By Christina Ianzito Special to The Washington Post
Now is the season when women take their freshly pedicured toes al fresco, often courtesy of strappy high-heel sandals or open-toed pumps
They 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.”
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, he said.
By wearing a high heel, “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 see in women are calluses and, more painfully, corns, those hard nuggets of keratin buildup caused by pressure.
With high heels, corns develop under the balls of the foot where the weight of your body presses down, and they feel like small rocks underfoot when you walk.
Other problems are capsulitis, a painful inflammation of the joints, and neuromas, or pinched nerves.
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 at the end of the day, the extra stretching of the tendon can lead to Achilles tendinitis.
Wearing high heels can also cause painful inflammation of the connective tissue at the bottom of the foot, the plantar fascia.
That can result in the need for aggressive treatments such as oral anti-inflammatories, oral steroids, cortisone injections, walking boots and crutches.
Liebow said his patients will take the shots, but give up the shoes?
Some women, Liebow said, “will wear their high-heeled shoes until their feet are bloody stumps.”
Erika Schwartz, a Washington, D.C., podiatrist, says she understands that many are in professions that demand a more fashionable shoe than the 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.”
Did we mention that walking too long in high-heeled shoes can also result in stress fractures, or cracks in the bones of the feet?
Schwartz also suggests that women avoid the thin, stiletto-styles: “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, if you fall from wobbly high shoes.
Another D.C.-area podiatrist, Franklin Polun, says many of patients aren’t willing to throw out their Manolo Blahniks (or knock-offs). “A high-heeled shoe is sexier-looking,” he said. “I get that.”
So he tries to give them “an action plan that’s actually doable.”
Polun’s advice includes going with a rubber-soled shoe over leather, because rubber absorbs pressure on nerves in the feet.
He also suggests shopping for shoes at the end of the day, when your foot is most swollen.
Polun’s website is called Mydamnfoothurts.com.
Liebow, too, has a short list of alternatives:
If you insist on wearing high heels, buy shoes with good padding at the balls of the foot and a gradual slope.
“Most women can handle a heel of an inch or two with minimal side effects,” Liebow said.
And the proclivity toward foot problems does depend somewhat on the person. Some people have problems wearing slip-on woolly winter boots, which often have little or no arch support, Liebow said.
Ditto for that other summertime favorite, flip-flops.