up and check that there is at least 3/8 inch to 1/2 inch of space in the shoe beyond your longest toe.
Make sure the ball of your foot fits comfortably into the widest part of the shoe.
Don't buy shoes that feel tight, expecting them to stretch.
Your heel should fit comfortably in the shoe with minimum slippage.
Walk in the shoe to make sure it feels comfortable.

Extracted from the Washington Post, May 12 1998, written by Susan Okie

For more information or an appointment please call: Salima Kassam, Registered Chiropodist Foot and Health Clinic, 728 Burloak Dr. Burlington, Ontario 905.632.1414