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Sunday, April 19, 2009

The new trend: Skyscraper six inch heels...

As an adjunct faculty member of MidWestern University's Podiatric School of Medicine, I was fortunate enough for appear on Channel Three's Good Morning Arizona to discuss the newest fashion trend to hit the red carpet and the cat walk - the six inch "Skyscraper Heel." 

Previous to my appearance, I suggested to the Producer that we take X-Rays of her feet in the "Skyscraper Heels" and, although I knew the shoes were bad, examination of the actual X-Rays were horrifying. The central two-thirds of the foot are almost at a complete vertical and the first toe joint is so dorsiflexed that the woman is actually bearing her full body weight on the inside cartilage of the first toe joint. Yikes! 

This extreme stress across that small area can cause:
Degenerative Joint Disease
Stress Fractures
Knee, Hip, and Lower Back pain
Ankle Sprains 
Achilles Tendonitis Contracture

The shoes that we reviewed on the show were all beautiful in an artistic "Wow" factor way but I am amazed that women would subject themselves to this kind of pain (the words "Medieval torture devices" were the first words that sprung to mind when I saw the extreme six inch heeled shoes). It's rumored that some of the celebrities who wear this fashion do what's called a "PT BLOCK" prior to appearing on the red carpet or at an event in these shoes. Basically, that means they are injecting the Posterior Tendon with lidocaine to numb it up prior to an event so they can walk pain free. 

Being a woman and a Podiatrist, I'm in a unique position to not only be a big fan of beautiful shoes but also to know what constitutes a good shoe and I've spent over a decade treating people for various foot ailments - many caused by poor shoe-gear.  

I'm not advising that women give up their heels - unless of course you have a specific foot problem that makes it dangerous and/or uncomfortable to wear such shoes (such as Diabetes, Neuropathy, ligament laxity, extreme flat feet, Posterior Tibial Dysfunction, ect). I am recommending, however, that women follow some simple rules when looking for a good dress shoe. 

If you feel you must wear a high-heel shoe, here are some things to look for:

* Try to limit yourself to a two and a half inch heel. 
If you have limited motion of the big toe joint (hallux limitus) be particularly careful of your heel height. There's a simple test for this - stand on the ground and, without shifting your weight, have someone try to pick up your big toe. How far does it go upward? However high it goes - you should not ever go in a higher heel height than that. If you do, your body will compensate: just remember, if your body cannot get the motion it needs across one joint, it will find the motion it needs across another joint - whether it is your knee, your ankle, or, more commonly, walking on the outside of your foot which can lead to multiple "mechanical strain" problems. 

* Look for the "Wedge" shoe as it has a more rigid sole that will protect your foot. There are several advantages to the "Wedge" shoe. First, you can get some of the height that you are seeking from a dress shoe while limiting the range of motion that you are forcing across your big toe joint. You can have a four-inch wedge but actually only be in a two-inch heel. Secondly, a solid wedge will decrease the wear-and-tear on your foot that a more flexible, thin sole will allow. 

* Avoid a thin, flexible forefoot area - try to get a dress shoe with a thicker more rigid front.

* Look for a shoe with a wider front - the wider the front of the shoe, the more pressure per square inch for the force/weight of your body to be distributed over. 

* Although you are looking for a thick, rigid-soled sole - try to find a shoe with some padding and cushion built into the interior.  

* Strap in the Forefoot area and the Rearfoot area securely for more protection and to minimize injury. Remember, the more motion you have, the greater the chance of injury. Everyone thinks that you need a thin, cushy, flexible shoe but it's the exact opposite - you need rigid, biomechanical control. 

* Most importantly - everyone is different! What works for one person does not necessarily work for another. The acid test is PAIN! If the shoe hurts, forget it. Pain is a warning sign that something is going on and you need to stop and listen to what your feet are telling you. (If you have Peripheral Neuropathy you should not be in this type of shoe at all because if your feet are numb - you can't feel the pain that is warning you of a foot problem, which can set you at risk for limb threatening problems). 

I really enjoyed my stint into television land and, as much as I appreciate the aesthetics of these lovely shoes as works of art to admire - I cringe at the thought of the damage that occurs to the foot, knee, hips and lower back while walking in them. 

As I tell my patients, what would you rather do - wear a more sensible shoe so that you can run around in, having a blast as you do everything you want to do or look fashionista fabulous but be in pain and not be able to keep up with your friends as they run around and do everything that you can't do? 

Have a great day!
Cathy McCarthy, DPM