Hi Everyone! I often talk about cold & heat exposure - and exercise. This is my expertise and why I created the worlds first practical and science based education in thermal therapy for professionals - the Thermalist Education. Todays newsletter topic is very supportive in the same mission on how to achieve our highest human potential - we need to zoom in on women foot health!
Foot health is highly underrated as no fashion magazine would ever address the issues, I’m going to do today.
A culture in narrow shoes
Are you a shoe lover? You don’t have to be, but I’m sure you know one - your wife, your daughter or mum - if they often choose style over comfort when it comes to footwear. If yes, then this article is for you.
As a woman, I understand the societal pressure to wear high heels and other fashionable yet uncomfortable footwear. I wear high heels for occasions though, but not on a daily basis. Not anymore at least. As a teen I wore heeled and narrow shoes all the time. Why? I loved the way I looked in them and the way it made me feel. The explanation is simple. However, it was often painful. Back then I didn’t think too much about the consequences and noone talked about it either. The awareness today is still limited, but very important though, as it may solve some painful (chronic) issues that roots in the the choice of wrong footwear.
When it comes to footwear, we are expected to put our fashion over our comfort and health. However, harmful female footwear can seriously affect our overall well-being.
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In recent years, female footwear has become more popular. Although it looks fashionable, it can seriously harm feet and overall health. I want to dive into the science to investigate how harmful these consequences are…
Many popular styles of women's shoes, from high heels to pointed shoes, have been linked to various foot problems. In fact, according to a study published in the Journal of Research Gate, nearly 58% of individuals who wear high heels experience pain while walking. This pain can range from mild discomfort to severe foot injuries.
One of the main reasons for this is the pressure placed on the feet and toes when wearing high heels. The narrow, pointed shape of many popular women's shoes can cause crowding and squeezing of the toes, leading to conditions like bunions, hammertoes, and even nerve damage.
In this piece, I would love to focus on the harmful effects of some popular female footwear and provide a public health perspective on why it is important to prioritize comfort and safety when choosing your shoes.
Studies and Expert Opinions
Several studies have identified the long-term health consequences of wearing high heels. A fascinating study by Jacek Lorkowski and colleagues aimed to shed light on the prevalence of high heels in website images related to fashion and footwear.
Fig. 1. Count of women wearing shoes in the respective heel-height category during live street surveillance.
The study revealed that despite their known negative health effects, high heels remain popular and fashionable among women in Western societies. This phenomenon is attributed to societal pressure, media influence, and advertising tactics used by shoe manufacturers.
The research pointed out that 59% of corporate women in industrialized countries wear high heels for up to 8 hours daily, resulting in foot pain and reduced mobility. This issue is becoming a public health concern. Due to their misalignment of the foot, high heels have been linked to distorted musculoskeletal geometry and local neuroinflammatory sequelae.
What are the Medical Issues Associated with High Heels?
However, as aesthetically pleasing as they may be, high heels can also bring about various medical issues that can cause discomfort and even long-term damage to the body.
High heels and foot deformities
You don't want to imagine being born with perfect feet and then suddenly having scary bunions attack your feet. And the cause of that? High heels! High heels are stylish and beautiful, but they can also be harmful to your feet. In fact, wearing them regularly over a long time can lead to foot deformities.
High heels have a narrow and pointed toe box which forces your toes to be pressed together. Over time, this can cause the formation of bunions, corns, and calluses on your feet. These deformities not only affect the appearance of your feet but can also cause pain and discomfort.
Moreover, high heels alter the natural alignment of your foot and put extra pressure on different parts of your foot. This can lead to issues such as hammertoes, where the middle joint of the toe bends downwards instead of pointing straight. It can also result in Morton's neuroma, a condition where the tissue around the nerves between the toes thickens and leads to pain, tingling, or numbness.
A study by Puszczałowska-Lizis and colleagues aimed to examine the correlation between foot deformities and the type of shoes traditionally worn at work by employed women. The study consisted of 150 women aged 30-40, divided into three groups based on their regular footwear choices:
Group I wore flat-soled shoes, Group II wore mid-heeled shoes (4.0±0.5 cm heels), and Group III wore high-heeled shoes (10.0±0.5 cm heels). Measurements were taken using the CQ-ST hodoscope.
The results showed significant differences in the right foot g angle between Groups I and III (p=0.033) as well as Groups II and III (p=0.040).
Figure 2. The method of determining the key indicators of foot structure.
The study found that women who regularly wore high-heeled shoes had flatter transverse feet and a more laterally flexed hallux compared to those who wore low-heeled or flat-soled shoes.
Additionally, wearing high-heeled shoes was associated with a higher incidence of hallux valgus, while varus deformity of the fifth toe was linked to this type of footwear choice. These findings suggest that the type of shoe worn may play a role in the development of foot deformities in women.
Foot Pain and Discomfort
Do you sometimes feel sudden pain in your feet? The most common issues associated with high heels are foot pain and discomfort. The unnatural position of the foot in high heels puts excessive pressure on the toes, causing them to be compressed and bent into an uncomfortable position. This can lead to various foot conditions, such as corns, bunions, and hammertoes.
Also, wearing high heels for extended periods can cause strain on the calf muscles, leading to muscle fatigue and soreness. This can further result in plantar fasciitis, where the tissue connecting the heel bone to the toes becomes inflamed.
One study by Hour Matar Abdulla Almadhaani and colleagues examined the effects of wearing high-heeled shoes on pain and discomfort in different body areas over 6 hours. They found that after approximately 3.5 hours, pain levels significantly increased, with the back, calcaneus, and metatarsals reporting the most intense pain.
It was also noted that heel height plays a role in this relationship, with 7.5 cm being the threshold where overall body pain becomes significant. Beyond this point, knee pain decreases as it shifts towards a more neutral position. The study suggests that footwear designers should consider these findings to create both stylish and comfortable shoes.
Ankle Sprains and Injuries
The elevated height of high heels also increases the risk of ankle sprains and injuries. Their unstable nature and the already compromised balance due to the foot's position can make it easy to twist or roll an ankle while wearing them.
Moreover, walking on uneven surfaces or even slight missteps can cause falls and other accidents, resulting in serious ankle injuries.
Here is yet another study where Alicia Foster and colleagues aimed to investigate how heel height affects the frontal plane biomechanics of the ankle joint during walking.
The findings showed that wearing high heels significantly increased ankle plantarflexion and inversion angles and activated the peroneus longus muscle, which is important for controlling ankle inversion.
Figure 5: Mean level of pain of the various body parts when wearing differing heel heights of shoes.
These results suggest that wearing high heels may increase an individual's risk of experiencing a lateral ankle sprain due to altered biomechanics and muscle activity.
Back Pain
Wondering where that back pain might be coming from? Wearing high heels also affects the feet and back. With increased lower back and spine pressure, the body's natural posture is altered when wearing high heels, which can lead to back pain, especially in the lumbar region.
Furthermore, high heels can also cause an imbalance in the body's weight distribution, leading to strain on the lower back muscles. If not addressed promptly, this can result in chronic back pain.
A study by Wardah Hussain Malick and colleagues examined the association of musculoskeletal discomfort with the use of high-heeled shoes in females. The study was conducted on 174 female residents of Islamabad and Rawalpindi who were frequent users of high heels.
The 18 to 55 participants were assessed using the Nordic Musculoskeletal Questionnaire (NMQ) and Numeric Pain Rating Scale (NPRS). Additionally, a self-structured questionnaire was used to gather information on factors related to high-heeled shoes, such as duration and frequency of use.
The results showed a positive association between shoulder discomfort and the length of women's high-heeled shoes. Similarly, upper back discomfort was also found to be associated with the length of the heeled shoes.
Apart from the major medical issues discussed above, wearing high heels can also cause pain and stiffness in the ankles, knees, hips, and lower back.
Foot pressure and static balance
Wearing high heels can also impact the foot's pressure distribution and static balance. It causes increased pressure on the forefoot, which can lead to calluses and bunions over time.
A study by Young-Hyeon Bae and colleagues investigated the effects of revised high-heeled shoes (HHSs) on foot pressure distribution and static balance during standing compared to general HHSs.
The study was conducted using 36 healthy female subjects wearing both types of HHSs while standing still on wireless force plates. Foot pressure was measured in four zones (front, back, left, and right), and scores for static balance were calculated under three conditions (eyes open, eyes closed, screen blocked).
Data analysis showed that revised HHSs resulted in significantly higher rearfoot pressure and lower forefoot pressure than general HHSs. Regarding static balance, revised HHSs showed a greater positive effect than general HHSs.
This study suggests that wearing general HHSs can cause postural imbalance and foot-related issues such as pain and deformities due to increased forefoot pressure and decreased rearfoot pressure. However, revised HHSs with tunnel technology and an optimized wedge angle help normalize physiologic standing posture and improve balance control.
Before our final words - I want to thank todays Newsletter sponsor - Vivobarefoot.
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Final Word
While high heels may be fashionable and enhance a person's appearance, they can also have significant negative impacts on an individual's health in the long run. From ankle injuries and back pain to musculoskeletal discomfort and foot pressure, wearing high heels can lead to various physical issues.
Therefore, it is crucial to wear high heels in moderation and consider choosing more comfortable and supportive options when necessary.
Key Protocols and Takeaways
Wearing high-heeled shoes for approximately 3.5 hours leads to a significant increase in pain levels, with the back, calcaneus, and metatarsals reporting the most intense pain.
Women who regularly wore high-heeled shoes had flatter transverse feet and a more laterally flexed hallux compared to those who wore low-heeled or flat-soled shoes.
Wearing high-heeled shoes is associated with a higher incidence of hallux valgus, while varus deformity of the fifth toe was linked to this type of footwear choice.
Due to altered biomechanics and muscle activity, high heels may increase an individual's risk of experiencing a lateral ankle sprain.
High-heeled shoes may contribute to musculoskeletal discomfort in females, particularly in the shoulders and upper back.
Due to increased forefoot pressure and decreased rearfoot pressure, high-heeled shoes can cause postural imbalance and foot-related issues such as pain and deformities.
I hope you enjoyed the article today! I wish you all a great Week!
Susanna
Founder @ Soeberg Institute