The things we do in the name of beauty and vanity: from Botox to Spanx, fad diets, fake this, press-on that, frying our hair with styling products and straighteners, impaling ourselves with underwire, padding and pushups, and compromising our hips, backs, spines, alignment, legs, knees, and all 26 bones and 33 joints in our feet by trotting around in high heels.
Women are more likely to develop foot problems because of ill-fitting shoes, painful shoes, and shoes that are just too tight. But we aren’t the only culprits. Men’s pointed dress shoes, cowboy boots, in some cases stilettos and pumps, and if you’re a member of KISS, running, jumping, and high-kicking onstage in six-inch platform boots — all of these are as high risk as women’s exaggerated quests for a shapely looking leg and some added height.
“The higher the heel, the more it throws the weight onto the forefoot and toes,” says orthopedic surgeon Dr. Mark Thigpen. “The sheer force on the sides of a narrow, pointed shoe can cause crowding, hammer toes, corns, calluses, claw toes, overlapping toes, neuromas, and bunions. Ligaments are stretched, bones are pushed out, the foot is forced to spread, the fat pad that protects the foot under the heel and metatarsal head is pushed toward the toes, and the bones are more likely to hit the bottom of the shoe, which is why you see imprints of your feet inside the shoes. The fascial band that holds the fat pad in place also shifts over time. The nerves on top of the toes are pinched as the foot is forced upward. Women wear heels because they define the calf, but that definition comes because of increased tightness in the leg, which also throws the body forward and puts stress on the back, knees and hips.”
As if all of that weren’t enough, add Achilles tendonitis and plantar fasciitis (painful foot swelling) to the list. “There is also inflammation and issues that develop in the legs,” says Dr. Thomas F. Smith, podiatric medicine. “Ankle sprains occur from falling out of an open shoe or falling while wearing a high heel or platform. When you wear heels, it can affect your back and your knees, and even your entire body. I tell patients to think about it in terms of a vehicle: If the front wheel of a bus is out of alignment, passengers will feel it when riding in the back. The foot is forced into the front of the shoe, which is snug in the toe area to make it stylish, and this causes pressure areas in the toes. Long-term wearing of a pointed-toe shoe will cause the foot to assume the shape of the shoe. Look at the shape of your shoe. This is what your foot looks like when it’s inside of it. A snug, pointed shoe forces the joints to work in positions they aren’t intended to. It’s like flexing the knee and making it bend sideways. Wear and tear on those small joints in the foot can lead to arthritis, and once you get it, you’re stuck with it.”
Open-toe shoes don’t help much, says Dr. Smith. “They’re a little better because they eliminate some of the crowding, but again, you’re pushing the foot forward and the shoe can only be open so far. It’s OK to wear high heels and pointed shoes if done in moderation, but we tend not to be moderating people.”
Anyone who has worn a pair of outrageously high heels or platforms for hours knows what it’s like to take them off at the end of the night. Instead of relief from the torture (assuming your feet didn’t simply “go numb” after the first few hours), once your feet hit hardwood or carpeting, the pain of solid ground is even worse than the shoes. And forget putting them back on, because that falls under the category of “excruciating.”
“The foot has been compressed for hours,” says Dr. Thigpen. “This affects blood supply and puts pressure on the nerves. When that pressure is removed, it causes the burning sensation. By that time, the foot is swollen, collects fluid, and it’s bigger than when you put your shoes on the first time. It’s similar to when your arm goes to sleep and you feel pain when it ‘wakes up.’ We neglect our feet in the name of style and to appease our eyes and others’ eyes. It’s simple: If you wear a shoe and all you think about is taking it off, you’re wearing the wrong shoe.”
While many of us will live with the thrill of style and the agony of the feet, what passes as style has changed. Today, it’s commonplace to see men and women shopping, dining, and going to nightspots in footwear commonly known as thongs, zoris, or flip-flops — flat pieces of rubber with plastic straps.
“The cheap ones have nothing, but some of the newer ones actually have an arch and give some support,” says Dr. Thigpen. “A thong, or flip-flop, spreads the toes apart so that they aren’t confined. Some shoes, like Birkenstocks, allow the foot to relax, which is why they’re so popular. Crocs also have a good arch and are plenty wide. They’re ugly, but they’re soft and cushiony and feel good.”
“Wearing flip-flops feels great, but they have no support,” says Dr. Smith. “Wearing them a lot can cause plantar fasciitis as a result of that lack of support. I’m also amazed at how many people I see in flip-flops these days. Years ago, no one would have thought to wear them to a restaurant. Now they’re almost as accepted as a shoe.”
For some, no risk is great enough to keep them out of their platforms. To the stubborn, Dr. Thigpen advises the following: “Get out of them whenever you can, and wear something soft and cushioned as an alternative.”
“You can’t beat a nice-fitting gym shoe,” says Dr. Smith. “It doesn’t have to be an expensive one. It’s better to buy a less-expensive shoe and feel comfortable about throwing them away when they are worn out. When you pay $200 for a pair of gym shoes, you want to bronze them! Another common mistake is to turn an overly worn pair of gym shoes into yard-work shoes. When a shoe is worn out, don’t use it while you’re doing something stressful, like pushing a lawn mower. That’s the time to wear boots or walking shoes. When you can bend or twist a work or athletic shoe in half, it’s time to replace it. A good athletic shoe is stiff.”
“Running shoes are the best for day-to-day wear,” says Dr. Thigpen. “They’re designed for heel impact, there’s plenty of room for the toes, and there’s soft cloth on top. The problems come when people try to get too sophisticated and buy high-end shoes. A lot of those have deep pronators built in that you don’t need, and you end up with knee or back problems. They turn the foot toward the outside, twist the ankle, the knees hurt, and you can develop plantar fasciitis. Once again, people buy them because they look good. Instead, get a neutral-heel running shoe that doesn’t roll you in or out. I tell patients that when they’re shopping for shoes, any shoes, they should draw an outline of their feet and put the shoes on top of that in order to get a shoe that fits.”
Despite all the warnings, some of us will swear by our platforms until you pry them from our cold, dead feet. If you fall into this category, there are a few things you can do to try to improve your comfort. “Lambswool is feathery, light material to wrap around your toes. It’s what ballet dancers use,” says Dr. Smith. “Avoid adhesives. Peel-off pads can add insult to injury. Go with non-adhesives and soft cotton. Gel pads inside the shoes are fine, but don’t get too much, because there’s barely enough room for an entire gel liner. Most of all, use moderation. Enjoy your high-heeled shoes, but switch into something else whenever you can.”