Should high heels foot all the blame?

SORE FEET?: Heels do cause us some grief, but so do our genes.

SORE FEET?: Heels do cause us some grief, but so do our genes.

We've all read about them - terrible problems caused by terrible heels. Pump bumps, bunions and hammer toes – the price we pay for bad shoe choices.

But no one's hanging up their heels just yet. It seems Carrie Bradshaw's devotion to her Manolo Blahnik pumps may have rubbed off on the rest of us, only fuelling our determination to balance our weight on a spear, risking foot damnation in the process.

But what if high heels have copped too much flak? Are they the root cause of our foot woes, bending our feet all out of shape? 

It seems if you talk to four different foot experts, you get four different answers on what's really to blame for problem feet. And yes, in most cases, the problem has more to do with genetics than your high heels.

For Canterbury foot surgeon Dr Frederick George, bunions are the most common problem he sees. And he's adamant – "it's an inherited trait, it has nothing to do with shoes".

Shoes might aggravate the problem, but people can be genetically predisposed to having a foot problem, such as bunions, hammer toe or spurs, whether they wear high heels or not.

Very few people have perfect feet, so over a period of time they might develop different sorts of bone deformities from the way they walk and where they lean their weight, he explains.

He does see shoe-related problems – typically corns and calluses caused by friction and rubbing against the fourth and fifth toes – but these are normally caused by tight, pointy shoes, not necessarily heels, he says.

"High heels are actually good for arch and heel pain, shifting weight from the heel to the front of the foot. And heel pain is very common, especially if people are heavier," he says.

He's not talking about the sky-high circus-like creations that are ankle sprains on stilts, but more your everyday court shoe.

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"Wearing a higher-heeled shoe is often as good as wearing an orthotic. I tell patients 'if you can wear a heeled shoe comfortably and it doesn't bother your toes, then it can be… actually quite beneficial'."

You might imagine that's the only time you'll hear a foot doctor say that… until you hear the same thing from the next expert.

Auckland podiatrist Simon Speight is "very supportive" of heels. "Stiletto heels can actually fix musculoskeletal pain" because they're stable shoes and offer more support than some others, he says.

Some of the worst shoe culprits are the very flat minimalist running shoes and foot gloves that offer no cushioning or shock absorption.

Similarly, ballet flats – so popular now – are also problematic. "If you've got a shoe where you can twist it like a rag – if it's too flexible – you can get musculoskeletal problems like arch pain," says Speight.


That's not to say he doesn't see problems related to heels, too. He says about 90 per cent of his central Auckland clients are corporate clients whose problems pretty much come down to ill-fitting shoes.

But what makes for an ill-fitting shoe is any shoe that is inappropriate to a person's foot type. A pair of slippers can be an ill-fitting shoe, says Speight.

The issue for his corporate clients are heels that are too high and an inappropriate match for their foot. "If you've got a 'hobbit foot' and you're trying to put it into a pointed shoe, good luck."

He directly attributes corns and calluses to shoes that are too tight. But many other foot problems "are often hereditary to be honest".

"There's no evidence to prove that ill-fitting shoes lead to bunions, that's emotional stuff, that."

Indeed, he's right about the evidence, which seems to be pointing to our genes and not to the heels we wear.

The Framingham Foot Study published last year in the Arthritis Care & Research journal was the first to confirm the widely-held view that bunions and lesser toe deformities such as hammer toe and claw toe were "highly heritable in white men and women of European descent", suggesting a genetic predisposition to these conditions.

Frederick George says people blame their high-heeled dress shoes because it's while wearing them that they'll usually notice the problem for the first time: "If you have a bunion, wearing a high-heeled shoe will put weight on it".


But a Tauranga podiatrist, Gerrard Huck from Foot Mechanics, is still firmly in the anti-heels camp.

He sees a number of foot and knee complaints, including metatarsal issues and shortening of the calf muscle and achilles tendon, that can be "wholly related back to the shoe".

"Some of the problems we get are with very high heels pushing the whole foot forward onto the ball of the foot, so quite an unnatural position."

"There's always a hereditary factor with these things," he notes. But it's usually a combination of genetic predisposition as well as environmental factors, such as the person's footwear.

"I do think there are some things that are solely down to poor footwear choice."

He says quite often the only change a podiatrist might recommend is changing a client's footwear, and often that's all it takes to feel better. "If you follow the logical path, the problem's got to be the shoes."

He agrees that heels are not the only culprits and "have probably copped an awful lot of flak over the years".

"But it's pretty well recognised that they're not a good shoe for support. The foot was never designed to be put at that sort of angle."

There is no one answer for everybody, he adds. "If we think it's the shoe, we'll change that. But for most women who are happy wearing their heels with no problem, would we change that? Probably not."

And that's exactly what most women want to hear – that they can keep their heels.

Simon Speight knows this better than anyone. His corporate clients prefer to see him every three months or so, to remove their corns and calluses in a half-hour treatment, than to stop wearing their shoes of choice. "These visits are just a routine part of their life… like getting a haircut," he says.

"I allow them to enjoy what they do (wearing heels) and I compensate for the ill-fitting nature of it," says Speight.



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