By Dr. Shane Drakes

This article will focus on the possible dangers of excessive wearing of high heels and what can be done to help prevent such consequences.

Why do women wear high heels? There are multiple reasons, including:

• To look more professional at work
• To make the legs look longer
• To accentuate an outfit
• To appear taller
• To appear more attractive
• Improved self-esteem and confidence

Unfortunately, the potential consequences of long-term excessive use of high heels can significantly outweigh the short-term benefits that may be gained. Significant pain and deformity may result and in some cases, may require corrective surgery which can be costly and associated with a long recovery. Some of these include:

• Corns and calluses
• Making bunions worse
• Ingrown toenails
• Lower back pain
• Joint pains in the lower limb
• Shortened Achilles tendon

The development of corns, calluses and ingrown toenails is related to the height of the heel of the shoe and the width of the toe box. The higher the heels, the greater the slope between the ball of the foot and the heel. Increasing the slope increases the tendency for the foot to slide forward and strike the front and sides of the shoe, corns and ingrown toenails.

A higher slope also increases the pressure on the ball of the foot, resulting in calluses being formed. A narrow toe box, which is common in pointy toe high heels, increases the likelihood of these conditions and can contribute to the development of or worsening of bunions. A bunion can lead to pain and difficulty in wearing some footwear due to pressure over the area.

Increased pressure on the balls of the feet when wearing high heels leads to the pelvis tilting forward. The body compensates by increasing the arch in the lower back to keep upright. This puts abnormal strain on the spine and can also cause muscle overuse. These factors can cause back pain or worsen an existing back problem.

High heels lack shock absorption and prevent the natural rotation of the foot which occurs while walking. These factors mean that the ankles and knees have to act as shock absorbers and this can cause pain or worsen pre-existing arthritis symptoms. Wearing heels also means that your ankle supports most of the weight of the body and causes impaired balance, leading to sprained ankles and possibly falls. Prolonged increased pressure on the balls of the feet decreases the padding in that area and causes significant pain.

The calf muscles attach to the heel bone via the Achilles tendon. Excessive use of high heels can lead to shortening of these structures which impairs ankle joint mobility. The body compensates by causing abnormal movement at other joints. One of these compensations, midfoot pronation, causes flattening of the arch of the foot, pain in that area and possibly midfoot arthritis in the future.

Some injuries that can result from the shortened calf structures include:

• Achilles Tendinitis/ tendon tear
• Calf strain
• Ankle sprain
• Runner’s Knee
• Plantar Fasciitis

What can be done to prevent the harmful consequences of wearing high heel shoes? There are some measures that can be tried:

• Avoid wearing high heels for prolonged periods
• Stretch the calf muscles regularly
• Limit the height of the heels
• Avoid pointy toe heels
• Buy shoes in the afternoon when feet are at their largest
• Shoes with leather insoles stop feet from sliding forward
• Vary your shoe choices

For persons who may have already developed complications, seeing the appropriate specialist is important to guide care. Ingrown toenails, corns and calluses are treated best by a podiatrist. Back and joint pains can be managed by a rehabilitation specialist who may also be able to provide strategies to manage a shortened Achilles tendon. Any corrective surgeries would have to be carried out by an orthopedic surgeon with expertise in performing foot surgery.

Of course, all efforts will be in vain if you keep wearing those high heels!

(Dr. Shane Drakes is a Specialist in Physical Medicine & Rehabilitation and Sports Medicine. He can be contacted at sdoptimalfunctioning@gmail.com. )