Flats Or Heels?

What are your shoe choices? Sexy stilettos? Flip-flops? Boots? Whatever your shoe preferences are, improperly fitting shoes are posing a huge public health risks. In the US alone, about one in six persons (which roughly translate to 43.1 million Americans) have foot problems. About 36% regard their foot problems as serious enough to require medical interventions including surgery. Especially among women, here are some facts according to the American Academy of Orthopaedic Surgeons (AAOS):

• Nine out of 10 women are wearing shoes that are too small for their feet.
• Eight out of 10 women say their shoes are painful.
• More than 7 out of 10 women have developed a bunion, hammertoe, or other painful foot deformity.
• Women are nine times more likely to develop a foot problem because of improper fitting shoes than a man.
• Nine out of 10 women’s foot deformities can be attributed to tight shoes.

High heeled shoes are a major problem. A survey of 200 women who wear high-heeled shoes revealed frequent complains of leg and low back pain. Marco Narici from the Manchester Metropolitan University also undertook another study and found out that high-heel wearers appear to have shorter muscle fibers by 13% compared to flat shoe wearers. By looking at the Achilles’ tendon of these two groups of women, according to this study, the high heel wearers’ tendons were much thicker and stiffer that the flat shoe wearers. They inferred that by thickening and stiffening, the Achilles’ tendon compensates for the shortened muscle fibers in the calf muscles. This allows the high heel addicts’ calf muscles to function optimally while walking, but causing discomfort when walking on flat feet because of the tendon’s inability to stretch sufficiently.

So what are the health costs of wearing improperly fitting shoes?

• Heel pain – Plantar fasciitis involves pain and inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes. This is one of the most common causes of heel pain. Under normal circumstances, the plantar fascia acts like a shock-absorbing bowstring, supporting the arch in the foot. Too much tension on this bowstring can create small tears in the fascia. Repetitive stretching and tearing can result to the inflammation and irritation of the fascia.

There are several risk factors involved in the development of plantar fasciitis. These would include age (middle age onwards), some forms of exercise and improper shoes. If improper shoes cause this problem, you should avoid loose, thin-soled shoes, as well as shoes without enough arch support or flexible padding to absorb shock. If you regularly wear high heels, your Achilles tendon – which is attached to your heel – can contract and shorten, causing strain on the tissue around your heel.

• Bunion – This is an abnormal, bony bump that forms on the joint at the base of the big toe. Bunions form when the big toe pushes up against the other toes, forcing the big toe joint in the opposite direction, away from normal profile of the foot. The abnormal position enlarges the big toe joint overtime, which further causes crowding of the other toes and pain.

There are a number of causes why bunions occur, like an inherited structural defect or stress on foot. Medical conditions like arthritis can be a cause too, but a common reason is wearing shoes that fit too tightly.

• Hammertoe or mallet toe -  A hammertoe is a toe that’s curled due to a bend in the middle joint of a toe. Mallet toe is similar, but affects the upper joint of a toe. Otherwise, any differences between hammertoe and mallet toe are subtle. Both hammertoe and mallet toe are commonly caused by shoes that are too tight in the toe box or shoes that have high heels. Under these conditions, the toe may be forced against the front of the shoe, resulting in an unnatural bending of the toe and a hammer-like or claw-like appearance.

You may have to change your footwear to relieve the pain and pressure of hammertoe and mallet toe. Severe cases of hammertoe or mallet toe may require surgery to render relief.

What shoes should you wear? “It’s really difficult to rank shoes because there are different situations that make the various shoes good or bad,” says Dr. Marlene Reid, spokesperson for the American Podiatric Medical Association. But here are few tips that you can learn when it comes to shoes:

• Flats – Check out for ones that offer arch support and cushioning and don’t bend on half as they are sure signs of poor support. Flimsy ones can cause plantar fasciitis.

• Heels – Don’t go for ones that are higher than two inches. The higher the heels, the greater the tension they put on the calf muscles. So, reserve your three to four inches high-heeled shoes for very special occasions.

• Wedges – These are better choices than the heels because they offer balance between the balls of the feet and the heels. Dr. Robin Ross, a podiatrist from the New York State Podiatric Association, advises that “Platform, or wedges, are ‘in’ and come in all sizes and shapes. The higher the platform or wedge, the worse the center of gravity becomes when walking. A high platform or wedge may cause the individual to lose their balance and twist an ankle which may lead to chronic ankle instability or even a broken bone in the ankle or foot. It is important to make sure that the shoe material is made of cotton or a soft, supple leather. Plastic will irritate the skin and may dig into the skin causing blisters. Tight straps may feel like a tourniquet, as the day (or night) progresses, and the feet naturally swell over the course of the day and can become very uncomfortable, if not downright painful.”

• Negative heels – The ones that you see in toning sneakers are not necessarily favorable to your ankle because they can exacerbate Achilles tendonitis.

• Flip flops – They are not advisable for everyday use as they do not provide enough feet support. Their constant use can cause plantar fasciitis, heel cracks, broken toes and sprained ankles.

Should you give up on heels? Not necessarily as Dr. Narcisi says. His recommendation is to perform regular stretching exercises, like standing with your toes on a step and letting your heels drop down.

On the other hand, on orthopaedic foot and ankle surgeon Gail Dalton reports in Scientific American “Wearing uncomfortable shoes remains prevalent throughout the world today, despite an increasing body of knowledge that improperly-fitting shoe wear can lead to foot problems… Hopefully, by convincing women that high heels, pointy toes and poorly fitting shoes can harm their foot health over a lifetime, we will start to see women demanding healthy shoes that are fitted properly.”

Think about this. Foot surgery is costing Americans about $2 billion a year from tight-fitting shoes.  If you count the time off from work for the surgery and recovery, the cost could sum up to $3.5 billion!

Sources:

American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00146

Lee, C.M. et al (2001).”Biomechanical Effects of Wearing High-heeled Shoes”. http://www2.ie.psu.edu/Freivalds/Personal/HighHeels-IJIE01.pdf

Mayo Clinic. http://www.mayoclinic.com/health/flatfeet/DS00449

Science Daily. (July 16, 2010) “Why Walking Flat-footed Hurts Habitual High-heels Wearers: The Effects of Wearing High Heels on Women’s Legs“. http://www.sciencedaily.com/releases/2010/07/100715194407.htm

Washington Post. “On Your Feet: High Heels’ Effects on the Body” http://www.washingtonpost.com/wp-dyn/content/graphic/2007/05/07/GR2007050700484.html

Wong, Kate (September 19, 2001) “High-heeled Shoes Injure Nearly All Women’s Feet” Scientific American. http://www.scientificamerican.com/article.cfm?id=high-heeled-shoes-injure