High-Heeled Shoes and Musculoskeletal Problems
Convincing patients not to wear high-heeled shoes is a problem, however, the following information should help you make a strong and logical choice.
A recent survey of 620 women established that the majority was dissatisfied with their dress shoes because they hurt their feet, even though most had paid between $50 to $200 per pair. Women account for about 90 percent of the nearly 800,000 annual surgeries for neuromas, bunions and hammertoes. There is a clear link between the types of shoes worn and the development of abnormal foot conditions.
A neuroma results from compression of a plantar nerve or bursa between two metatarsals. The resulting inflammation and fibrotic changes can diminish both nerve and vascular flow, resulting in a burning sensation that extends into the toes. The most common area involved is between the third and fourth metatarsals, but may occur at any site of compression. A 3-inch heel was found to create seven times more stress on the forefoot than a 1-inch heel.
A recent clinical trial that involved 29 patients suffering from Morton’s neuroma revealed the following: average pre-treatment history of foot pain was 19 months. All patients received a series of foot manipulations, with the number of treatments ranging from 3-26. Manipulations included the metatarsals, forefoot, cuboid and cuneiforms. Eighty percent of the patients were fitted with orthotics to control excessive movements and hyperpronation (flat feet). Three months after the treatment, 83 percent reported moderate to excellent relief of their pain. Adjustments that restore the articulations, combined with flexible orthotics that maintain the corrections provide a long-term solution in many cases.
A study to compare gait patterns in low-heel versus high-heel shoes was performed and found that the reported shift in weight distribution over the third and fourth metatarsals, combined with the compressive toe box common to most high-heel shoes aided in the development of a neuroma.
Wearing heels also concentrates abnormal forces on the ankle and foot, relative to the forefoot. Anyone who has seen an inexperienced high-heeled walker knows exactly what repetitive micro-trauma is. There is only one true supportive stance, and that is when the foot is in a neutral position. That allows the body to function and be stress-free relative to other supporting structures.
In essence, high heels disrupt gait and posture for the entire body. In a study of varying heel heights, it was found that knee, hip and back problems may in part be related to a restriction of the subtalar joint pronation. The subtalar joint pronation that normally occurs at heel strike aids in shock absorption. If this pronation is limited, an increased shock wave must be absorbed the joints proximal to the foot.
Fashion is still "in fashion." Accordingly, it is not necessary to wear completely flat shoes. Only high heels greater than 5 cm. (2 inches) significantly influence lower extremity mechanics and gait. Make the compromise and adjust accordingly for continued overall good health.
Dr. James Iwanoff is located in Agoura Hills and has been in practice for more than 20 years. He may be reached at (818) 707-BACK or at www.ChiroExpert.com.