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High Heels’ Hidden Dangers

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We’ve all heard that heels can cause serious damage to our feet, backs, and bodies in general. As I recently strapped on one of my favorite pairs and saw a sexier, longer version of my legs in the mirror, I got to thinking about the power of heels. The confidence factor they give me is non-negotiable—regardless of the harm (and the anti-feminism of them) it’s pretty unlikely that I’ll ever quit wearing them. With that realization, I wondered what sorts of health issues I should be prepared for. Are there some heels that are less cruel to our bodies than others? A recommended regimen of how often we should wear flats? 


High heels, reportedly, were first used back in the Middle Ages to help people keep their feet in stirrups as they rode horses. And ever since Carrie met Mr. Big, we’ve all felt entitled to our own collection of glamorous, confidence-inducing spikes. And I’m hardly the only one unwilling to give up my claim to Carrie-like gams. 


“Probably nothing would convince me to stop wearing them,” says Amber Hearst. 


“An extreme injury might stop me for a little while,” says Maria Madeiros. “But I’d go back when I could.” 


It’s this extreme dedication that has foot and spine experts worried. 


Skeletally Speaking …
Big, small, bony, pudgy, our feet endure tremendous pressure on a daily basis. An average day of walking, according to the American Podiatric Medical Association brings a force equal to several hundred tons down on our tootsies … and that’s in foot-friendly walking shoes. Yet we continue to squeeze them into our high-up, hard-to-balance heels (for good reason, of course). Podiatrists classify any shoe with a heel of more than two inches as dangerously high, “bio-mechanically and orthopedically unsound.” Yikes. 


High heels alter our body’s balance, forcing it to find a new equilibrium. Dr. Richard Brassard, the president of the American Chiropractic Association, compares the musculoskeletal system to a mobile, hanging in perfect harmony with each part balancing the other. When we alter one part (our feet), the whole system has to compensate. Wearing heels for any length of time does just that—it increases the normal forward curve of the back, causing the pelvis to tip forward. By bringing the heel up, we also shorten our hamstring muscles and change our center of gravity. The change in foot position alters the way we walk, moving the center of gravity to the ball of the foot. And the higher the heel, the more that center of gravity shifts and the more compensating our bodies have to do. 




In addition to wreaking havoc on our posture, heels can also cause irreparable foot damage. Our feet are designed to stand much flatter than those sexily-arched heels that beckon us from store shelves; the flat design is optimal for distributing body weight evenly across the entire sole of the foot. When we force our feet up and out of this position, we’re going against thousands of years of evolution, forcing the ball of the foot to do all the work. This causes a list of culprits we’re all too familiar with (whether we’d like to admit it or not): pain in the balls of the feet, bunions, calluses, and corns. Prolonged, regular heel wearing can actually change the shape of our feet and prevent them from doing their jobs properly in any kind of shoe. (You know, walking, running, things like that.) The Barbie-like position our feet take on in heels shortens the Achilles tendon, the tissue that connects the calf muscle to the heel bone. This becomes inflamed and irritated, making it increasingly difficult to stretch, making walking in flats or even running shoes increasingly painful over time. 


Is It the Style?
All right, I’ve been scared into thinking about my heel choices. If I lay off of the spikes that are extra hard to balance on and opt for thicker heels or even wedges, will I counteract this damage at least a little? Probably not, according to a series of medical studies. 


In 1998 a team of Harvard researchers linked heel wearing and a painful, degenerative joint condition called knee osteoarthritis—basically the breakdown of the knee’s cartilage. Surgeons perform about 300,000 knee operations each year because of this condition. The lead professor in the study, Dr. D. Casey Kerrigan, associate professor of physical medicine, and her team found this connection in women who wore very narrow stilettos. In 2001 they went back and took a look at the chunkier heels that are now in fashion (and that I’m clinging to in hopes of them being less harmful) and published their findings in The Lancet. Even though they’re often more comfortable and feel easier to balance on, thicker heels also increase the risk of knee problems: “Wide-heeled shoes give you the perception of more stability when you’re standing, and they feel comfortable, so women wear them all day long,” Kerrigan writes. “They are better for your feet than stiletto heels, but just as bad for your knees.” Both types increase knee pressure by around 25 percent. But my knees feel just fine … 


“It takes a long time to feel the effects of knee osteoarthritis,” writes Kerrigan. “And once you do, it’s too late.” 


So if we’re talking about knees, low-heeled shoes (meaning less than two inches) are our safest bet. Do wedges offer any benefit? 


When it comes to wedges, the rise still matters. As we learned from the Harvard study, our center of gravity is still changing as we’re pushed up onto the balls of our feet, which is bad for the back. We’re also still pushing the foot up from its natural, flat position. A three-inch rise means seven times the body weight of a one-inch heel is pressing down on the front of the foot. That’s a whole lot of stress, heel or wedge. 




Easing the Stress
Now that I’m no longer blissfully in denial (but still unwilling to quit the habit), is there anything I can do? For those of us stubborn heel devotees, there are some tricks for easing the pain and at least prolonging the damage a bit: 


  • Try not to stand in heels for longer than half an hour and don’t walk in them farther than absolutely necessary. Bringing a pair of commuter shoes can save thousands of hours and pounds of pressure, prolonging the days we can continue wearing them around the office once we get there.


  • Break them in before you wear them out. This is more than wearing them five minutes before hitting the town. Four to five hours of wearing them around the house will allow us to walk more naturally and comfortably when we wear them out for an entire night. 


  • Wear flats at least two to three times per week. This will keep your Achilles tendons stretching and moving. Invest in a few shorter pairs of heels, too. The American Podiatric Medical Association recommends varying heel height throughout the week to avoid prolonged tightening of the Achilles. 


  • Stretch those muscles. Move them around each evening after they’ve been pushed into heels all day. Do daily calf stretches and look for specially made gel insoles, which can act as shock absorbers. 


I’m the first to admit that some outfits just aren’t complete without the right pair of high-heeled shoes—for me at least. It’s ridiculous, it’s probably anti-feminist, and I now know it’s definitely harmful to my body, but at least now I have some techniques for keeping fancy footwear from cramping my style too early. My legs still have some serious fun to have before I retire my heel collection.

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