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Week of 12 March 1999

Vol. II, No. 26

Health Matters

Dressing for success? Leave your heels at home.

Are high heels bad for your feet? What else do I need to consider when buying women's shoes?

High heels may well be the rage in fashion magazines, but from a medical standpoint they are literally a walking health hazard. According to Edward Hurwitz, D.P.M., staff podiatrist at Boston Medical Center, almost nothing can be said in defense of high heels. "There isn't a high heel in existence that is good for the average woman, and the higher the heel, the worse the potential problems," he says. "Especially when a woman wears nylons, high-heeled shoes become a sliding board, shoving the foot to the front of the shoe and compressing the toes together. This leads to a host of problems that affect not only the toes, but the arch, the ankle, the knee, and possibly even higher body parts."

A small lift in the heel -- a little less than half an inch -- is necessary for the foot to grab the ground well when walking. The toes are designed to act as small shock absorbers when the foot hits the ground. However, when women "ratchet up" on high heels, the toes become locked into place and can no longer absorb the force of each stride. One possible result is a condition known as hammer toes, where the toes are permanently bent in the middle joint, causing them to be shaped like claws. In addition, because the toes are pressed together, ingrown toenails are a major risk.

Other unpleasant side effects can include corns between the toes and a pinching of the nerves in the foot, called a neuroma. This condition can be extremely painful, creating a burning, shooting pain in the bottom of the foot. It is usually treated by injecting steroids into the foot, but chronic cases may need to be treated by surgery.

The grisly details don't end there, however, Hurwitz says. "Heels can cause problems all the way up the leg. When the big toe doesn't rotate properly because it can't move, the knee must rotate to compensate. Eventually the stress on the knee can cause lasting damage." Some women may adjust their stride to counter the discomfort, but this can lead to low back pain.

A very small percentage of women -- those with heel spurs -- can actually benefit from high heels. "Heel spurs are bony projections, like thorns, that come off the front of the bottom of the heel bone," says Hurwitz. "These spurs don't point down but forward, which is why putting a cushion in the bottom of a lower shoe won't help. A high heel, by design, puts pressure on the arch, which in turn eases the pulling pain of bone spurs."

What is a good shoe purchase? Hurwitz says a few simple guidelines make a big difference. The best time to buy shoes is in the afternoon, not the morning. Since feet tend to swell slightly as the day passes, a pair of shoes that fits snugly in the store in the morning may become tight hours later. Look for low-heeled shoes, especially ones that prevent the foot from sliding. Shoes made of soft material, such as canvas or suede, cushion the toes, and natural leather shoes are generally better than synthetics. To prevent your toes from compressing, avoid wearing shoes that come to a point. Finally, perhaps the most important point is that the shoes should feel comfortable when you try them on. If they cause any discomfort in the store, no amount of breaking in will help.

While regular use of high heels is a bad idea from a health standpoint, they're okay to wear to formal occasions -- on a very limited basis. "High heels won't cause damage if you wear them for a few hours," Hurwitz says. "But I wouldn't make a habit out of it."

"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on women's shoes or other health issues, call 638-6767.