Foot pain: It's shoe design, often not the heel size!

We often find high heel shoes blamed for any type of foot problem. The fact is that most often the heel pain is due to a swollen piece of tissue called planter fascia that connects the heel bone with the toes. Medical fact is that it get inflamed when people walk on flip-flops or have shoes with too soft or hard soles and not when they wear high heel shoes!

Yes, high heels will hurt too if you have non-fitting high-heeled shoes or wear them for long times or walk in them on rough or slippery surfaces or have  a biological problem in your feet [a list of good high heel wear practices here], you might end up hurting yourself. But, who said that high heels are for playing football or racing?

Women's shoes in the market often have a poor shoe design because the thrust is on fashion. Mass producers of women shoes seldom care for design and copy top brands and whatever is in vogue. They copy the looks but can't and won't copy the care that good brands have taken to counter-balance the ill-effects of very high heels, narrow shape and other shoe design aspects.

For many more posts on foot care, do visit this section.

So many factors decide whether your shoe is comfortable!

You cannot blame a shoe brand or design if it is not fitting you well. Not always.
Even the best footwear manufacturer will make shoes with the standard foot in mind, but there are tens of factors that decide whether the shoe is perfectly suitable for your foot. Consider these:

Foot anatomy and body type: 

Your foot may not be of the perfect shape due to age, change in shape caused by misfit shoes or else.
Foot ‘anthropometry’ or proportions may differ considerably on whether you are a Chinese or a Mexican.
Feet differ a lot on the strength of the heel, the way toes and their bones are set inside the foot, slight bent of the foot towards left or right, comparative length of toes and so on. We are not even considering a malformation such as flat feet and bent toes. Infirmities can also involve ankle and leg.
A high body weight magnifies even slight foot disorders.
The way you walk matters a lot too.

External factors:

The shoe fit and comfort depends on climate too.
Feet as well as the material behave differently under different conditions of temperature and moisture.
The surface on which you walk also matters and also the duration for which you wear the shoe. Walking with high heels on gravely, spongy or very slippery surfaces is like inviting danger, but even if you are able to avoid the visible danger, it may hurt the inside of the feet because of awkward and unbalanced gait.
Even how you wear the shoe matters: too tight fit, tightly tied laces and too tightly fitting elastic may lead to bruises and bunions in addition to temporary discomfort.
The shoe size may not be exact for your feet. When you buy a tight-fitting shoe, it is also important to know that the feet are longer and plumper after a long day’s work.

Shoe itself:

Here comes the craftsmanship, design, material and science behind shoe making. Generally speaking,in this compartment reputed brands would score better than street vendors.

High heels without injury: body weight on feet

While I am a die-hard high heel lover, I take care to use my understanding of the mechanics behind Human walk and the engineering behind good shoes.

Let me share some of this stuff with your in a series of posts. I will make it as jargon free as possible.

This one is on the weight distribution in the foot and high heel wear. The next one will be on walking.

All our body weight  is held by our feet and when we stand and walk, it comes concentrated at the ankle joint. Consider it like a rod constantly pressing this point from above with over 50 kg load, about 4-5 thousand times a day for many years.

foot's weight distribution changes
with high heel shoes

pressure points on foot

Nature has devised a way so that the pressure does not crush the tissues and bones below the joint and still we have sufficient flexibility to walk. So, this pressure is distributed to the entire foot through a complex chain of bones. In normal standing, about half of the weight goes to the heel while the rest half goes to the balls behind the toes. An arch, with lining of tough ligaments etc helps further in this distribution..

Look at the second figure. It shows the points where the pressure is the highest when we stand. When we wear high heeled shoes, the weight distribution goes awry. About 90% of the pressure now is directed towards the balls while heels bear 10%. Our feet are not made to bear this huge pressure at the small joints that transfer the weight from the ankle joint  and the balls. The joint itself bears the load in an unnatural way, leading to unusual wear and tear if we do not take care to walk properly.

heel deforms alignment of bones surrounding the arch

and at ankle joints

The distortion in the anatomy and load distribution increases with the height of the heel, and is also influenced by many factors such as body weight, make of the foot and shoe design.

The simple takeaways from this knowledge are-

We should not keep standing in high heels for a long time, even if we do not feel immediate pain and fatigue;

We should do simple exercises of ankle and toes, and massage the feet, after long high heel wear;

If there is a congenital deformity in the feet / legs / back, or there has been some injury in these parts, we should consider that before going for high heels, especially more than about 2 inches; and

Ladies with bulky build should avoid too high heeled shoes.

I posted this general post earlier on care of feet while wearing high heeled shoes.

Wavering stiletto shoes: recipe for disaster

When walking in my neighborhood mall, I saw a lady walking in very sexy high heels. The stilettos, without the lady in them, were real eye candy. But the lady's walk left me wondering how much time she'd take to break her ankles. And the lady was not bothered at all about the stiletto - badly twisting to one side.         

This prompted me to write this post and maybe I'll write a detailed one on the topic sometime later.

Do hold your stiletto in your hand and try to twist is mildly to each side. If it twists easily, you have a problem in hand [actually, in feet ;) ]. When you walk in such a shoe, you roll to a side [mostly the outside]. This stretches ligaments at the ankle too much, paining and even tearing them. It leads to ankle sprain, osteoarthritis if the problem is allowed to persist.

There could be two reasons for this:

One, shoe related: the curvature that joins the toe area with the heel top is secured with a hard object [called shank], which keeps the shoe from distortions when we walk. When this loosens due to an inferior work or material, the shoe will twist when you walk, especially in an uneven surface. If the shoe is of poor make, discard it outright and promise to yourself never to buy a shoe from that brand. If the loosening occurred due to an accidental cause [e.g., soaking in water, heel twisting when it heel dug into a pit on the ground], take it to an expert shoe repair shop. If the shoe is old and inexpensive, forget that and throw the shoe away. The other reason could be worn heels. Never wear high heels with even a small side-erosion.

Two, foot related: the shank fixing can weaken or the heel can wear out on one side if you have some gait related problem. The answer is in wearing customized shoes [if the walk is too wavy] and repairing heels as soon as they show signs of wear.
Whatever the reason, don't walk in high heels if the heel does not stand straight on the ground.

For my other shoe related tips, please visit this section.

Stylish high heels: need they be uncomfortable?

Christian Louboutin, the king of high heel shoes, is reported to have said recently that he doesn’t want to create painful shoes, but it is not his job too to create something comfortable. He said, his priority is design, beauty and sexiness much above comfort. He is so candid!

But his very high heels, I find, are more comfortable than less high makes of some other brands. I discovered it with one friend of mine. She has a great collection of shoes and she agreed to discuss them with me last week. We found that some highly elegant heels were quite uncomfortable: they tended to be uncomfortable when they were brand new – like many shoes – but they remained uncomfortable after use too. After some use, a highly expensive shoe’s heel cushion turned flat and didn’t give the required softness under the heel. In some cases, especially less expensive ones, the synthetic sole cracks or decomposes after some months though the upper still is fine. In many cases, the basic design is faulty. [It only confirmed my observations on high-heel curvature.]

By the way, this friend broke her ankle while walking briskly in high heels in a Singapore street. That’s how the topic started on high heels. I will talk of her ankle too later. Right now, I just want to reiterate my saying: wear high heels only from well-known brands and wear them sensibly.   

High heel shoe shapes: curves and the arch

Look at the regular curvature [yellow];
compare it with the shoe shape [dark blue]
and the slope [light blue]

The foot is so highly flexible that we tend to ignore it and apply pressure wrongly on its bones, joints, ligaments,tendons, pads, nerves, vessels and muscles. Then we blame the habit of wearing high heels for all our foot miseries.

It is not the high heels per se, but wearing wrong heels and in a wrong way is what mostly causes foot related problems. Wearing high heels that are not made keeping the foot’s anatomy and walk dynamics in mind can not only cause pain, it can hurt the foot [and also legs and back] badly and permanently. One way to avoid these is to buy shoes only from recognised manufacturers. Fakes are good so long as they are exact replica of the original; but can they be? Will they have high quality components? Will the material that is used in fakes and duplicates behave the same way as the material in the original, even if the shape and looks have been copied perfectly? The same goes for mass produced cheap shoes. They seldom care for finer elements of foot comfort. Even ‘custom-made’ shoes may not be too fine if the shoe-maker does not have a sense of the working of the human foot.

In this post, let me talk of one important aspect of high heel shoes – their curvature as seen from the side.

• Do have a close look at the first figure in the drawing here. This is the generally accepted curvature for tall heels [2 inches and above]. The heel goes slightly inwards from top to bottom so that its base comes where the ‘center of gravity’ of the body falls when standing.  The shoe has a heel top with a low slope - followed by the main arch that is slightly convex and with a steeper slope. The front is nearly flat.  
• The second figure shows a bigger toe space at the cost of the arch; this results in more pressure on the balls and arch of the foot as they are not supported from behind and under. 
• Figures 3 and 4 show shoes with a flat heel top. This leads to a sharp bend of foot just in front of the ankle, leading to muscle cramps in the lower leg and pain in the heel. Such shoes are also not stable enough to walk. 
• Figures 4 and 5 have concavity at the arch area, leading to improper support to the foot arch. 
• The last figure shows a rather straight sloping shoe. This is seen usually in custom-made and mass produced shoes and wedges. Such shoes, even with a mid-level heel height, are not good for the foot as they constantly push the foot forward.

Another relevant consideration here. Foot shapes and sizes come in a wide range. They differ according to age and also differ among racial groups: Asian feet are usually broader and smaller while American feet are bigger, and so on.The arch also decides suitability of a particular type of curvature: flat feet, low arched and high arched feet - all need different levels of support at the arch area.

Like to see this earlier post on shoe design and comfort?
   

Plastic surgery for high heel comfort

This article in the Daily Mail of the UK on plastic surgery for high heel comfort is interesting. This has appeared in many papers and websites since its publishing a week ago.

I find it interesting on two counts: One, women can go to any length to look and feel sexy and stylish. Two, the pain would be so less in wearing high heel if we ladies took a bit of care of our feet and wore high heels sensibly. I do not think women in general [not grandmas, nor infants, nor in their ninth month of pregnancy, nor infirms] can hurt themselves of high heels if they wear the right types and for the right period of time. I have talked of foot health and high heel shoe engineering earlier too [with some overlap], so I'm not repeating them here.

"By the way," a male friend of mine said, "what is so abnormal about it? Women are used to sitting in the beauty parlor for hours, undergoing pain in hair removal, breast implants, butt firming and so on, shopping for the entire day. You people should love it iff a surgery removes some of your pain."