Ladies: Say No to High Heels

From the WebMD Archives

April 6, 2001 -- Pretty woman, walking down the street ... may be better off doing her strolling in flats if she's concerned about developing "wear and tear" arthritis of the knee.

Many women may choose wide-heeled shoes over stilettos or narrow-heeled shoes because they are more comfortable, but a Harvard study in this week's issue of TheLancet finds that wide heels raise the risk of developing knee osteoarthritis as much as, or more than, stiletto heels.

Affecting more than 21 million Americans, osteoarthritis is characterized by the breakdown of the joint's cartilage. This breakdown causes bones to rub against each other, causing pain and loss of movement. It usually affects hands and weight-bearing joints, such as knees, hips, feet, and the back.

"Just wear flats," Harvard researcher D. Casey Kerrigan, MD, an associate professor of physical medicine and rehabilitation, tells WebMD. "I am strongly against wearing heels at all," says Kerrigan, who never wears them." Throw them out," she says, adding that women shouldn't be victims of fashion.

Osteoarthritis is the most common form of arthritis, and it's twice as common in women. "The use of heels is a likely reason," Kerrigan speculates.

During the study, 20 women, with an average age of 35, wore wide- or narrow-heeled shoes with a heel height of 2.75 inches. The stiletto heel was less than half an inch in width, while the wider heels were 1.77 inches wide. They walked 30 feet -- approximately one-half block -- in each type of heel and then did the same barefoot.

Both types of heels increased pressure on knee joints while walking, Kerrigan and colleagues report. The wide-heeled shoes increased knee-joint pressure by 26%, while the stilettos upped pressure by 22%. Increased pressure in the knee joint is thought to play a role in the development of osteoarthritis.

"Wide heels may be comfortable on your feet and you may feel more stable, so you tend to wear them longer than stilettos, but the forces that cause pressure on the knees are the same, if not greater, than what occurs with narrow heels," she says, so wide heels may be even more dangerous to the knees that narrow heels.

"Wider heels may spare feet and reduce the risk of tripping or falling, but the long-term risk to the knee is greater," she says.

But other experts aren't so quick to kick out the heels.

"My feeling is that this doesn't get to be a major problem because most people are not wearing that high of a heel for a long period of time," osteoarthritis expert Roland Moskowitz, MD, tells WebMD.

Moskowitz says he has never been asked about heel height or width and osteoarthritis, and he feels there are other parameters besides knee pressures that affect osteoarthritis risk.

"If you are wearing high heels when you are in your 20s or 30s, you are less likely to do huge damage to your knee than when you are older and have some change in the joints that is already there," says Moskowitz, a professor of medicine at Case Western Reserve University and the chief of rheumatic diseases at University Hospitals, both in Cleveland.

"At that point, most people spontaneously stop wearing high-heeled shoes for very long periods of time," he says, as pain is the earliest symptom.

But wearing high-heeled shoes also can damage the feet, leading podiatrists tell WebMD.

"Many women will complain of pain under the ball of their foot or a burning sensation due to lack of cushioning in the heeled shoe," says one New York City-based podiatrist, Suzanne Levine, DPM, who often wears heels.

This is particularly common as women age because they lose fat under the ball of their foot, she says. "If you are going to wear heels, make sure they have the proper cushioning," says Levine, who authored Your Feet Don't Have to Hurt.

In addition to pain in the ball of the foot, blisters, corns, calluses, back pain, and heel pain are common foot problems, says Jane Andersen, DPM, a podiatrist in private practice in Durham and Chapel Hill, N.C.

"And on a more significant note, we see foot deformities get aggravated by high heels," she says. "I have also seen a lot of patients who have failed foot surgery because they continue to wear high-heel or pointy-toed shoes."

Levine, a clinical podiatrist at New York Presbyterian Hospital in New York City, advises heel-wearers to choose heels that are no higher than 2 inches with wide heels.

"Limit the time spent in them, and change heel heights to avoid pressure on knees and back," she says.

To minimize foot pain and discomfort, Anderson recommends keeping "heels as low as possible with a wide heel and round toe box. Wear athletic shoes for commuting to work and put on your dress shoes when you get to the office."