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Well-Heeled Now, Hobbled Later

Blame High Heels: More Women Than Men Have Surgery for Bunions and Other Painful Foot Ailments


Doctors have determined that high heels can be hazardous to your health.

For several years, foot surgeons have been warning women that wearing shoes with high heels and narrow toes can lead to painful and often-permanent foot deformities. Now, a study has found the first evidence that high-heeled shoes may also contribute to knee arthritis in women.

Meanwhile, a group of surgeons took their pro-foot campaign a step further, announcing results of extensive tests of comfort, fit and flexibility that were performed on 11 shoe styles they found to be the most popular among working women.

The group, the American Orthopaedic Foot and Ankle Society, awarded a seal of approval, similar to the American Dental Assn. seal that often appears on tubes of toothpaste, to four styles that passed all the tests. They're not revealing which shoes failed.

"We're not trying to identify bad shoes," said Cherise Dyal, an assistant professor of orthopedic surgery at New York's Albert Einstein College of Medicine. "Our goal is to educate women on how to buy shoes appropriately . . . to prevent problems and pain."

For many women, painful and misshapen feet are the ultimate cost of a long-term love affair with high-heeled shoes. In the United States, women visit orthopedic surgeons for foot problems four times as often as men, and they undergo about 87% of operations performed to correct acquired foot deformities, such as bunions and hammer toes. In societies where people go barefoot or wear flat sandals, acquired foot deformities in adults are rare, and their frequency is the same in both sexes.

The deformities that often develop after years of wearing high-fashion pumps are similar to foot problems that had been seen in Chinese women whose feet were bound by their parents, said Michael J. Coughlin, a clinical professor of orthopedics at Oregon Health Sciences University who practices in Boise, Idaho.

When the feet of such Chinese women were X-rayed, "the deformities were not in the bones at all. They're just in the joint," Coughlin said. "Women of today . . . are achieving the same thing. They're causing these joint deformities by binding their feet in constricting footwear."


Problems tend to develop in the front half of the foot (the forefoot) and include bunions, hammertoes or claw toes, and bunionettes, conditions common in middle-aged and older women that often require corrective surgery.

A bunion is a bump or enlargement on the inner side of the foot, at the base of the big toe. A bunionette is a similar enlargement on the outer side, at the base of the smallest toe. Hammertoes and claw toes are deformities in which the toe curls and its joints protrude upward, often rubbing against a shoe and causing painful corns.

Foot structure, heredity and the elasticity of ligaments can predispose some people to such deformities. But narrow, pointed shoes and high heels also contribute, by compressing the toes and increasing force on the forefoot during standing and walking. With a 3 1/4-inch heel, pressure on the forefoot is more than seven times greater than with a flat shoe.

Coughlin analyzed 3,000 surgeries for forefoot deformities performed in his Boise practice during a 15-year period and found that 87% were done on women's feet. Women had 94% of the bunion surgeries, 90% of bunionette surgeries, 81% of hammertoe surgeries, and 89% of surgeries for neuromas, a painful thickening of a nerve that runs between two toes.

Surgery can improve such foot deformities but usually can't restore the foot completely to normal, said Michael W. Bowman, a foot and ankle surgeon who is chairman of the AOFAS Orthosis and Footwear Committee. "I tell patients up front, 'You can't expect to have surgery and go back and wear this type of shoe,' " he said.

In addition to choosing unhealthy shoe styles, women frequently buy shoes that are too narrow for their feet, according to a 1993 survey by the AOFAS.

Of 356 women who responded to the survey and had their feet measured, 88% were wearing shoes that were too narrow, by an average of one-half inch. Most women's feet are between 3 1/4 inches and 3 3/4 inches wide, Coughlin said, but fashion shoes are usually only 3 inches wide.


New evidence, published in May in the British medical journal the Lancet, suggests that high heels are also bad for women's knees. D. Casey Kerrigan, an assistant professor at Harvard Medical School who specializes in physical medicine and rehabilitation, used special laboratory equipment to analyze the forces that were generated in the knees of 20 healthy women while walking in high-heeled shoes. The research subjects, whose average age was 35, habitually wore high heels.

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