To Wear a Heel, or Not to Wear A Heel, That is the Question

To Wear a Heel, or Not to Wear A Heel, That is the Question 

When I watch women walking in high heels, as a man, I think, “Wow, how do they do it?” As a podiatrist, however, I think, “Wow, why would they do it?” It's a known fact that when a woman wears heels they look taller (duh!) and slimmer, their legs look longer and to some, this may be more attractive. Some women love wearing heels, some women hate it but do it anyway, some women don’t mind, and others just stay away from them altogether. Here's the scoop on heels from a podiatrist's perspective.

Let me share some information that you may thank me for later, or better yet, your tired high-heel-wearing feet, will thank me. The ideal heel height is not 4 inches (thank goodness), it is not 3 inches, and it's not 2 inches. The ideal heel height is 1 inch. Wearing a short heel is better than not wearing a heel at all. Wearing a shoe with a short heel places less tension in the Achilles tendon and will feel more comfortable. Wearing shoes that are completely flat will contribute to pronation and the collapse of the arch which can lead to plantar and posterior heel pain, shin splints, knee pain, and back pain. And of course, you should always wear a shoe that has arch support to minimize discomfort.

Now, as good as a high heel might look on your legs (hello, 4 inch pumps!) the long term effects of wearing such heels is not worth it. Constantly wearing high heels can result in painful damage to your feet. One of the negative effects of wearing high heels is the damage that it can cause to your toenails. Wearing high heels compresses the toes together causing the big toe nail to grow into the skin and eventually resulting in an ingrown toenail. High heels also aggravate the symptoms and progression of bunion deformities as the shape of the shoe does not accommodate the normal structure of the forefoot.  A heel-type shoe will press up against the great toe pushing it over towards the second toe further exacerbating bunion deformities.  When wearing high heels most of your body weight is pushed forward to the balls of your feet and this can lead to metatarsalgia.  Shoes with a narrow toe box can also cause this condition.  Hammertoes are also a condition developed by high heels.  The heel height forces the toes to bend as they lean forward.  Overtime, the bent toe can no longer straighten on its own.  Wearing high heels can cause tendonitis.  When wearing high heels you put constant pressure on the Achilles tendon by shortening and tightening it. Repeated and extended wear of high heels shortens the tendon permanently. This leads to inflammation and pain when you wear flat shoes and forces the tight tendon to stretch. 

As a podiatrist I pay a lot of attention to the shoes that people wear. It's easy to tell when a woman is wearing the wrong shoes. I can tell a woman is wearing the wrong shoes when her body is not positioned at a 90 degree angle with the ground: her sway is longer and her chest is pushed forward while her buttocks is further back.  The body weight pushes forward so the center of pressure is moved towards the balls of the feet.  The walk translates to being a more jerky stride rather than smooth.

When looking for heels it is important to not only pick the right heel height but also to look for one with a wider toe box to accommodate the toes comfortably.  This can reduce the probability of developing Morton’s Neuroma or aggravating an existing bunion deformity. Also, heels with ankle straps help support the shoe on the foot and eliminates the need for your toes to hang onto the shoe thus reducing the development of hammertoes.  A platform on the heel allows the wearer to increase height without compensating the arch however the height difference between the front and back of the shoe should be no more than an inch. One should never wear a heel over 3 inches in height because it changes the biomechanics of how you walk. This leads to shorter strides, more pressure placed on the balls of your feet, and unnecessary stress on your knees and lower back.

Proper fitting shoes provide a proper platform for our feet to support our body. Our feet are the foundation to our bodies and caring for them means caring for the rest of your body too. Shoes that are too big mean you will be accommodating the improper fitted size in a dysfunctional way which may lead to foot problems. I suggest getting your feet measured for length and width with a brannock device and buying the right fitting shoe. It is important to take into consideration that size of shoes varies from company to company.  

Heels are designed for fashion; they are not made for comfort or for happy feet. Keep in mind, love your feet and they will love you back!

Author
Dr. Miguel Cunha Dr. Miguel Cunha, founder of Gotham Footcare and a leading podiatrist in Manhattan, is a highly trained and skilled foot and ankle surgeon with experience treating a wide array of foot and ankle conditions from minor problems to complex reconstructive foot and ankle surgery. Dr. Cunha takes pride in having a genuine interest in each and every one of his patients while providing them the utmost compassion and exceptional care.

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