Our Doctors

Noreen Noelle Oswell, DPM

In The News

On Your Toes
Stilettos may look sexy, but podiatrists say the damage they can do to your feet is ugly.

By Barbara Kantrowitz and Pat Wingert
Newsweek

Nov. 29, 2005 - A few weeks ago, formerly fat actress Kirstie Alley kicked up her heels on "The Oprah Winfrey Show" in a demonstration of her weight-loss secret: dancing in stilettos. "You never see a stripper in flip-flops," she said. "Flat-footed doesn"t make you feel sexy."

The studio audience loved it (and so did we, to be honest) but foot doctors were less enthusiastic. "All that weight on stilettos," muses Dr. Noreen Oswell, clinic chief of podiatry at Cedars-Sinai Medical Center in Los Angeles. "The bigger you are, probably the less coordinated and less agile you"re going to be, and the more likely you are to fall over."

Although Alley stayed upright, working out in heels probably isn"t an idea that"s going to catch on with many of us. But killer heels like hers have become a mainstay of every would-be fashionista"s closet since Sarah Jessica Parker started skipping so fetchingly down the sidewalks of Manhattan in her Manolo Blahniks on "Sex and the City." And killer is the operative word here. In the last few years, podiatrists around the country have been doing a good business trying to repair the considerable damage wrought by shoes that have only a tangential relationship to the actual structure of the female foot.

Let"s start with the toes. Squeezing them into pointy prisons exacerbates deformities like bunions (an enlargement of the joint at the base of the big toe) and hammertoes (a contraction of the toe that makes it look like an upside-down V), says Dr. Zachary Chattler, a podiatric surgeon and instructor in the department of orthopedics at Johns Hopkins Medical School. If your toenails are turning a yucky color, you could have a nail fungus aggravated by too-tight shoes, Chattler adds. The higher the heel, the more pressure on your foot and that can lead to a neuroma, a pinched nerve that causes pain in the ball of the foot and a tingling in the toes. Your soles suffer as well. The fat pads underneath your toes begin to thin as you age and wearing high heels accelerates that process, which means you"ll feel more pain when you"re walking or even standing.

Long-time high-heel wearers are at higher risk for bursitis, capsulitis and arthritis (all conditions that cause pain, swelling or inflammation around joints). Heels also strain tendons, which can lead to pain and inflammation. Many of Chattler"s female patients are surprised to find they can"t wear sneakers after years of wearing heels. "I try to explain to them that the high heels have contracted their Achilles tendon so much that they can"t get their feet flat down on the ground any more," he says. Bone spurs aggravated by shoes can also form at the back of your heel. That"s called a "Haglund Deformity" or "pump bump," Chattler says.

All of these problems get worse as women age. Oswell, a spokeswoman for the American Podiatric Medical Association (APMA), says one study found that older women who have knee surgery are more likely to have worn heels all their lives. "Their knees end up being shock absorbers," she says. "Your foot is supposed to absorb some of the shock of walking but if your foot is in a certain position, it can"t do it and the shock travels up your leg." With more and more younger women spending so much time in heels, they"re likely to suffer from arthritis and to seek knee surgery earlier, Oswell says.

Have we scared you enough? Probably not. Most women know heels aren"t really good for their feet, yet few are willing to give them up because, like Alley, they think they"re sexy. A recent APMA survey found that 82 percent of women polled were willing to sacrifice comfort in order to be chic. Some women even seek surgery--cutting off part of a toe bone, for example--to fit into fashionable shoes, a practice that"s certainly not encouraged by many doctors. "We in the West would be the first to look back at the Chinese and the foot binding and say, "My God, how archaic, how barbaric, how primitive,"" says Chattler. "And yet women today are really binding their own feet."

We"re not going to tell you to throw out your heels, just to make a few changes in how you buy and wear them. To make sure you"re getting the right size, ask to be measured while standing at the shoe store. The size you wore 10 years ago is irrelevant, Chattler says, because feet get bigger as you get older (it"s wear and tear on the joints and a general loss of elasticity). Always buy shoes late in the day because feet swell. If they fit snugly in the morning, you might have blisters by evening. Try on both shoes and walk around the store; one foot is usually bigger than the other so you should buy shoes that fit the larger one.

Chattler suggests sticking to heels that are no more than an inch-and-a-half high. Look for a more rounded or square toe box. Shoes that fit well should have wriggle room for your toes. Give your feet a break by wearing more comfortable flats to and from work. Carry higher heels in a tote bag and wait until you"re in the office to slip them on. Reserve the stilettos for really special occasions and then treat your feet kindly before and after by wearing supportive flats. Padded inserts in the front of the shoe help reduce pressure on the ball of the foot. Heavier women should also be extra cautious when wearing higher heels.

"The heavier you are, the more problems you"ll experience," says Oswell. "The negative effects are cumulative."

If you love Mary Janes, go for it. Ankle straps can make shoes a little safer, says Oswell. "The more things you have helping you keep the shoe on the foot, the better," she says. Shoes with a strap at mid-foot mean you don"t have to grip so hard to keep them on your feet. If you"re gripping, you"re more likely to get blisters, foot fatigue and arch pain, says Oswell. As you might expect, Oswell is not a fan of backless slides which, she says, can easily slip off if you"re not constantly tensing your feet to keep them on.

Instead of Manolos or Jimmy Choos, check out the burgeoning number of comfort-shoe brands like Naturalizer, Easy Spirit, Aerosoles or Taryn Rose. They"re easy to wear and won"t break your budget. Even higher-end manufacturers like Cole Haan offer extra cushioning in some styles. Customers for these shoes have been getting younger in recent years, perhaps an indication of healthier feet in the future. Now, that"s a real reason to dance!