High heels and your health - HealthLINK (Women)

The high price of high heels

This study confirms what orthopedists have known for a long time. High heels, whether they're thick or thin, can cause problems in women's knees, their ankles and their feet. Shoe-related problems I see very frequently include ankle sprains and breaks from rolling over on high-heeled shoes. These are immediate problems, unlike osteoarthritis in the knee, which may develop after decades of wearing high heels.

"Shoe-related problems. . . include ankle sprains and breaks from rolling over on high-heeled shoes."

What is osteoarthritis?
While the exact cause is unknown, we do know there are several contributing factors, including injuries, age, congenital predisposition and obesity. It is characterized by the breakdown of the articular cartilage within the joint. Articular cartilage is a firm, rubbery material that covers the end of a bone. It acts as a cushion or shock absorber between the bones. When it breaks down, this cushion is lost, and the bones grind together. This causes the development of symptoms such as pain, swelling and decreased motion. Osteoarthritis commonly affects weight-bearing joints such as the knee, but it may affect any joint.

"Walking on high heels puts abnormal stress on both the front and the back of the knee…."

Walking on high heels puts abnormal stress on both the front and the back of the knee as The Lancet study demonstrates. In the case of the shoes they tested, pressure on the knee was increased by 22 to 26 percent. The health of the cartilage that forms the padding between the bones in the knee is dependent on the fluid in the knee. It absorbs the nutrients it needs from this liquid to repair itself, but stress on the knee restricts the absorption of the fluid, and the cartilage begins to dry out and shred. Over time, it wears out and arthritis sets in. There are also genetic components of arthritis and there may be nutritional aspects as well, but we know high heels don't help.

Treatment approaches
Treatment depends on the stage of the disease. If we catch it in its earlier stages, glucosamine and chondroitin sulfate supplements may be helpful. There is a lot of anecdotal evidence that taking these natural substances, which dissipate as we age, helps to rebuild cartilage.

We also give injections of Synvisc®, a substance produced from chicken cartilage that is in the same chemical family as glucosamine. The injections can be helpful for up to six months and then additional injections are necessary.

If the arthritis is more advanced, we can do arthroscopic surgery to clean the joint of debris and repair any torn cartilage. If the arthritis is well advanced, total knee replacement surgery may be necessary.

High heels also cause foot problems
High heels can also result in a variety of foot problems, including metatarsalgia, which is pain in the ball of the foot. Another condition, called Morton's neuroma, which is 10 times more common in women than men, is caused by a thickening of tissue around a nerve between the third and fourth toes. It usually develops in response to irritation and excessive pressure such as the weight burden high heels place on the ball of the foot. It is often treated with orthotics, cortisone injections and in stubborn cases, surgery.

Pointed toe shoes and shoes that pinch lead to other foot problems such as bunions, calluses and hammertoe.

The most healthy shoe
Surprisingly, flat shoes are not the ideal for overall foot and leg health. Low heels of one-half to three-quarters of an inch are good for both the front and back of the foot. Square-toed shoes with a roomy toe box help prevent the pinching and scrunching of the foot that can lead to lots of painful problems.

Dr. Sella is an attending orthopedic surgeon at Yale-New Haven Hospital and an associate clinical professor at the Yale University School of Medicine. He directs the Foot and Ankle Service.

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