By Donald E. Casebolt, M.D.
A bit of an explanation is in order. Even before I went to medical school I was interested in preventive medicine. Although I have appreciated the privilege of helping people with their diseases and injuries I am more excited about preventing disease.
For many years I have had an sense of uneasiness about the pointed toes and high heels that some women wore. But it was not until 1998 when I read two journal articles that I understood the magnitude of the problem. Here are quotes from those two articles: "Blame it on those stiletto heels. Women have about 90 percent of the 795,000 annual surgeries for bunions, hammertoes, neuromas, and bunionettes, reports the American Othorpaedic Foot and Ankle Society. A three-inch heel, while possibly quite fashionable, creates seven times as much stress on the forefoot as a one-inch heel." (1) "Few conditions are as common or debilitating as foot pain. It affects one in six people in the U.S. today....The shoe has been called the enemy of the human foot; that is often the case with athletic shoes and almost universally true of women's footwear whose designers invariably ignore the dictum that form should follow function. From their high heels to their sharp, pointed toes, women's shoes are notorious for causing discomfort and downright injury." (2) See also (3)
However within the last month I had begun to wonder if high heels might contribute to backache. So when the head of the Chronic Pain Clinic at the University of New Mexico gave a talk on Comprehensive Pain Management at our local hospital on June 26, 09 I asked her if she thought high heels might contribute to chronic back pain. She thought it was quite possible.
With that in mind in the last two weeks I have spent several hours reviewing the medical literature via Pub Med on the Internet. The findings have been interesting, and for me, surprising, and troubling. Those findings will be detailed as follows:
1. In an article that comes not from a medical institution but from the law school at the University of Iowa it states: "For 250 years medical scientists have propagandized about the health hazards of high-heeled shoes, which originated four centuries ago...This article describes the history of the medical profession's recognition of this worldwide health problem and the current understanding of the deleterious and often irreversible biomechanical effects of high-heeled shoewear" The authors urged the need for up-to-date full-scale epidemiological studies in order to bring about substantial social-behavior change. (4)
2. The wearing of high heel shoes has a significant negative effect on postural control in women. (5)
3. "Osteoarthritis of the knee is twice as common in women as in men." The wearing of high heels significantly increases the torque (forces about the leg joints) and may predispose to osteoarthritis of the knee. (6)
4. "Larger muscle movements and increased work occur at the hip and knee" in people wearing high-heeled shoes and could lead to pain in the hip and knees later on. (7)
5. "Even shoes with moderately high heels (1 1/2 in.) significantly increase knee torque thought to be relevant in the development of and/or progression of knee OA( osteoarthritis)" (8)
6. "Among the contributing factors for back pain, the relationship between wearing high heels, heavy lifting, and back pain was significant statistically." (9)
7. Women who habitually wear high wear high heels can develop hyperlordosis ( an accentuation of the normal curvature) of the lumbar spine (the low back). This can affect low back pain. (10,11) Some people think that it can cause low back pain.
8."The use of high-heeled shoes increases muscular effort during walking and diminishes the leg venous pressure compared with barefooted" (12)
If someone wants to google bunions and click on the Mayo Clinic website they will find high heels at the top of the list as the cause of bunions.
So we see that a number of carefully done studies show that high heels significantly alter the body's mechanics. Besides playing a role in causing bunions and plantar calluses (painful calluses on the bottom of the feet) they increase the workload at the knee and the hip and alter the curvature of the lumbar spine.
At this point no one knows for sure how much one has to wear high heels to cause these problems. My wife only wore high heels for dress occasions and yet at the age of 28 she had to have surgery on both sides of both feet for bunions. She could have been one of those who had an inherited tendency for bunions. It appears that not everyone who wears high heels will get any of these problems. Not everyone who smokes gets lung cancer. But everyone who smokes or uses tobacco pays some kind of a price for doing that. I personally suspect that the same thing is true with the wearing of tight footwear or high-heeled shoes.
Did the Lord reveal anything to Sister White in regard to footwear. She never mentioned high-heeled shoes but here is what she did write: "If the feet are clothed with good-sized, thick-soled, warm boots or shoes, for comfort rather than for fashion." {HR, April 1, 1871 par. 1}and "The shoes should be thick-soled, and perfectly comfortable." {RH, January 9, 1900 par. 7}
One article suggested that the proper foot wear for women would be "a low heel, a round toe, and a cushioned sole." (13 ) Of course open toed shoes would help alleviate some of the problems.
Perhaps the government should require a statement on every box containing poor footwear saying, "Beware. The wearing of these shoes could cause permanent damage to your health."
Someone may ask why I have chosen to publish this information at this time. For one reason I did not realize until the last two weeks the serious problems that could arise. For another reason,quite frankly, it hurts me to see anyone suffer illnesses unnecessarily whether they have gotten sick because of their own choice such as smoking or because they have ignorantly followed the dictates of fashion. Another reason is that I am concerned about the example for children and young ladies. My wish for everybody is like the apostle John when he wrote, "Beloved, I wish above all things that thou mayest prosper and be in health." 3 John 2
It is my conviction that information of this kind should be furnished in all the schools beginning with about the age of 10 and continuing down through high school. As a final note for this paper, since high heels can significantly affect a person's health I wonder if this quote from Sr. White may be applicable to this issue
"It is a terrible sin to abuse the health that God has given us; for every abuse of health enfeebles us for life and makes us losers, even if we gain any amount of education." {3T 150.2}
References: 1)American Family Physician 1998 57:620 2)Emergency Medicine May 1998 , p.72 3)Clin Orthop Relat Res 2000 372: 32 4)Int J Health Serv 1998 28:201 5) Conf Proc IEEE Med Biol Soc 2005
3: 2761 6) Lancet 1998 351: 1399 7) J Am Podiatr Med Assoc 2003 93: 27 8)Arch Phys Med Rehabil
2005 86: 871 9)Int J Nurs Stud 2004 41:67 10) J Orthop Sports Phys Ther 1995 21: 94 11) Spine
1988 13: 542 12) Angiology 2006 57: 424 13) Instr Course Lect 1995 44: 379
