When passion for high heels turns sour | Sunday Observer

When passion for high heels turns sour

High heels have been described as the secret passion of every woman, young and old. Yet, few women know that wearing heels, especially, very high heels over a long period of time can do immense damage to her body without her being aware of it. Any heel over two inches changes the biomechanics of how you walk, You can’t walk fast . And as your weight is shifted from your heel onto your forefoot, it puts your bones, muscles and joints out of alignment and increases the risk of ankle instability and injuries.

So says Chartered Physiotherapist Dr Gopi Kitnasamy who has been treating women with high heel related ailments with simple easy to do home exercises and electropathy for over two decades at the physiotherapy clinic he heads at a leading private hospital in Kollupitiya.

Excerpts from his interview with the Sunday Observer …

Q. The focus now is on women’s health. A subject that has been sidelined but is very common in women, are the adverse effects of wearing high heels, since many women are still ignorant of the risks involved. How high should the heel of a shoe worn by a woman be in order that no damage is done to the rest of her body?

A. High heels have been blamed for a range of health problems in women from bunions to back pain. The ideal height of the heel should be one inch, which puts the foot into a more stable position. Always avoid heels that are either too flat or too high.

Q. If it is above the maximum height what happens to the feet?

A. Anything over the two-inch mark changes the biomechanics of how you walk, your strides are shortened, you can’t walk as fast, your body weight shifts to the ball of the foot, which throws off your centre of gravity and stresses the knees and lower back. When you wear high heels your weight is shifted from your heel onto your forefoot which puts more pressure on the ball of your foot. This would put your bones, muscles and joints out of alignment and increase the risk of ankle instability and injuries.

Q. Will it also affect the spine?

A. High-heeled shoes unnaturally place the heels above the toes. Even the slightest adjustment to the foot can throw off your body’s entire alignment. The spine is very vulnerable because it has specially designed curves that evenly distribute your weight. High heels alter these curves. Eventually, this poor posture places too much uneven wear on the discs, the joints, and the ligaments of the back. It also increases lumbar lordosis (curvature) and increase compressive forces on lumbar vertebra that are leading towards lumbar spondylosis (wear and tear of the vertebral discs).

Q. Studies have shown that wearing high heels can increase the risk of osteoarthritis in women. Do you agree?

A. High-heeled shoes increase the force across the patellofemoral component of the knee (behind the kneecap) and the compressive force on the medial compartment of the knee (the inside of the knee joint). This additional force from wearing high-heeled shoes may result in degenerative (Osteoarthritis) changes to the knee.

Q. Will it increase the risk of bunions?

A. A bunion is an abnormal, bony growth on the joint that connects the big toe to the foot. Bunions are often caused by heredity, but they may be caused and aggravated by improper footwear, especially, high heels . Wearing high heels forces the weight of your body onto the ball of your foot, and if you are wearing narrow shoes, this forces your toes into a small space which may encourage bunions to form.

Q. What about risks of ingrown toe nails ?

A. High heels and tight-fitting or pointed-toe shoes are a leading cause of ingrown toenails. These shoes create chronic pressure on the big toenails and prevent them from growing properly.

Q. Are sprains and strains also caused by wearing high heels regularly?

A. Your ankles move up and down when you walk. When you wear high heels, however, your feet are in a permanent plantarflexion (bent downward). The ankle ligaments are in a permanent stretch downward while the Achilles tendon is pinched. Up and down movements in your ankle is reduced. Every step lands on the balls of your feet. The arch of your feet can no longer support your body weight. High heels put your bones, muscles and joints out of alignment. Prolonged use eventually causes muscle tightness, weakness, ankle instability and imbalance, which are crucial predictors of ankle injury.

Q. Is it true that regular heel wearers can actually shorten their calf muscles ?

A. Yes, high-heel wearing can cause fibres in the calf muscle to shorten, and the Achilles tendon, which connects the calf muscle to the bone, to stiffen and become thicker. This can cause a tightness of the muscles on the back of the thigh (hamstrings) and can also increase the curvature in the lower part of the spine (lumbar region) which can lead to back pain.

Q. Can a girl develop problems wearing high heels at a young age?

A. Wearing heels, makes your muscles work extra hard. For children whose muscles are still developing , this puts unusual fatigue on it. Walking in heels puts pressure on specifically the first ball of the foot near the big toe. For children who have yet to develop their normal gait pattern, this may have serious repercussions later on.

Q. What about elderly women who wear high heels?

A. Inappropriate footwear such as excessively flexible heel counters, high heels and narrow heels can impair balance in older people, possibly leading to an increased risk of falling and fractures. Hip fractures are one of the most serious consequences of falls.

Q. Often a heel wearer experiences pain and discomfort even after removing their shoes. Why?

A. This pain or discomfort is also known as High Heel Hangover. The reason for these after effects are the fixed position of the foot in the high heels, continuous stress on the muscles and other soft tissues, poor circulation and cramped position of the foot in narrow shoes.

Q. Symptoms a woman must look for if she is a chronic heel wearer?

A. Calf muscle, foot, ankle and heel pain, knee and low back pain/discomfort, numbness and tingling sensation in the feet, muscle cramps, imbalance, difficulty in walking barefoot and limited movements in ankle.

Q. As a Chartered Physiotherapist with over two decades of experience in treating a range of disabilities such as I have mentioned, among women, what is the role of a Physiotherapist in treating the different symptoms they present caused by wearing high heels?

A. Depending on the nature of the injury, ,a Physiotherapist can help by applying various strategies to reduce stiffness, pain and discomfort in joints or muscles. Strategies include manual techniques, such as, joint mobilization and manipulation, deep friction massage, stabilization exercises and electrotherapy i.e. ultrasound therapy. . Most of the foot and ankle deformities are caused by muscle imbalances that occur with :

• Poor loading through the foot from poor posture and poor postural control

• Footwear that does not allow the foot to have normal biomechanics

• Compensations the foot makes to stay on the ground while the body moves above it.

Q. What are the exercises you recommend? Can they be done at home?

A. The most important exercises for high heel wearers are calf/quadriceps/hamstrings stretch, calf/foot roll, ankle circles, hip stretches and pelvic raises. All these exercises will take a maximum of 30-45 mins and need to be done twice a day. You don’t need any special equipment, and can be done easily at home.

Q. Your word of advice to parents of young daughters and to women in general on this particular issue?

A. Get your feet measured, buy the correct and appropriate size. Buy the shoes in the afternoon, when the feet are their largest. Don’t go for pointed shoes, prefer the ones with wider toe box. Try and set your limits to two inches. Opt for shoes with leather insoles to keep foot from slipping. Try to get the soles with a small arch raise. Buy a variety of shoes and vary your footwear day to day. Avoid wearing the high heels for long periods of time. Stretch your leg muscles before and after putting them on. Keep toenails short and keep calluses shaved off. Spend time in your bare feet and let your feet have some freedom to move. 

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