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The High Toll of High Heels

Heels may be glamorous, but they exact a huge toll on the health of your feet.
 
 
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Editor's Note:The following is an excerpt from Bad Shoes & the Women Who Love Them (Seven Stories Press) written by Leora Tanenbaum and illustrated by Vanessa Davis.

Shoes have the power to transform an outfit from the mundane to the magical. High-heeled shoes give the illusion of elongating the legs, which is slimming. And shoes are relatively easy to shop for; you don’t have to enter a dressing room and disrobe. For many women, myself included, that fact alone makes shoe shopping particularly alluring. So what if my toes squish just a little to fit, or if I get some cuts and bruises? Isn’t that the price of being a woman?

I don’t enjoy being the messenger of bad news, ladies, but you should be aware that your most fashionable high-heeled shoes, no matter how chic and status-laden, harm your feet. And it is not only high heels we need to consider. Flip-flops and ballet flats can be just as harmful as heels. Since the gladiator sandal trend rose up, sphinx-like, there have been lots of ankles encased in complicated straps and buckles. Don’t be fooled. Pancake-flat shoes without arch support can make a woman feel like she’s been fighting all day long in a Roman amphitheater.

But don’t worry. There are still myriad captivating shoes out there that you can wear comfortably, safely, and femininely. By the time you finish reading this book, you will know all the tricks to look enchanting without suffering. You don’t have to give up your fancy shoes, but you do need to be smart about wearing them.

It’s okay to wear stilettos for a few hours once or twice a week at a party, date, or special event. I am not telling you to haul a bag filled with all your heels to the Salvation Army. Even if I did, you wouldn’t listen. So keep your heels. But know this: it is foolish to wear them when you will be walking or standing for long periods of time, and it is downright dim-witted to wear them all day, every day, for years on end. If you choose to ignore these warnings, the day will come -- maybe next year, perhaps in five or ten -- when you will wake up in pain. You will look back at your years of bad decisions and wonder: “My god, what have I done?”

In Sex and the City, Carrie and her friends pound the Manhattan pavement in stilettos very similar to the offerings at Saks -- shoes with itty-bitty toe boxes, zero arch support, inhumanly narrow foot beds, and a slope that forces feet forward so that you have no choice but to walk on the balls of your feet. For me, the mystery is not if they live happily ever after but whether or not they develop bunions (when the big toe shifts angle, pointing toward the little toes instead of straight forward) and hammertoes (when toes curl down), among other nasty afflictions.

Many of us recoil from the sight of orthopedic shoes because they are sexless, devoid of any style, and instantly add years to the wearer. But guess what? By wearing shoes you associate with sex appeal and youth, you are actually uglifying your feet. It is paradoxical but true: in the pursuit of beauty, you are creating ugliness.

Every spring, when the temperature rises and children gleefully run out to parks and pools, millions of women look down and groan. They notice that their toes are misshapen; ugly corns have sprouted, and hey, what is that hideous bony protrusion on the base of the big toe? Instead of enjoying the freedom of sandals, many women cover up their feet with embarrassment. According to a 2008 American Podiatric Medical Association (APMA) study, more than 50 percent of women say their feet embarrass them “always, frequently or sometimes.”

“It is generally agreed that if you wore women’s fashion high-heeled shoes with the narrow pointed toe box for up to ten years, you will end up with common foot deformities that are a direct result of the shoe,” says Dr. Carol Frey, a leading researcher on the hazards of fashionable shoes on women’s feet as well as an orthopedic surgeon in Manhattan Beach, California, and a clinical professor of orthopedic surgery at University of California–Los Angeles. “These conditions include bunions, bunionettes, pinched nerves, ingrown toenails, corns, and calluses.”

Furthermore, many women fall so in love with a shoe style that they will buy and wear it even if it’s too small. “Around eight years ago,” one woman confides, “I had been eyeing a pair of Prada platform high heels with a zebra print and a hot pink bow on the front. They were insanely expensive and I couldn’t justify spending that kind of money. Then they went on sale but only in a half size too small for me. So I bought them and squeezed my feet into them. They hurt but I wore them. I knew it was a bad idea, but I got so many compliments.”

Often the shoe size technically is correct for a particular woman, but the style of shoe does not fit her feet properly because the shape of the shoe is unnatural. But that doesn’t stop her. “I wore a pair of shoes the other day that were the right size but killed my feet,” another shoe lover relates. “I wore them anyway, knowing that by the end of the day I would be in excruciating pain. The heels were around three inches and I walked around in them all day. They matched my dress perfectly. They are tweedy, grey and black, with a silk grosgrain ribbon. I will probably wear them again because they go so well with this dress.”

Most women’s fashionable shoes are shaped differently from women’s unfettered, naked feet. Feet tend to be wider in front than at the heel, and toes do not naturally scrunch up to resemble the point of an arrow. Like most women, you probably have had no idea that wearing shoes with a shape that deviates from the shape of your feet is a recipe for disaster. After all, it’s perfectly fine to squeeze your fanny into tight jeans: the worst that will happen is the sprouting of “muffin tops” above your waistband. You can change into a different pair of jeans, the muffin tops will disappear, and you can breathe again. Phew! But shoes are not jeans and feet are not love handles. Says New York City podiatric surgeon Johanna Youner, “If you continue to wear a high heel, you will mold your feet into what a high heel looks like, but that is not what a foot is supposed to look like.”

When it comes to fashion for feet, we must remember that bones, tendons, muscles, and ligaments are involved. The pressure of your body landing on your feet with each step is enormous. “Bottom line, the foot’s primary responsibility is to be a shock absorber to the body’s superstructure,” emphasizes Dr. Rock Positano, director of the Non-surgical Foot and Ankle Service at the Hospital for Special Surgery in New York City, and the foot and ankle consultant to the New York Mets and New York Giants.

Men and women alike need to take care of their feet to prevent problems, but women in particular need to wake up and smell the nail polish. According to a 2009 study by the APMA, far more women than men -- a whopping 87 percent versus 68 percent -- suffer because of painful footwear. Because of cultural expectations of femininity, only women feel pressured to endure pain on a regular basis. Only women are conditioned to believe that chronic pain is normal and the price of being considered attractive.

Women far outnumber men as foot surgery patients. A staggering 94 percent of all bunion surgeries are performed on women. Women also disproportionately go under the knife to correct hammertoes (81 percent), neuromas (89 percent), and bunionettes (90 percent).

My belief is that if a woman knows full well that wearing her favorite shoes may lead to hammertoes and bunions, and she makes this choice with informed consent, that is her decision. However, most women are not informed and therefore put their feet at risk for the sake of fashion and beauty without even realizing what they are doing.

In all seriousness, I suggest that pointy-toed, high-heeled shoes come with a warning printed on the shoe box, just as with cigarettes: “These shoes are a health hazard. Wearing them for prolonged periods on a regular basis may lead to deformity, pain, and ugly feet. Your Achilles tendons may shorten, making it impossible to wear flats even if you want to. Wear with caution.”

Many people mistakenly believe that the way celebrities live is attainable for the rest of us. But stars are not like us, even if paparazzi capture them at the market buying the same cereal we eat. Too many otherwise sensible women foolishly deduce that since Susan Sarandon gave birth at forty-six and Geena Davis at forty-eight, they too will be able to conceive beyond their peak reproductive years. Just because we see celebrities in stilettos on red carpets at award shows and premieres does not mean that the rest of us can or should wear the same shoes on a regular basis.

Today there is an urgent need to educate women to make smart footwear choices because of two current trends.

First, today many women consider extremely high heels to be an indispensable part of their wardrobe, and they don’t just save these shoes for special occasions; they wear them all day, every day. High heels worn to work and around town are nothing new, of course, but now dizzying heights are taken for granted as “normal.” In previous years, a three-and-a-half-inch heel was ooh la la. Now that height is categorized as “medium height” and women feel pressured to go as high as five inches.

When I visited the Jimmy Choo boutique on Madison Avenue in Manhattan, I picked up a pair of slingbacks with obscenely high heels (and no platform) and turned to the saleswoman. “Over five inches,” she reported. “Can you walk in these?” I asked her. “I can’t,” she said. Another pair on display had a three-and-a-half-inch heel. “That’s the medium-height heel,” the saleswoman told me, without a trace of irony. “That one people can walk in.”

Actually, even the three-and-a-half-inch heel is painful for many and treacherous for most. Yet this heel height is dismissed as child’s play. The June 2009 “What’s In, What’s Out” page in Harper’s Bazaar says it all: “In: Sky-high stilettos. Out: Mid-height pumps.”

The new five-inch norm has been manufactured in large part by Christian Louboutin, the designer of signature red-soled shoes, currently favored by red-carpet celebrities. Few fashionistas know the pronunciation of his name, but that doesn’t stop them from wearing his pornography-inspired stilts. (For the record, the correct way is KRIST-yen Lu-bu-TEN, with soft Frenchy “n”s). When I visited his Madison Avenue boutique, some of the heels were -- I am not making this up -- over six inches high. I couldn’t decide which was more obscene: the height or the price. Marked down on sale, most of the styles were being sold for $657 (from $1,095).

What I find most surprising about the trend to go higher and higher is that it flies in the face of common sense after September 11, 2001. Among other horrible images from that day, I vividly remember the women in downtown Manhattan who had worn heels to the office. In desperation, they took off their shoes and fled barefoot. This extreme case exposes the impractical reality of many women’s shoes. Aren’t shoes supposed to offer mobility, or at least not inhibit it?

I asked the question of Elizabeth Semmelhack, chief curator of the Bata Shoe Museum in Toronto and author of Heights of Fashion: A History of the Elevated Shoe. She also finds the trend counterintuitive. In 2001, Semmelhack had just completed a timeline charting the history of the high heel through the centuries. “The last shoe I put in was from Tom Ford. It was very fetishy with a very high heel. Then September 11 happened. Women were quoted saying that they would never wear heels again. I wondered what the next shoe would be on the timeline. I was fully expecting a flat. But there was no hiccup at all! There was not a moment in which women embraced a common-sense approach to footwear. It never happened.”

Another trend is the widespread enthusiasm for flip-flops. Over the last decade, flip-flops have become a staple in the wardrobes of women, men, children, and adolescents. Even high-end designers such as Chanel and Manolo Blahnik manufacture them. It is estimated that 220 million pairs costing more than fifteen dollars (in other words, excluding the rubber pairs sold in drugstores) are sold each year.

Many women turn to flip-flops because their feet hurt after hours in heels. They mistakenly believe that flip-flops are like medicine to soothe their aching feet. They could not be more wrong. The lack of support in this type of sandal causes the foot to move and roll, leading to multiple injuries and problems, such as the painful heel condition called plantar fasciitis. Since flip-flops remain fashionable and trendy -- with millions choosing to wear them when walking and even bicycling -- it is critical that women be educated about the damage they are doing to their feet. Flip-flops belong at the beach or pool, and for a half-hour after a woman paints her toenails and isn’t going anywhere anyway -- and that’s it.

LEORA TANENBAUM is the author of Slut! Growing Up Female With a Bad Reputation, Catfight: Rivalries Among Women—From Diets to Dating, From the Boardroom to the Delivery Room, and Taking Back God: American Women Rising Up for Religious Equality. She is a blogger for the Huffington Post. She has appeared on Oprah, The Today Show, Inside Edition, The O’Reilly Factor, Politically Incorrect, and other programs. Tanenbaum lectures widely at venues including the Commonwealth Club in San Francisco, the 92nd Street Y in New York City, and campuses such as Stanford, Columbia, Duke, University of Michigan, and Spelman College. She lives in New York City with her husband and two sons.
 
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