Foot problems in women: High heels and your health

Shoes are your passion. You love shopping for them, trying them on and — most of all — buying them. High heels are the mainstay of your professional image and a highlight of dressing for nights on the town.

But your feet don't feel so great, and they look even worse. Forced too often into the tight confines of the narrow toe box of your high heels, your toes have bent into an unnatural position. As a result, you've developed bumps and areas of thickened skin that rub painfully against your shoes. Are your beloved high heels the source of your foot problems?

In fact, they probably are. High heels are one of the biggest factors leading to foot problems in women. The other is age. Frequently wearing high heels, along with the natural changes in your aging feet, can set the stage for foot problems.

How aging affects your feet

Over time, your feet become wider and longer and the natural padding under your heel and forefoot thins. Years of standing and walking flatten your arches and stiffen your feet and ankles. When you wear high heels — shoes with a heel 2 inches or higher — your foot slides forward in your shoe, redistributing your weight, creating unnatural pressure points and throwing your body's natural alignment out of whack.

Foot problems associated with high heels

If you frequently wear high heels or shoes that are too narrow or too short for your feet, such as the pointy-toed styles that are so often in fashion, you could be setting yourself up for one or more of these foot problems:

• Corns and calluses. Thick, hardened layers of skin develop in areas of friction between your shoe and your foot. Painful rubbing can occur from wearing a high heel that slides your foot forward in your shoe or from a too-narrow toe box that creates uncomfortable pressure points on your foot.
• Toenail problems. Constant pressure on your toes and nail beds from being forced against the front of your shoe by a high heel can lead to nail fungus and ingrown toenails.
• Hammertoe. When your toes are forced against the front of your shoe, an unnatural bending of your toes results. This can lead to hammertoe — a deformity in which the toe curls at the middle joint. Your toes may press against the top of the toe box of your shoe, causing pain and pressure.
• Bunions. Tightfitting shoes may worsen bunions — bony bumps that form on the joint at the base of your big toe. Bunions can also occur on the joint of your little toe (bunionettes). Experts disagree on whether tightfitting, pointy-toed, high-heeled shoes cause bunions or bunionettes, but such shoes can exacerbate an already existing problem.
• Tight heel cords. If you wear high heels all the time, you risk tightening and shortening your Achilles tendon — the strong, fibrous cord that connects your calf muscle to your heel bone. Your Achilles tendon helps you point your foot downward, rise on your toes and push off as you walk. Wearing high heels prevents your heel bones from regularly coming in contact with the ground, which in turn keeps your Achilles tendon from fully stretching. Over time, your Achilles tendons contract to the point that you no longer feel comfortable wearing flat shoes.
• Pump bump. Also known as Haglund's deformity, this bony enlargement on the back of your heel can become aggravated by the rigid backs or straps of high heels. Redness, pain and inflammation of the soft tissues surrounding the pump bump result. Heredity may play a role in developing Haglund's deformity, but wearing high heels can worsen the condition.
• Neuromas. A growth of nerve tissue — known as Morton's neuroma or plantar neuroma — can occur in your foot, most commonly between your third and fourth toes, as a result of wearing tightfitting shoes. A neuroma causes sharp, burning pain in the ball of your foot accompanied by stinging or numbness in your toes.
• Joint pain in the ball of the foot (metatarsalgia). High heels cause you to shift more weight to the ball of your foot, rather than distributing your weight over the entire foot. This causes increased pressure, strain and pain in your forefoot. Shoes with tightfitting toe boxes can lead to similar discomfort.
• Stress fractures. Tiny cracks in one of the bones of your foot — stress fractures — may result from the pressure high heels place on your forefoot.

These problems don't happen overnight, but rather develop over time. And it's not just your feet that are in jeopardy. High heels have also been linked to overworked or injured leg muscles, osteoarthritis of the knee and low back pain. You also risk ankle injuries if you lose your balance and fall off your high heels.

Hammertoes

Hammertoes

High heels with tightfitting toe boxes can cause foot deformities such as hammertoes. Standing or walking in high heels forces your feet to the front of your shoes, placing pressure on your toes and bending them into an unnatural position. Corns and calluses can develop on the top and the base of your toes.

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Bunions

Bunions

High heels may or may not be a specific cause of bunions — bony bumps at the base of your big toe. However, if you're prone to bunions or have the beginnings of a bunion, frequently wearing high heels exacerbates this foot problem.

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Time to surrender the high heels?

You can still wear high heels — just save them for special occasions.

Martin Ellman, D.P.M.

Maybe you consider your high heels an essential part of who you are, and the thought of giving up these fashion accessories is more than you can bear. Do you have to give up your high heels? Not entirely, according to Martin Ellman, D.P.M., a specialist in podiatry at Mayo Clinic, Rochester, Minn.

"You can still wear high heels, but save them for special occasions," says Dr. Ellman. "For instance, church on Sunday or an evening out. Avoid wearing high heels every day to minimize your risk of developing foot problems."

Dr. Ellman suggests wearing more comfortable shoes, such as athletic or walking shoes, for commuting to and from work, and changing into high heels once you arrive. Limit heel height to an inch and a half, and don't wear your high heels all day. For instance, if you have an important event in the morning, wear the high heels then, and switch to lower heeled shoes in the afternoon. Alternate your shoe choice throughout the day or from one day to the next.

Shoe-shopping tips to minimize foot problems

The next time you're shoe shopping, keep these tips in mind:

• Choose sensible heels. Select shoes with low heels — an inch and a half or less — and a wide heel base. Narrow, stiletto-type heels provide little support.
• Check your shoe size. Your feet get longer and wider as you age. You don't have to have your feet measured every time you go shoe shopping, but it's a good idea to recheck your shoe size every few years or so. Stand up when being sized because your feet expand when you step on them.
• Don't rely on shoe size alone. Gauge proper fit by how the shoes feel when you try them on. Sizes can vary from one manufacturer to another and from one style to another.
• Compare the width of the shoe with the width of your foot. Stand next to the shoe in your bare feet. Which is wider — your foot or the shoe? Avoid shoes that are too narrow for your feet, no matter how much you like them.
• Try on both shoes before buying. Do they both feel comfortable? Many people have one foot that's larger than the other. If this is the case for you, select shoes that fit the larger foot. Make sure you have at least a finger's width between your longest toe and the end of your shoe.
• Shop for shoes late in the afternoon or in the evening. Your feet swell during the day. A shoe that feels fine when you try it on in the morning could feel tight that afternoon.
• There's no such thing as a 'break in' period. Shoes should feel comfortable right away. Don't buy a pair that you think will fit well after you've worn them for a while.
• Ask about the store's return policy. Buy a few pairs of shoes and try each of them in your home for a few days. Most stores will allow you to return shoes within a certain time frame if there aren't obvious signs of wear.
• Pay attention to materials and style. Select materials that breathe and allow flexibility, such as leather or nylon mesh. Stay away from shoes with seams across the toe box, which can rub.

Compare shoe width and foot width

Compare shoe width and foot width

Before buying a shoe, make sure it fits the width of your foot. This woman's foot is too wide for the shoe she's standing next to.

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Be kind to your feet; they'll return the favor

Your feet are, quite literally, your base of support. By some estimates, you'll log several thousand miles walking during your lifetime. Don't let your sense of style cripple your ability to stand, sit or step pain-free. Take small steps now to prevent foot problems later.

Related

Hammertoe and mallet toe
Flatfeet
Footdrop
Achilles tendon rupture
Plantar fasciitis
Bunions
Metatarsalgia