Now is the season when women take their freshly pedicured toes al fresco, often courtesy of strappy high-heel sandals or open-toed pumps that look fabulous but sometimes feel like the masochistic torture tools that many podiatrists insist they are.
Michael Liebow, a podiatrist in Bethesda, Md., pulls out a wince-inducing photograph of a foot X-rayed in a high-heel shoe: It reveals the ball of the foot at a nearly 90 degree angle to the bones in the rest of the foot. It does not look good.
The X-ray is a prop that Liebow says he shows to patients who "walk into the office in six-inch heels and say, 'My feet are killing me! Why?' " He says he tells them, "That is not how your foot has evolved to walk."
To sum up his brief and frequently futile plea for foot health: Humans are meant to walk heel-to-toe, with the leg at about a 90-degree angle to the foot and the ankle joint employing a 60-degree range of motion during normal daily activities. By wearing a high heel, Liebow explains, "you're altering the position of the foot and how the foot is to function. Therefore, lots of bad things happen."
Shall we count the ways?
Among the more common problems podiatrists say they see in women are calluses and, more painfully, corns, hard nuggets of keratin buildup caused by pressure on the skin. With high heels, corns develop up under the balls of the foot where the weight of your body presses down, and they feel like small rocks underfoot when you walk. Liebow also sees capsulitis, a painful inflammation of the joints where the toes attach to the foot, and neuromas, or pinched nerves, where pointy high heels squeeze the toes. And when the heel is frequently in a high-heel shoe, it can cause the Achilles tendon (which connects the calf muscle to the heel bone) to tighten. When you kick off your shoes and the heel comes down to the floor at the end of the day, the extra stretching of the tendon can lead to a condition called Achilles tendinitis.
Wearing high heels can also cause inflammation of the connective tissue at the bottom of the foot, the plantar fascia. That can result in severe heel pain and the need for aggressive treatments such as oral anti-inflammatories, oral steroids, cortisone injections, walking boots and crutches.
All of these conditions can be incredibly painful, requiring corticosteroid shots and, ideally, flatter and wider shoes. His patients will take the shots, but give up the shoes?
Women, Liebow says, "will wear their high-heeled shoes until their feet are bloody stumps."
Take Danielle Pletka, vice president for foreign and defense policy studies at the American Enterprise Institute. She wears four- or five-inch heels to work most days; on a recent Tuesday, she towered in five-inch stiletto-heeled black Sergio Rossi open-toed booties.
"There are lots of things that impact the way you look that aren't necessarily optimal for every muscle in your body," says Pletka, who admits that she has some high pairs "that are uncomfortable, no question." But, she adds, "you want to look nice. I always get nice comments on my shoes. And I like it."
Erika Schwartz, a podiatrist who practices in Washington, says that when she asks her patients to stick with heels less than two inches high, "some say, 'Oh, you're so cute! No, I'm not going to wear under two inches, but it's very cute of you to say that!' "
Schwartz says she understands that many are in professions that demand a more fashionable shoe than the comfy, orthopedically correct footwear she wears to work. So she tells them to at least "walk in something else. Put those dress shoes on when you get to the office. Minimizing the amount of time that you're standing or walking will minimize the issues that come along with such an unnatural position of the foot."
Did we mention that walking too long in high-heeled shoes can result in, besides all of the above, stress fractures, or cracks in the bones of the feet?
Schwartz also suggests that women avoid the thin, stiletto-style heel: "The bigger the heel, if it's chunky or a wedge, seems to be better because the shoe has a wider base of stability. A skinnier heel and you're more likely to have ankle spraining." You can also break your ankle or injure the ligaments on the side of your ankle, among other body parts, when you fall from wobbly high shoes — thus becoming "fashion roadkill," a la Carrie Bradshaw of "Sex and the City," who in one episode fell face first while walking the runway in sky-high heels.
Franklin Polun, a podiatrist with offices in Washington and Maryland — the name of his Web site is Mydamnfoothurts.com — estimates that at least a quarter of his female patients come in with issues related to high heels. Like Schwartz's patients, many of them aren't willing to throw out their Manolo Blahniks (or knock-offs). "A high-heeled shoe is sexier-looking," he says. "I get that." So he tries to give them, as he puts it, "an action plan that's actually doable."
Polun's advice includes going with a rubber-soled shoe over leather, because rubber is better able to absorb pressure on nerves in the feet. He also suggests shopping for shoes at the end of the day, when your foot is most swollen, rather than in the morning.
Liebow, too, has a "short list of things you can do to minimize the problems" if you insist on wearing high heels. The list includes buying only shoes with good padding at the balls of the foot and a gradual slope (rather than the 90-degree angle shown in his X-ray), so "the force is more evenly distributed" over the foot.
As for how high you can safely go with heels, Liebow says, "there's no height that's good." But "most women can handle a heel of an inch or two with minimal side effects."
And the proclivity toward foot problems does depend somewhat on the person. Pletka says her feet rarely hurt in her four-inch heels, and she points out that, though heels have their problems, "Uggs are really bad for your feet: They don't support your arches." Liebow agrees that some people have problems wearing such slip-on woolly winter boots, which often have little or no support; ditto for that other summertime favorite, flip-flops.
"Not only that," Pletka adds, "they're ugly as sin. So it just goes to show you."
A spokesman for UGG Australia said the company makes many varieties of boots, for all tastes, and has versions with plenty of support.
Ianzito is a writer based in Washington.