Live Life, "Feet First"

Ask

DOCTOR

GOTHAM

Dear Dr. Gotham,

Everyone always tells me that my obsession with heels will come back to bite me. No matter how much they kill my feet, my motto is “the higher the heel, the better.” What are the long-term effects of wearing high heels?

Sincerely,
Heel Obsessed

Dear Heel,

The common misconception is that flat shoes are better for your feet than a heel. That’s not always true. I typically recommend shoes that are 1 inch in height as opposed to a shoe that is completely flat as it places less tension on the Achilles Tendon and will feel more comfortable. With that said, heels exceeding a 1-inch height can include long term damage to your toenails, agitate bunions and encourage hammertoes.

Long term effects to wearing high heels include:

1) Damage to the 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. An ingrown toenail is a common condition typically affecting the great toe, in which the corner or side of the nail becomes incurvated (turned inward) and grows into the skin and soft flesh of the toe. This results in irritation of the surrounding soft tissue, often causing pain, redness, swelling, warmth, and sometimes and infection.

2) Bunions. A bunion is a biomechanical imbalance involving the great toe joint. It is often described as a bump on the side of the big toe. 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.

3) Metatarsalgia. When wearing high heels most of your body weight is pushed forward to the balls of your feet and this can lead to metatarsalgia (pain and inflammation in the ball of the foot). Shoes with a narrow toe box can also cause this condition. 

4) Hammertoes. Hammertoes are contractions of the toe caused by a muscular imbalance in the foot where the tendons on the bottom of the foot over power the tendons on the top of the foot. This condition is frequently developed by wearing heels. The heel height forces the toes to bend as they lean forward. Overtime, the bent toe can no longer straighten on its own.

5) Achilles Tendonitis. Achilles tendonitis is inflammation along the Achilles tendon. The Achilles tendon is the largest tendon in the body and is responsible for plantarflexion of the ankle (causing the front of the foot to lower and lift the heel off the ground). When wearing high heels you put constant pressure on the Achilles tendon by shortening and tightening it. Repeated and extended wear of high heels shorten the tendon permanently. This leads to inflammation and pain when you wear flat shoes and forces the tight tendon to stretch.

6) Arthritis in the toe joints. It is possible that years of wearing high heels can lead to arthritis of the toe joints.  When you wear heels you shift your center of gravity forward leading to a biomechanical imbalance that alters the pressure distribution of weight across your foot and onto your toe joints. The accumulation of weight onto your toe joints over time may lead to the erosion of cartilage and the formation of boney spurs that restrict the motion of your toes ultimately leading to painful and debilitating arthritis.

7) Sprained ankles. It’s not uncommon for heels to be flimsy with no supportive structure to the shoe. These shoes can bend easily, and get stuck in a sidewalk crack leading to a bad ankle sprain.

8) Knee and back pain. Heels with a height exceeding 3 inches changes the biomechanics of how you walk. This leads to shorter strides, more pressure is placed on the balls of your feet which throws off your center of gravity putting unneeded and unnecessary stress on your knees and lower back.
 
Good luck!
Dr. Gotham

Winter is coming. What does that mean for our feet? 

Winter is… here? As the weather gets cooler and we swap out our flip-flops for boots, many of us don’t realize the toll it takes on our feet. How we treat our feet in the summer affects us in the fall and into the winter. As a result of the shoes we choose to wear (if any at all), the cycle continues year-round and can put them at risk. Our feet are precious – yet we often take them for granted until we injure ourselves or develop a blister from the latest shoe trend or exacerbate an underlying issue. Here are a few foot injuries you may experience this winter.
 
1) Ingrown nails. Transitioning from the summer to the fall/winter brings forth this common problem. As you go from open toe to closed toe, feet still have swelling from summer activities and humid weather. As a result, an ingrown toenail happens due to irritation of the surrounding soft tissue, often causing pain and sometimes infection.
 
2) Plantar Fasciitis. Plantar fascia is a band that stretches from your heel to your toes to support the muscles and arch of your foot. Too much tension on the tissue can cause it to stretch too far, resulting in tiny tears that cause pain and inflammation. Transitioning from flat shoes to boots can throw off your arch and aggravate this underlying condition.
 
3) Shin splints. Walking with flip flops for prolonged periods of time as well as barefoot on hard surfaces allows our foot to collapse, which can lead to a tremendous amount of stress not only to the foot but to the rest of the body. This imbalance can start the progression of shin splints, affecting someone further down the line.
 
4) Bunions and hammertoes. Similar to shin splints, bunions and hammertoes can be caused by barefoot walking or shoes without an arch. This imbalance and stress also further progresses these underlying foot deformities.
 
5) Athlete’s Foot. A common condition in the summer months, as people go to pools and gyms more often (and barefoot). But because we wear thicker shoes and boots in the winter that air out less, athlete’s foot can be exacerbated and cause more issues during this season.
 
6) General foot pain. It takes time for our feet to adjust to different shoes, especially if it forces our gait or arch to change. If you don’t experience any of the problems above, it’s still possible to feel general foot aches and pains as weather and foot fashion changes.  

Foot Care 101: Hydrate!

If you’re dealing with cracked heels H20 may be your best friend. Dehydration can have a negative impact on your feet – causing them to become dry and cracked. I encourage my patients to hydrate by drinking plenty of water and eating water rich foods such as cucumbers and watermelons. This helps soften the skin on your feet and other areas. If your skin remains dry even after a lot of water intake, schedule an appointment with your podiatrist. You may suffer from a fungal infection that could easily be treated with some ointments or prescribed medications.

Health Focus: Ankle Sprain 

Ligaments help stabilize the ankle joint and prevent excess motion. Ankle injuries occur when ligaments are stretched beyond their normal range of motion and the ankle moves in an awkward motion beyond the normal range of that joint. The most common mechanism of ankle sprain is a combination of plantarflexion and inversion, or a downward-inward motion of the foot about the ankle.  When this takes place, the 3 main outer ankle ligaments stretch or tear depending on the severity. With severe ankle injuries, fractures and joint displacement can occur. READ MORE.

Product Plug: Betadine 

Many people think they should apply Neosporin to a blister, but that doesn’t help dry it out. We have normal hydration to our bodies so whenever something is too wet, you want to dry it out. Whenever something’s too dry, you want to wet it. While Neosporin is great for something like a scab, betadine is much better for blisters because the underlying skin is wet and raw. Applying Betadine several times a day will help dry out the blister. This medication is also an antiseptic that can prevent infection and help your blister feel better.