Fashionable ladies shoes with heels and cramped toe space hurt the knee, feet and back

Posted : Jan, 2007

Fashionable ladies shoes with heels and cramped toe space hurt the knee,
feet and back

A skewed sense of beauty in modern culture has put women into shoes that hurt.

A skewed sense of beauty in modern culture has put women into shoes that hurt. Studies found that even wide-based shoes with medium heels of 1.5 inches high could result in painful knee osteoarthritis, with worn down knee cartilage and loss of mobility. Heeled shoes are also linked to lower back pain, shoulder pain, overworked leg muscles, and injuries from falling.

Pointy shoes with cramped toe space fosters the development of bunions, hammer toes, corns and callus, joint pain, tight heel cords and even stress fractures of bones.

Protect your feet, knees and back by choosing shoes with:

	Heels of less than 1 inch high. Flat shoes with no heel are the best.
	Wide and supportive heel base
	Round or square toe box - with sufficient space for the toes
	Flexible area at the ball of the foot. Soft and flexible upper
	Sufficient space between the toes and the tip of the shoes

Shoes with correct fitting should be comfortable right away, and do not require any breaking in period. Buy shoes in the afternoon or evening instead of early in the morning, because the feet swell after standing and walking during the day.

Shoes with medium heel of 1.5 inch high also hurt the knee

Even medium heel of 1.5 inch will speed up the wear down of knee cartilage, resulting in knee osteoarthritis

Shoes of wider heel are as bad as those with narrow ones

Shoes with wider heels are as bad as those with narrow stiletto heels in terms of hurting the knee.

Even shoes with medium heels (1.5 inch) can increase the risks of knee osteoarthritis

In a research done in the University of Virginia in the US, Dr. Casey Kerrigan found that even wide-based, orthopedic-type shoes with heels of 1.5 inch high would increase stress on the knee and lead to the development of knee osteoarthritis. A total of 40 women were tested while walking with and without custom-made heeled shoes on a walkway with force-sensing plates.

The results showed that heels of 1.5 inch high would increase the knee torques (rotational force) by 9% to 19% when compared to wearing no heel. The younger women experienced the highest increase in knee torques. This demonstrates that traditional footwear has potentially damaging impact on the long-term health and quality of life.

The research result was published in the May, 2005 edition of the Archives of Physical Medicine and Rehabilitation. (Related News: May 5, 2005)

Previous studies of Dr. Casey Kerrigan showed that heels of 2 inches (reported in 2003) also had damaging effects on the knee cartilage, with 23% increase in pressure on the knee joint compared to walking bare foot.

For high heel shoes, wider heels are as bad as the narrow ones

In a study on the health impact of heels of 2.75 inches high (reported in 2001), Dr. Casey Kerrigan compared the stiletto heels of width less than half an inch with wider heels of 1.77 inch. It was found that the increased pressure on knee joints was 26% for wide-heeled shoes, and 22% for stilettos.

People may feel more stable and comfortable on wide-based heels, and tend to wear them longer than stilettos. However, the forces that increase pressure on the knees are the same, if not greater. Therefore for high heel shoes, wider heels may be more dangerous to the knees than narrower ones.

X-ray film of knee osteoarthritis with loss of knee cartilage

Knee osteoarthritis with loss of knee cartilage. The bones rub against each other, causing pain and loss of motion.

Distortion of body posture with heeled shoes

Heeled shoes distort the body posture.

Barefoot - even distribution of weight

Heeled shoes - body is tilted forward, shifting weight to the ball of the foot

Body adjustment - body is pulled backward to maintain balance, increasing stress on the knee, ball of the foot, leg muscles and the back.

What is knee osteoarthritis

Osteoarthritis is one type of arthritis, and is sometimes called wear-and-tear arthritis. Knee osteoarthritis is caused by degeneration of cartilage in the knee joint. As the cartilage breaks down, the leg bones rub against each other. This results in swelling, mild to severe pain, and loss of motion in the joint. For long-termed patients, the joints may be deformed, and painful bone spurs may grow at the ends of the joint.

Knee osteoarthritis affects most people to a certain extent as they age. It causes more disability on mobility than any other single disease among the elderly. Limited mobility increases the risks for cardiovascular disease, obesity and diabetes, and is linked to anxiety and depression.

Why knee osteoarthritis is much more common among women

Knee osteoarthritis is twice as common in women as in men. A major reason, according to Dr. Casey Kerrigan, is that the shoes worn by most men are flat ones or of minimum heel. These shoes do not affect the rotational forces that increase pressure on the knee joint. In addition, men on average have a larger volume of knee cartilage, hence more protection, than women.

However, a large portion of ladies shoes have very tight fitting, cramped toe space, and medium or high heels. These designs would increase the stress on the knee joint and speed up the wear-and-tear of the knee cartilage.

How heeled shoes increase the stress on the knee and toes

On bare foot, the weight of the body is distributed over the entire foot. Heeled shoes changes the way we walk, shifting the centre of gravity (hence the body weight) on the ball of the foot. The higher the heel, the worse is the situation. This results in an extra rotational force (called torque) on the knee joint.

Normally, there are 4 parts of a step:

1.	The heel hits the floor
2.	The foot falls flat
3.	The heel lifts off
4.	The leg swings through to prepare for the next step

Between the second and the third parts, the movement of a series of small bones on the foot allows the arch to go down and absorb shock. With high-heeled shoes, it goes from the first to the third step directly. The small bones on the foot are not locked as they should be, causing excessive pressure on the bone at the base of the big toe (resulting in bunions), as well as the joints of other toes (resulting in hammer toes).

Pointy shoes with crammed toe space lead to many foot and back problems

Many ladies shoes have pointy toe box and crammed toe space, causing a lot of foot, knee and back problems.

Bunions and bunionettes are bony bumps formed on the joint at the base of the big toe or the little toe respectively.

Hammer toes is a deformity with the toes bent at the middle joint.

Nail fungus and ingrown nail result from tight-fitting or heeled shoes

Other bad effects of heeled, pointy and crammed shoes

1. Lower back pain, sore neck and shoulder pain

	The increase in stress on the knees in wearing heeled and crammed shoes may radiate up into the lower back, causing lower back pain. The hip bones may be pushed up and the patient will also suffer from sore neck and shoulder pain.

2. Joint pain in the ball of the foot

	Wearing high heel shoes will shift more body weight to the ball of the foot. This results in increased pressure, strain and pain in the forefoot, especially around the ball of the foot. Shoes with too small toe boxes may lead to the same problem.

3. Corns and calluses

	Thick, hardened skin will develop in areas of friction between the foot and the shoe. High heel shoes would slide your foot forward in the shoe, resulting in painful rubbing at the pressure points. Shoes with pointy or narrow shoe boxes also create a lot of frictional points where hardened skin layers are formed.

4. Bunions and bunionettes

	Bunions are bony bumps formed on the joint at the base of the big toe. Those formed at the little toe is called bunionettes. Tight-fitting, pointy-toed or high heel shoes are possible causes for bunions and bunionettes, and will worsen an existing condition.

5. Hammer toes

	Hammer toes is a deformity with the toes bent at the middle joint. When wearing tight-fitting, pointy-toed or high heel shoes, the toes are forced forward and pressed against the front and top of the toe box. This results in unnatural bending of the toes at their middle joint.

6. Tight heel cords and pain in wearing flat shoes

	The heel cord, called Achilles tendon, is a strong and fibrous cord that connects the calf muscle of the leg to the heel bone. Its function is to help us point the foot downwards, rise on the toes and push off as we walk. Wearing high heels prevents the heel bones from touching the ground level. Hence the heel cord is not fully stretched.

	Over time, the heel cord will shrink in length. If you change back to flat shoes, it may be very painful when the shortened heel cord becomes fully stretched. Pain also results from overworked or injured leg muscles due to wearing high heels.

7. Nail fungus and ingrown toenails

	Wearing high heels or tight-fitting shoes, the toes are being forced against the front of the shoe. Such constant pressure on the nail beds may result in nail fungus and ingrown toenails. Ingrown toenails may result in severe pain, swelling and infection.

8. Morton's neuroma

	Morton's neuroma is a non-cancerous (benign) growth of nerve tissue in the foot, often between the third and fourth toes. It causes a sharp, burning pain in the ball of your foot. The toes also may sting, burn or feel numb. Morton's neuroma may occur in response to irritation, injury or pressure — such as from wearing tight-fitting or high heel shoes.

9. Stress fractures

	Constant pressure on the forefoot from wearing high heels may lead to tiny cracks (called stress fracture) in the bones of the foot. The symptoms include a generalized area of pain, tenderness, and pain when walking.

10. Injuries from falling off the high heels

	These include broken bones, sprained ankles, and dislocations. Sometimes, the damage may be permanent.