High Heels: So Sexy It Hurts

Rosemary Gabriel fully embraces her love of high heels.

Okay, high-heeled fashionistas, you’re not going to like this. Neither are all those men who love leggy ladies in Manolos and Escada. But according to foot surgeons, chiropractors, and physical therapists, women who wear high heels can, over time, develop a host of related health problems including ankle injuries, foot deformities, and back and neck problems. Fortunately, with just a little expert advice and some common sense, you and your tootsies can strike the healthy balance between sensible and chic.

The History of Heels

First, a little history. As far back as 1000 BC, women have been wearing high heels to convey social status and sex appeal. The earliest precursors of stilettos were discovered in the tombs of ancient Egypt, and many a French belle wore them under her hoop skirt in the royal courts of the 1600s. In the 1700s, European elegants teetered on heels five inches and higher, using stylish canes to prevent them from toppling over.

In the 19th century, high heels enjoyed widespread popularity until the newly liberated 20th-century women demanded more comfortable, flat-soled shoes. Then, in the roaring 20s, hemlines rose and heel lengths soared to new heights along with them.

Today, high heels are still alive and kicking. Just glance through the glossy pages of any fashion magazine, and you’ll find giraffe-limbed Prada models lengthening their legs anywhere from one to eightinches with stylish footwear.

Sure, they look great. Walking in heels causes the back to arch and the chest to thrust forward, giving women that sexy come-hither stance. But in the long run, high heels could leave you without a healthy leg to stand on.

Backs Out of Whack

“Centering the body’s weight on the ball of the foot instead of distributing it over the entire sole while shoving the toes into a narrow toe box may feel stylish, but it will likely cause posture problems and a host of other difficulties,” says physical therapist Jane Snyder, in a recent online PT bulletin. Snyder is a member of the American Physical Therapy Association (APTA). “Basically, high heels cause the back and neck to hyperextend,” said Snyder.

According to Snyder, a woman’s body will attempt to compensate for the off-kilter balance heels cause by flexing, or forward bending, the hips and spine. In order to maintain balance, the calf, hip, and back muscles become tense. At the end of the day, this makes for excess muscle fatigue and strain. Over time, wearing high heels can also cause the calf muscles to cramp and bulge.

“I’ve seen patients for whom high heels are absolute disaster,” says Fairfield chiropractor Dr. Jon Estrin. “It varies with the individual body and resilience, but for some people high heels create a definite overload to the nervous system . . . a virtual short circuit to their physiology. The system is completely affected. After all, the woman is walking, standing and dancing on an incline, sometimes for hours.” Estrin says that on a mechanical level, high heels can cause neck and back pain, muscular strain, spinal subluxation (partial dislocation of a bone in a joint), and can also lead to degenerative change in the joints of the body.

A 2001 Harvard study also found that high heels can set the stage for osteoarthritis of the knees. Osteoarthritis, known as the wear and tear form of arthritis, destroys the protective cartilage that surrounds bone.

Tortured Soles

High heels can also create long-term problems for women’s feet. Statistics show that 43 million Americans today experience painful foot problems—such as hammertoes, callouses, and bunions—and high-heeled women comprise the vast majority of them. For every five women in the U.S., one suffers from aching feet as a result of donning heels to impress partners or colleagues.
“High heels are the major cause of foot problems in women,” says Dr. Oliver Zong, a Manhattan podiatrist who has seen his fair share of “high heel feet.” According to Dr. Zong, feet crammed into ill-fitting footwear, or “heels from hell,” often begin to assume the shape of the shoes themselves. Dr. Zong describes the typical “high heel foot” as being triangular shaped in the front, with toes wedged together and the big toe and pinky leaning towards each other. The three center toes tend to curl upwards (hammertoes), and bunions and corns abound.

On the upside, however, Dr. Zong claims that wearing a low heel can actually be beneficial for women who suffer from “flat feet,” a condition where the sole does not have a natural arch. “By wearing heels, you actually increase the arch that you have,” says Dr. Zong. He recommends that women with flat feet wear a low heel of one to two inches, but warns against going much higher than that.

For the rest of us, Zong offers this: “Women who insist on high heels should at least look for shoes with wide toe room, reinforced heels that are relatively wide and cushioned insoles. They should also keep the amount of time they spend wearing high heels to a minimum.”

When Only a Heel Will Do…

While experts unanimously agree that long-term, prolonged high heel wearing can cause major health problems, many of them feel that, for most women, donning heels on special occasions or for short periods of time can be fairly innocuous.

Sometimes only a heel will do—try wearing penny loafers with an elegant evening gown. But the next time you feel the need to raise your stature or amp up your womanly assets, consider the following tips for reducing stress to the feet, back, and body from the website of the American Physical Therapy Association:

  • Avoid wearing high heels for long periods of time, and stretch the muscles in the back of your leg before and after putting them on.
  • “High” is a relative term. Try and set your limit to two inches.
  • Pelvic tilts and calf stretches will minimize any muscle cramping and shortening. Buy shoes in the afternoon or evening, as feet swell during the day.
  • Change into low heels whenever you can.
  • Don’t go for the pointed toe.
  • Buy shoes with leather insoles to keep the foot from slipping.
  • Buy a wide variety of shoes, including sneakers, oxfords, and sandals, and vary your footwear day to day.