Head over heels

Wednesday, December 10, 2003 | 12:00 a.m. CST; updated 5:51 p.m. CDT, Monday, July 21, 2008

They’re all over the runways of Paris and Milan — on the feet of fashionistas everywhere — and can be seen walking the sidewalks of Columbia. Pointed-toe high heeled stilettos are all the rage. But just how much is the price of fashion costing women these days?

Shoe designers know women love fashion at any price, and sometimes that price includes the health of their feet.

Pointed-toe shoes can cause foot deformities, no matter what the style or cost. Scott Foster, a doctor at Columbia Podiatry said, “High heels cause the most problems, mostly due to their narrowness and pointed toe. These problems mostly occur near the ball of the foot due to increased pressure.”

The three most common foot problems related to wearing pointed-toe stilettos are bunions, hammertoes and neuroma, Foster said.

But these problems don’t only affect older women who have been wearing high heels for years. Patty Holmstrom, a sophomore at MU, has already begun to worry about the future of her feet.

“I typically wear high heeled shoes twice a week for about four or five hours, and my feet usually hurt the next day,” she said. “My mom has bunions, and I am aware that I will get them from wearing high heels, and I will have to deal with the surgery to correct them someday.”

Holmstrom said she continues to wear high heels because they make her feel feminine and “most cute shoes in stores are ones with heels.”

Bunions affect the big toe, making it enlarge and point inward. Although about 75 percent of bunions are hereditary, wearing pointed shoes contributes to the formation of bunions, Foster said. Depending on the procedure, surgery to fix bunions costs anywhere between $1,000 and $1,800. However, there are several treatments to relieve discomfort, including supports, insoles and pads.

High heels can also cause hammertoes, since all body weight is concentrated on the ball of the foot.

“Due to increased pressure, the body has to compensate, and muscles tighten and are overused,” Foster said. “When you walk, all weight is on one foot. Usually, that weight is distributed to the

High heels

whole foot, but when you wear high-heeled shoes, that weight is concentrated to only two to three square inches. There is an imbalance in the muscles and tendons, which causes the toes to curl up and tighten.”

Over time, a hammertoe can develop. It is a fixed deformity that causes the toe to stiffen. Surgery can fix hammertoes, but it usually costs between $700 and $800, Foster said. The pressure and pain can also be relieved by toe pads or orthotics, which are pain-relieving foot supports.

Hammertoes can also cause corns, or calluses, to develop. Since the toe is bent, shoes may rub on the top of the toe, creating a patch of hard skin from the shoe pressure. Corns can be treated with medicated corn pads, or they can be trimmed off, but these treatments are only temporary — corns tend to reoccur if the conditions are not changed, Foster said.

Neuroma is also caused by wearing high heels because of the increased pressure on the ball of the foot. Neuroma is an irritation of the nerve, causing the nerve to become enlarged between the bones of the feet, Foster said.

“A neuroma can be felt between the bones as a nodule or bump,” he said. “It causes burning pain and discomfort, and toes may be numb. A neuroma can be relieved by taking the shoe off, using an orthotic support to alleviate pressure,

or administering a cortisone injection. A neuroma may also be surgically removed, “ which typically costs between $700 and $800.

High heels can also shrink the Achilles tendon if worn extensively. This problem was prominent in the 1950s and 1960s when women wore high heels more frequently than women do today, Foster said. This condition happens when feet adjust to being contorted to fit in a high heel, and the Achilles tendon shrinks to a shorter length than needed for flat-footed

High heels

walking. Similar to Barbie, whose feet are permanently formed to wear high heels, women with this condition have trouble adjusting to normal shoes. This condition can cause heel problems and also puts a strain on the back of the knee because the Achilles tendon affects muscles and tendons behind the knee, Foster said.

Cutting back on wearing high heels is a good idea if you want to preserve your feet. Foster said they are “OK to wear for two to three hours at a time two to three times a week, like for going to church or an evening event, but not on a daily basis. One-inch heels are a safe height for every day.”

Relief may be in sight, however. With stylish rounded-toe Mary Jane and T-strap style pumps breaking into the fashion scene, as displayed by the fall and spring lines of BCBG and Guess, trends may be on the verge of change. Women’s feet would be grateful for the extra breathing room these shoes provide.

“Rounded-toe shoes are much better for your feet,” Foster said. “They wouldn’t contribute to as many problems as pointy-toe shoes. Platform shoes are also OK. They aren’t really high-heeled, so they are better for your feet. The only problems I have seen with platforms are sprained ankles.”

To ensure a good fit, Foster recommends that customers try on shoes before buying them.

“The rule of thumb is that you need a thumb’s width between your longest toe and the end of the shoe,” Foster said. “Dress shoes can be shorter, however, and your toe can come to the end of the shoe.” If a shoe is too small, problems with feet and toenails are more common, Foster said.

The best time to shop for shoes is in the late afternoon or early evening, Foster said, because feet are slightly swollen and the shoes are more likely to fit comfortably throughout the day.

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