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High heel injuries on the rise: How to wear heels without hurting yourself

Photo by John Lamparski/Getty Images
Photo by John Lamparski/Getty Images

A pair of three-inch wedges was all it took for Heather Lochner to experience some of the most intense pain she’s ever felt in her life. The Toronto public relations professional ended up in hospital after rolling her heel at a local restaurant.

“My ankle actually hit the floor while I was still in my heels,” Lochner says. “Aside from the dislocation of my shoulder, it was the most painful thing I’ve ever done, including childbirth twice without medication. The pain was so sharp and so intense. I had to hop out of the restaurant.

“I was in a walking cast for two weeks,” she adds. “When I explained the story to the nurses, they just shook her heads and said, ‘those darn wedge heels are the worst.’”

Wedges, stilettos, platforms, slingbacks, or mules: maybe they’re called “killer” heels for a reason. New research has found that injuries resulting from high heels are on the rise.

More than 123,300 heel-related injuries were treated in emergency rooms in the United States from 2002 to 2012, with the rate doubling during that 10-year span, according to a recent study published in the Journal of Foot and Ankle Injuries by researchers at the University of Alabama at Birmingham.

Using data from the Consumer Product Safety Commission's National Electronic Injury Surveillance System, they found that women in their 20s were most likely to get hurt, with sprains and strains of the foot or ankle being the most common injuries. Half of these injuries happened at home, not at the office or out on the town.

And while women may find they get used to their pumps, wearing them regularly does all sorts of damage to your body. Another recent study, this one published in the International Journal of Clinical Practice, found that heels weaken ankle muscles over time and cause imbalances in those muscles, leaving you more prone to injuries and harm.

“When you wear high heels, you shift your weight to the ball of the foot, and to maintain balance you tilt your pelvis anteriorly,” says Ottawa pedorthist Sal Sabbagh, founder of PodoCanada. (Pedorthists specialize in using footwear to help manage problems of the foot and lower extremities.) “That anterior pelvic tilt can cause low back pain. Having more weight on the ball of the foot stresses your metatarsal joins. High heels [worn] for years can tighten calf muscles. Ankle sprain can occur when the foot is in excessive inversion, and this position is promoted with high heels.”

Back issues can also arise because as you pitch yourself forward, you change the pressure dispersion on your feet, explains Kitchener, Ont.-based pedorthist Jennifer Krulicki.

“The purpose of the foot is to provide a stable base of support and aid in impact of absorption, so if you alter the mechanics of that in a pair of heels, obviously you’re going to change how it works and there can be injuries related to that…. By changing the centre of pressure, you’re forced to contract muscles to stand upright that aren’t used that often, depending on joint mechanics. That can cause back problems, and strain on those muscles can create fatigue, soreness, and achiness.”

Improper shoe shape or fit can also result in pain because of rubbing on the toes. (Although many people say shoes can cause bunions, she says the deformity is due to genetic factors.)

So what are heel-wearing women to do when it comes to staying stylish and sexy without messing up their bodies for good?

Krulicki, who loves heels herself, is a big fan of Cubans, which have a wider heel base than most.

“Heel design is huge,” she says. “The more narrow it is, the less support you have. Shoes with a broader heel base like a Cuban have better support.”

Not surprisingly, the higher the heel, the greater the potential for sprains, strains, and other damage.

“If you’re pitched further forward, there’s going to be more load in the toes and less in the heels,” Krulicki says. “Some heels have a little platform under the ball of foot. So it may still be a three-inch heel, but with an inch under your ball that significantly changes the height differential and gives more of a base of support. It’s still narrow, but there is a little more cushioning for some people.”

Be careful with flats, though; in some cases, they can actually just as bad as a high heels, Sabbagh says.

“If you’re used to wearing high heels, wear lower heels,” he says. “Flat shoes or negative soles where the heel is lower than the forefoot can be equally damaging. Avoid flat shoes when you have tight calf muscles as this will put of stress on your knees.

“Some heel—18 to 25 millimetres—is recommended for heel pain, things like plantar fasciitis and heel spur.”

Shoe shape plays an big role in comfort and injury prevention. Be sure to seek out the right “toe box” to accommodate the shape of your foot.

“If you have a square foot, you don’t want a pointed shoe,” Krulicki says. “Don’t force yourself into a pointed, narrow fit. Be sure to find a shoe that accommodates the width you need.

“If you have longer second or third toes, you need a little bit more length,” she notes. “Round and stubby shoes are not so good. If you have a triangle foot—a narrow heel and wide forefoot—it can be difficult to find heels that fit. Higher-end shoe companies have leather that’s soft or stretchy, and that can help contour so there’s nothing pinching across [the front of the foot].”

Other advice?

Take breaks. Take a pair a flats with you and change in and out of your heels so that you’re not wearing them for excessive periods.

If you’re feeling pain, Kulicki suggests seeking help from a health professional like an osteopath, massage therapist, or chiropractor. And remember that orthotics are no longer for the elderly; the devices can be made for all kinds of shoes, including the type of wedges that had Lochner in that walking cast.

“I still wear them, but I now wear any heels with caution,” Lochner says. “I will only put high heels on at last minute and carry flats that I can actually walk in if I have to go any distance. I also don’t drive in heels anymore. Your foot can fall off the pedal and I don’t find it safe enough.”