Fashion Takes a Healthier Turn

By John Casey

Maybe Manolo Blahnik isn't yet shaking in his four-inch stilettos, but the shoe styles women are buying -- at least for work -- appear to be moving away from the traditional high heel of high fashion. A survey of 1,031 working women found that the majority, especially younger women, are wearing sensible shoes at work now.

"More than 67% of working women now wear flats, low-heeled pumps or other comfortable shoes on the job, and thus are reducing their foot injury risk," says Carol C. Frey, MD, interim clinical professor of orthopaedic surgery at UCLA and co-author of the survey. "If this trend continues, we expect that women will have fewer foot problems in the next century.

High Heels As Health Hazard

Women who wear heels have the highest percentage of ingrown toenails, bunions, neuromas, and calluses, according to the American Academy of Orthopaedic Surgeons. "The steep incline of a three-inch heel places enormous pressure on a woman's forefoot -- seven times that of the pressure of a one-inch heel," says Frey. She cites high heels as the main cause of serious foot problems in women and says that such high-heel-caused problems are estimated to cost the US economy as much as $1.5 billion annually in healthcare costs and lost productivity. It is heels higher than two and a quarter inches that cause the most damage.

Younger Women Are Breaking The Mold

The survey included phone calls to women while they were at work. They were asked a series of questions, including what brand and style of shoe they were wearing and what age groups and income ranges they fell into. They found that flats and athletic shoes now make up the bulk of women's workplace foot attire.

• 46% were wearing flats (defined as a heel of 1 inch or less).
• 25% wore athletic-style shoes.
• 21% wore high heels.
• 7% wore "other" styles.

In 1990, the last time the survey was done, 34% of working women were wearing high heels.

Many women today stay away from high-incline, spike heels, opting instead for flats or the elevated, platform shoes that raise the entire foot, not just the heel, 2 to 3 inches. When asked why women's choices of workplace shoe styles are changing, Frey said several factors may be coming to bear, but that changing roles for women at work are largely responsible.

"The workplace has been going more casual through the 90s, there is no question about that," says Frey, "but I think that women are more confident about their roles in the work world now. They don't feel the need to fit into some traditional feminine role." And it is younger women that are making the biggest changes. The study found that women in the 20 to 30 age bracket were least likely to wear high heels.

	20 to 30 years	Flats	88%	Heels	12%
	31 to 40 years	Flats	74%	Heels	26%
	41 to 50 years	Flats	76%	Heels	24%

"It is women in the lowest income group, under $25,000 annually, that have the highest percentage of high-heel use, despite age range," says Frey. "And the one state where high heels are most prevalent in the workplace is Florida."

What Makes A Healthy Woman's Shoe

"Many women ask me whether platform shoes are bad shoes," says Frey. "The answer is that they are good shoes, because they don't raise the heel very far above the ball of the foot. Plus, they make you feel taller."

Here is what she recommends as characteristics of a good shoe.

• Rounded, asymmetrical, or square toe box.
• Shock absorbing heel.
• Slip resistant soles.
• No break-in period.
• Flexible or soft uppers.

"As an informed consumer, you can find a lot of great shoes out there on the market," says Frey. "Shoe manufacturers respond to what women are buying, and now that women are buying more sensible shoes, there are more sensible, inexpensive shoes to choose from in stores."

Shoes As Dessert

"We don't want to tell women not to wear high heels," says Frey. "We know that's not going to happen. We recommend that women treat high heels like a dessert, something you have a little bit of now and then as an indulgence. They are great to wear for a few hours on a special occasion, but they aren't good for everyday wear at work."

Back to Aching Feet

Source: The National Institute on Aging, NIH, U. S. Department of Health and Human Services. May 2000.

Reviewed by Charlotte E. Grayson, MD, March 2002.
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