High Heels - Dangerous to Your Health
Foot problems? It is estimated that 43 million people in the United States have them; but only fifteen million of them eventually seek medical help.
By Liliane Balbach
Studies of unshod natives in Africa show relatively few foot problems and no foot deformities in women.1
What price are you willing to pay for being fashionable? Bunions, calluses, nerve irritations, ankle injuries, back, leg, and neck problems? In extreme cases, surgery? That is the price many women are paying for high-fashion footwear according to the American Physical Therapy Association (APTA). 2
Women have the most foot surgeries Dr. Michael Coughlin, an orthopedic surgeon, reviewed his surgical procedures to correct forefoot abnormalities over a 15-year period and found that 87% of the procedures were done on women's feet. Foot abnormalities in women peaked in the fourth, fifth, and sixth decades of life. A study of 23,000 men found that only 4% had forefoot deformities. 3
Another orthopedic surgeon states that from his 800 patients, who underwent surgeries for bunions, 94% were women. Of his 850 hammer toe surgeries, 80% were done on women. 4
In 1993, the American Orthopedic Foot and Ankle Society (AOFAS) evaluated 356 healthy women to determine their shoe wearing habits. Eighty per cent of the women surveyed complained of foot pain and deformity.
Some 88% of the women were wearing shoes that were about 1/2 inch too narrow for their feet. 5
Is it not obvious why so many women have foot problems? Almost nine out of ten women wear shoes that are too narrow or too small. Another problem is that women's shoes are not designed to fit the anatomy of their feet but rather the changing fashions of time. Men's shoes are designed to conform to the outer dimensions of the foot without causing it to compress or constrict. Women's typical, high fashion shoes, on the other hand, do not conform to the dimension of the foot. They often have a triangular toe box that constricts the normal rectangular dimensions of the forefoot.
Problems with high-heeled footwear
What's wrong with high heels? Higher heels increase the pressure on the forefoot. How much pressure is put on the forefoot by high-heeled shoes? Compared with no heel, forefoot pressure increases by 22% for 3/4-inch heel, 57% for a 2-inch heel, and 76% for a 3 l/4-inch heel. 6
Deformities associated with high heels include potential for pain, callus, bunions, corns, hammer toes, and neuroma. Neuroma is a painful condition that develops from the pressure of high heels pinching the nerves between the bones of the feet as the weight is shifted to the front of the foot. Although some cases of neuroma can be eliminated with physical therapy, others require cortisone shots or surgery.
Women who spend too many hours in heels more than 1 1/2 inches high are courting painful foot, leg, and back problems warned Maureen Wilhelm, a physical therapist and director of Sports Training and Physical Therapy in Livingston, NJ. The higher the heel, the more the body is forced into a posture that curves the spine and puts more stress on the back and neck, explained Wilhelm. 7
High heels also tend to shorten the muscles and ligaments in the back of the legs. Wearing high heels for more than six months may cause the calf muscle to become shortened all the time. The body compensates for this tightness in the calf muscle by lowering the arch of the foot or affecting the knee, hip or back.
In 1998, Dr. C. Casey Kerrigan and her team from Harvard Medical School linked high heels to knee osteoarthritis. This painful, degenerative joint disease is characterized by the breakdown of the cartilage around the knee. This problem was caused by the very thin, stiletto heels. A later study looked at the chunkier heels now in fashion. The results revealed that wide heels increase the risk of developing osteoarthritis in the knees as much or more than the spindly-heeled stilettos. What is Dr. Kerrigan's recommendation in light of this evidence? She says: “It takes a long time to feel the effects of knee osteoarthritis, and once you do, it's too late.” She concludes that low-heeled shoes or no heels are a woman's best choice against osteoarthritis. 8
Reasons for Wearing High Heels
Why do women wear high heels? High heels tend to make the foot appear smaller by positioning it more vertically. They also constrict the widest part of the forefoot up to an inch, making it appear narrower. Some women who wear high heels feel that high heeled shoes enhance their figure and give the illusion that they are slimmer. High heels change the gait and posture causing the hips to sway more which some find sexually attractive. Many working women wear high heeled shoes because they feel it is part of their business attire.
Height commands respect and projects an image of being in control. Some women feel this is important as they compete against the usually taller men.
Guidelines for buying shoes that fit
It is difficult to find shoes that fit women's feet because while the average foot is 3.66 inches wide at its broadest point, women's shoes are usually 3 inches wide. According to a survey by the AOFAS, foot widths in women can range anywhere from 3–4.5 inches. The following guidelines are given by the AOFAS:
- 1 Recognize that your forefoot spreads with age, and that you cannot wear the same shoe size as when you were in your twenties.
- Measure the width of your foot. While you are standing barefoot with your full weight on a piece of paper, have someone draw the outline of your foot. Measure the outline at the widest point. Always ask the sales clerk, if they have a “wide width” shoe.
Finally the shoe industry is beginning to listen to the medical community, and not only to the fashion shoe designers. More stores are carrying “wide width” shoes. Many companies sell wide shoes on the web.
- Measure the soles of your shoes. Ideally they should be as wide as your feet.
- The length of your shoe should be half an inch longer than the measure from the heel to your longest toe. Few people realize that their feet grow over the years. While the heel stays the same, the front of the foot becomes wider and longer.
“Shall we refuse to be puppets of the fashion industry?”
- Have both feet measured before buying shoes. Two out of three people have one foot significantly bigger than the other. Buy shoes to fit the largest foot.
- Shop at the end of the day when your foot swells to its biggest size. Remember that comfort and fit depend not only on the length and width, but also on the height of the toe box.
- High-heeled shoes increase the pressure on the front of the foot by at least 50%. AOFAS recommends that you wear high-heeled shoes only on special occasions.
We say: If high-heeled shoes contribute to so many health problems, why even bother wearing them?
- Choose round toe boxes and soft material over pointed toes and patent leather.
- If you can't wiggle your toes in your new shoes, do not buy them.
- Do not buy shoes that are small, planning to “break in” or make the leather to stretch. The tight shoe will deform your foot before you have a chance to “break it in.”
In most Western countries, boys and girls are involved in choosing their own shoes as young as 5 years old. Although most of them wear sneakers, by the time girls get to be twelve years of age, 15% are already wearing heels.
By age fourteen, 30% of them are wearing high heels. The consequences of introducing heels at such a young age increases the risk of deformity over time.
As consumers, we can influence shoe manufacturers by refusing to purchase unhealthful, ill-fitting shoes for ourselves and our children.
A marvelous design of our Creator
Twenty-six jewel-like chips of ivory make up the bony structure of our foot. Our Creator designed each little bone to last as long as we shall live. Most of us will walk about 65,000 miles, or two and a half times around the world, during our lifetime. According to our Creator's design, our body weight is evenly spread through architecturally perfect arches which function as springs. How do you think He feels when we squeeze our foot into high fashion, pointed shoes and deform the body He has created?
How does He feel when we follow the fashion industry in the selection of our footwear instead of our Master Designer and Creator? As we study the anatomy and physiology of this beautiful body, given by our Creator, we are ashamed to realize that some of us take better care of our cars and tires than of our bodies and our feet. We cannot go to a store and buy a spare set of feet. When we say with David: “I will praise thee; for I am fearfully and wonderfully made” (Psalm 139:14), do we realize what we are really saying? We are acknowledging God to be the Master Designer of our bodies and thank Him for the wisdom and beauty of that design. When we do anything to modify or squeeze any part of our body, we are trying to improve on the original design of our Creator.
Do you know that the prophet Isaiah foresaw the coming of high-heeled fashionable footwear in our society? “Moreover the Lord saith, Because the daughters of Zion are haughty, and walk with stretched forth necks and wanton eyes, walking and mincing as they go, and making a tinkling with their feet: Therefore the Lord will smite with a scab the crown of the head of the daughters of Zion” (Isaiah 3:16, 17).
Why does the Bible condemn high heels? Obviously, for all the health reasons mentioned above. There is, however, an additional reason which relates to the immorality of our age. Fashion experts acknowledge that high heels help to enhance a woman's sexual appeal by emphasizing certain parts of her body. Shall we refuse to be puppets of the fashion industry?
Make a choice
Several years ago, I attended a series of lectures by an orthopedic surgeon. He discussed the foot problems of his female patients who wore narrow and high-heeled shoes. After looking at several hundred slides of foot surgeries and deformed feet that were a direct result of improper shoe-wear, I determined never to buy another narrow, high-heeled pair of shoes again. Coming home, I evaluated all my shoes and threw out all those that did not meet the above recommendations. This was a painful process as I thought of how I had grieved my Saviour and paid money to deform the feet my Creator had given me. You also may have been unaware of the health and moral consequences of wearing high-heeled shoes. If you are still struggling in light of the evidence, go to Calvary. Look at our Saviour nailed on the cross. Blood flowed freely from His forehead, His side, and from those precious feet. He suffered much so He could save us. All He asks us is a surrendered heart. Why not ask Him to give you the strength to do what is right? “It is God that girdeth me with strength, and maketh my way perfect. He maketh my feet like hinds' feet, and setteth me upon my high places” (Psalm 18:32, 33).
1 Coughlin M.J. J. Musculoskel med. 1994;
2 Berkeley Wellness Letter, August 1994; 10(11).
4 Berkeley Wellness Letter.
5 Frey C ,Thompson F. et al. Foot Ankle 1993;
7 Whitlow, J. Star-Ledger; August 23, 1995,
8 The Lancet, April 7, 2001.
9 Clark, M.V., Presentation at the Annual
Meeting of American Academy of Orthopedic
Surgeons, 1994, New Orleans, LA.