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The High Toll of High Heels 

Know what you’re getting your feet into

click to enlarge heels.jpg

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 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 10 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, Calif., and a clinical professor of orthopedic surgery at the University of California, Los Angeles. The foot deformities, Frey says, “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, the muffin tops disappear, and you can breathe. Phew! But shoes are not jeans and feet are not love handles. “If you continue to wear a high heel,” says New York City podiatric surgeon Johanna Youner, “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. (He’s the foot and ankle consultant to the New York Mets and New York Giants.)

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 46 and Geena Davis at 48, 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’s 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.”

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 3.5-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 3.5-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 — for the record, it’s “KRIST-yen Lu-bu-TEN,” with soft, Frenchy n’s — but that doesn’t stop them from wearing his pornography-inspired stilts. When I visited his Madison Avenue boutique, some of the heels were 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 9/11. 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. Aren’t shoes supposed to offer mobility, or at least not inhibit it?

I asked the question of Elizabeth Semmelhack, 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 high heel through the centuries. “The last shoe I put in was from Tom Ford. It was very fetish-y with a very high heel. Then September 11 happened. Women were quoted saying they would never wear heels again. I wondered what the next shoe would be on the timeline. I was 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.”

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