I love my stilettos; but it’s a dysfunctional relationship. I walk on eggshells and pinched toes to make it all work. At the end of the day, I often regret the painful price I pay to stand in stilettos at the height of fashion.
“Watch out. That pain is telling you that your body is not happy with the way you are loading weight on your feet and walking,” says Christopher Hodgkins, M.D. [1] an orthopedic surgeon who specializes in foot and ankle surgery with Doctors Hospital Center for Orthopedics & Sports Medicine. “If you don’t listen to pain’s message, it could pay you back with toe deformities and possibly other injuries.”
Listening to that warning, I sat down and had a frank conversation about shoes and foot health with Dr. Hodgkins, a colleague of Thomas San Giovanni, M.D. [2] , who also addressed this issue in a recent news article. Here is a transcript of my conversation with Dr. Hodgkins:
SHR: What are the dangers of wearing heels?
Dr. CH: High heels, especially stilettos, force your feet into an unnatural position, leaving your toes to carry the full burden of your entire weight. Overloading the forefoot (the toe area) and bones on the bottom of your feet can lead to deformed toes, bunions and foot pain.
SHR: How do heels deform my feet?
Dr. CH: When you wear high heels, you place a lot of pressure on the ligaments around your toes. Due to weakened ligaments, your toes can drift from their original position and deform. Foot deformities include:
- Crossover toes [3]: Damaged ligaments enable toes to drift out of position and cross over or under another toe. Typically, the second toe overlaps the big toe.
- Hammer toes [4]: Problem shoes or poorly fitting footwear can distress toe muscles and lead to a deformity in the middle joint of your second, third or fourth toe. The deformed toe looks like a hammer.
SHR: What about lower heels, such as kitten heels?
Dr. CH: Anything with a heel is a high heel. Even a small one-inch heel places more stress on the front of the foot. Of course, the higher the heel, the greater the problem.
SHR: Do I need to retire my high heels?
Dr. CH: It’s OK to wear high heels—but in moderation and on special occasions.
High heels are not sensible for all-day, every-day use. I definitely do not recommend walking great distances in high heels. Anything more than mingling or walking around a party is too much. It’s useful to bring sensible shoes and carry your heels when you are walking to the car or to the party. When your foot hurts, that’s when you are wearing high heels too much.
SHR: So pain is a red flag?
Dr. CH: Listen to your feet. Listen before the pain becomes a bigger problem. I see a lot of patients who have ignored the pain for too long. If you have pain, wear sneakers as long as possible and avoid walking in bare feet or heels until the pain is gone.
SHR: When should I consult a doctor?
Dr. CH: If the pain does not subside after a few days, consult a foot and ankle orthopedic surgeon. Keep in mind that there are many different causes of foot pain. An orthopedic surgeon will target the source of the pain and recommend various treatments, with surgery as the last resort.
What about flip-flops?
Francis Wodie, D.P.M. [5], a podiatrist, and ankle and foot surgeon affiliated with Homestead Hospital and West Kendall Baptist Hospital, offers warnings about wearing flip-flops. He says most flip-flops lack arch support and padding in the sole.
“Those factors put you at greater risk for pain in your forefoot and heels. And the lack of arch support, especially if a shoe is too flexible, puts more pressure on the ligaments and joints of the foot,” he says. People should be extremely careful about buying and wearing flip-flops”
To minimize problems, Dr. Wodie recommends these safety tips from the American Podiatric Medical Association [6]:
- Select high-quality flip-flops with arch support.
- Do not purchase flip-flops that can be bent in half.
- Pay attention to toe irritations, especially in the thong area where blisters and infections can develop.
- To avoid injuries, do not perform yard work, participate in sports, ride a bicycle or drive a car while wearing flip-flops.