Effects of High-Heeled shoes

High heels are stylish, and they make you feel taller and sexier, but at what cost? High-heeled shoes can cause a slew of issues for your feet, as well as compromising your stability and raising your chance of injury. Some of the most common complaints include leg, back, and foot discomfort. Long-term use can lead to structural abnormalities in the foot, resulting in bunions, hammertoes, and other disorders that may necessitate surgical intervention.

In addition to injury, high heels place excessive stress on the back and lower extremities that can profoundly affect posture, gait, and balance.

JOINTS AND LIGAMENTS OF THE FOOT

The foot is the region of the body distal to the leg that is involved in weight bearing and locomotion. It consists of 28 bones, which can be divided functionally into three groups, referred to as the tarsus, metatarsus and phalanges.

The foot is not only complicated in terms of the number and structure of bones, but also in terms of its joints. These joints enable many movements of the foot that are essential for many functions; such are walking, jumping etc.

LIGAMENTS OF THE FOOT

1. Ligaments Stabilizing the Ankle Joint

• The anterior Talo-fibular ligament (outside or lateral ankle joint).
• The Calcaneo-fibular ligament (outside or lateral ankle joint).
• The posterior Talo-fibular ligament (outside or lateral ankle joint).
• The Deltoid ligament (inside or medial ankle joint).

1. Ligaments of the Upper Ankle (Holding the tibia and fibula together)

• The Anterior Inferior Tibiofibular Ligament.
• The Interosseous Ligament.

1. Ligaments of the Subtalar Joint

• The Cervical Ligament.

1. Ligaments of the Foot

• The Lisfranc Ligaments.
• The Intermetatarsal Ligaments.
• The joint capsule of the Great Toe.

While the bones in the foot can break, other common injuries and conditions of the foot include the following:

• Foot sprain.
• Plantar fasciitis.
• Ankle sprains.
• Flat foot.

The first ray is the segment of the foot composed of the first metatarsal and first cuneiform bones. The location of this joint is important as it intersects the transverse and medial longitudinal arches. This segment serves as a critical element in the structural integrity of the foot

The first metatarsal is the shortest, strongest, and most important weight-bearing point in the forefoot. In standing, this bone carries 40% of body weight.

The stability of the first metatarsal-cuneiform joint is supported by the tendinous attachments onto the first ray from the tibialis posterior, tibialis anterior and peroneus longus muscles. Additionally, the two sesamoid bones encased in the tendons beneath the head of the first metatarsal function to elevate the first ray.

The first ray serves numerous purposes, including resisting ground reaction forces, maintaining medial longitudinal arch integrity during midstance supination, allowing first metatarsal head to plantarflex at heel lift, and providing medial stability for propulsive phase.

POSTURE

A high heel places your foot in a plantar flexed (downward extended) position, thereby increasing the pressure on the forefoot. This compels you to compensate for the shift in balance by adjusting the rest of your body. The upper body must lean back as a counterweight to the lower body's forward leaning to maintain a center of balance. As a result, your body's alignment is disrupted, resulting in a stiff, unnatural posture rather than a comfortable, neutral one.

Again, the higher your heels are, the worse this gets. If wearing extra-high stilettos, women will often have a lumbered, giraffe-like gait, particularly if their backs, knees, and calves don't the strength to compensate for the imbalance.

BACK

The back's natural C-curve is designed to act as a shock absorber, minimizing the weight-bearing stress on the vertebrae and pelvis. High heels causes the low back's lumbar spine to flatten, while the mid-thoracic back's spine becomes hyper-curved.

To compensate, you will need to lean forward to relieve some of the pressure on your back (especially if you have been wearing heels all day and are feeling fatigued). Overuse of the back muscles and an increased risk of persistent back pain are inextricably linked to poor alignment.

HIP FLEXOR MUSCLES

The hip flexor muscles are located on the top front of the thighs. Wearing heels keeps them in a flexed position all day. While you might think of this as "exercising" your hip flexors and related calf muscles, repeated use can lead them to shorten and contract.

Contraction of the hip flexors can result in the lumbar spine flattening down and the development of low back and hip pain.

KNEE POSTURE 

High heels stimulate greater activity in rectus femoris, and cause larger vertical and anterior-posterior ground reaction forces during gait, and to increase erector spinae and tibialis anterior EMG activity. In addition, high-heeled shoes increase the external adduction moment at the knee joint, implying an increased medial compartment load. This may affect muscle activity around the knee joint, and theoretically could manifest as either an increase in vastus medialis activity, or a reduction in vastus medialis activity from inhibitory mechanisms elicited by altered biomechanical forces at the knee joint. Knee osteoarthritis is twice as common in women. Some of that blame may be due to high heels. The knee stays flexed and the tibia turns inward causing knee varus when wearing high heels. This position puts a compressive force on the inside of the knee (medial), a common site of osteoarthritis. If you already have osteoarthritis, it is best to avoid wearing high heel shoes.

Ankle and Foot Posture

 In normal function and anatomical position, the ankle joint has flexion known as dorsiflexion and extension known as plantar flexion. All other movements in the ankle region are created by the foot’s dynamic joint structure. The ankle is composed of the distal tibia, distal fibula and dome of the talus (also known as the ankle mortise or mortise joint). The foot is composed of 26 bones and 33 joints and has many intrinsic and extrinsic muscles. Although inversion and eversion are actions not of the ankle joint but of the foot, the musculature within the lower leg acts directly on the foot and needs no assistance from other muscles to create motion. Pronation and supination occur not in the foot but in its subtalar joint. The ankle joint is constantly exposed to extreme mechanical conditions during even the simplest motion, such as gait.  

High heels limit the motion and power of the ankle joint. The calf muscles (gastrocnemius & soleus) are shortened because of the heel height. The shortened muscles cause them to lose power when trying to push the foot off the ground. The position of the ankle may also cause a shortening of the Achilles tendon. This can increase the pull of the Achilles tendon where it attaches on the back of your calcaneus and may cause a condition called insertional Achilles tendonitis. As adequate levels of tension within the muscles and tendons are required for both effective force transmission to the skeleton and proprioception, the plantar flexor muscles might acutely react by increasing their tonic activity to take up the excessive tendon slack. A shortened gastrocnemius and soleus and increased Achilles tendon stiffness in habitual high heel wearers reduce the ankle active range of motion and thus explain the discomfort these women experience when walking in flat shoes.

When to see a doctor

If you develop heel pain, you may first try some home remedies, such as rest, to ease your symptoms. If your heel pain does not get better within two to three weeks, you should make an appointment with your doctor.

You should call your doctor immediately if you experience the following:

• Your pain is severe.
• The pain starts suddenly.
• You have redness in your heel.
• You have swelling in your heel.
• You cannot walk because of the pain in your heel.

Conclusion

Over time, there are negative consequences from wearing high heels. Some of the consequences of wearing high heels may include sprained ankles, lower back pain due to increased spinal curvature, leg pain due to added weight placed on the toes, shortened Achilles tendon, decreased stride and other changes to gait and mobility, and even the tendency of osteoarthritis in the knees.

HOW TO WEAR HEELS SAFELY

• Keep them under 3 inches- If heels are unavoidable or if you are desperate to wear them with a certain outfit, try to keep them at three inches or less. Heels higher than this drastically increases the pressure on your foot.
• Regular exercise can help strengthen your feet, helping keep them safe when wearing heels. Try stretching before and after wearing heels to help strengthen and relax your muscles. 
• Alternate the style of shoes you wear
• Wear soft insoles- Putting insoles into your heeled shoes will help cushion your feet and put less pressure and strain on the surrounding muscles. When you put on your favorite heels, you will notice that they no longer hurt so much.

Physiotherapy management

Physiotherapists play an integral role in the management of foot pain. At Tibabu Physiotherapy, our experienced and knowledgeable therapists will provide a comprehensive assessment of your foot pain. This assessment can include postural assessment, gait analysis (determining the positioning of the foot through the different phases of the gait cycle), assessment of joint mobility, strength assessment and testing to determine any muscle tightness that could be leading to foot pain.

Our therapists provide complete treatment that could include manual therapy, exercise prescription, orthotics referral and use of modalities such as shock wave therapy and ultrasound. Do not let your foot pain slow you down!