The Sports Doctor: Tips for wearing high heels

One of life’s great dilemmas: “I love how they look, but they’re killing me.” We’re talking shoes here.

Recently, Sarah Jessica Parker (remember “Sex and the City”?) commented: “If I only knew then what I know now, maybe I would have cooled it a little with all those heels.”

But she sure looked great!

Many women are reluctant to give up high heels for this very reason. Designed mostly by men — who, of course, don’t have to wear them; although, yes, more and more are designed by women — high heels come with a price. They cause all sorts of foot problems, and can affect the whole posture, including knees, hips and back. Blame it on the tilting forward of the shoes.

Podiatric surveys have shown that almost 75 percent of women admit to foot problems with heels, but more than 40 percent wear them anyway. Sexy wins out!

Let’s look at some examples of problems and then explore some strategies for improvement in “survival skills” that lead to accepting the challenge.

Foot problems often start with the lack of room for the ball of the foot and toes, the so-called toe box. Lack of room causes all sorts of pressure on the top of the toes, in between the toes/toenails and on the bottom of the ball of the foot. Women who already have hammer toes or a bunion deformity know all too well how cramped toes can be intolerable.

As heel height increases and once the heel height gets above 2 inches, the foot will slide forward in the shoe with each step, putting even more irritating pressure on these sensitive areas. Tendons in the foot and ankle also “feel the heat” as this tilt forward effect continues, and stress to the arch area is noted.

Tests have shown that knee and back stress are increased to compensate for the abnormal alignment the high heels demand. Ankle instability and balance challenges are increased with razor thin heel and platform widths. This is an ankle sprain waiting to happen!

Conditions and problems include metatarsal concerns (metatarsalgia), nerve entrapments (neuroma), and even stress fracture because of this excessive ball of the foot pressure.

Active women who run or do aerobic activities often have Achilles tendon problems when they’ve been aggressive high-heel users. The normal rise and push forward of the Achilles in bare feet or flats is compromised with the high heels, and the tendon can be permanently shortened thus causing problems with sporting activities.

Enough already!

Some strategies:

Know when to shop for high heels. During the course of the day, the foot might slightly swell because of all the activity, so purchase high heels, or any shoe for that matter, later in the day. Whatever swelling is already present will give you a better chance for a good fit. Wear heels around the house to help gradually get used to them and break them in. Stretchable materials with some give like leather and suede can be more forgiving than other materials. They allow more comfort and less constriction, which can result in less abuse to bones and tendons.

Know your foot type and get fit properly. If you have bunion or hammer toe issues, look for rounded, deeper toe boxes, which make sense anyway and try to minimize heel height and consider in some instances open toes. Pronated or flat type feet, supinated or high arch feet might fit totally differently in the same style, so for some, arch support feels good, for others, not.

Pads and more pads. The endless types and shapes of pads, moleskin and gels can be life savers. Ask any ballerina and she’ll tell you about pads — ball of foot pads, toe pads, callus pads — all can be helpful. Creams and emollients to soften hard skin can be helpful, so can pedicures.

Supports for insertion into shoes can be helpful to add some shock absorption and padding — make sure you’ve got room. You can velcro them in the heels to prevent sliding.

The “magic of orthotics” — I’ve been prescribing prescription dress orthotics for decades with great success. Minimal bulk devices that velcro attach in heels can really redistribute weight, support, and help align the foot and lower leg. There are over-the-counter inserts, but “the gold program” is prescription devices from a podiatrist.

Alternate and change heel heights and consider wider heel widths to reduce the chances of Achilles shortening and ankle instability.

Train for those high heels! Strengthening the foot, ankle and lower leg with rubber band exercises will help with stability and balance, keep tendons tight, muscles stretched and supple, and really help overall. Postural exercises for your core, legs and low back are also beneficial.

Balance on tilt boards or Bosu balls works all those “stabilizer muscles” that you are stressing with the unnatural tilt of the high heels. Besides your usual pedicure habits, include some massage or soft-tissue treatment. One to two times a month, massage can feel great and really help rejuvenate and condition those feet and lower legs.

Well there it is girls! Accept the challenge and have fun. Follow these guidelines and you’ll be “Dancing with the Stars.”

Dr. Robert Weil is a sports podiatrist from Naperville with an office in Aurora. Hear him on his weekly radio show from 3 to 4 p.m. on HealthyLife.net Positive Talk Radio. Access previous radio shows and articles on his website at www.sportsdoctorradio.com or email Dr. Weil at drrweilsportsdoctor@yahoo.com.

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