Since Martha Washington, stilettos and shoes similar to stilettos have been worn by women of all ages. Stilettos are classified as a shoe that has a very narrow heel that is 3 inches or higher, the sole of the shoes will be very thin, and the shoe is very narrow at the toes. There are many problems with this type of shoe design, some of the most common include:
• Poor support: Obviously with such a narrow heel, most of the foot will not be touching the ground. Where the ball of the foot makes contact with the ground, there will be a tremendous increase in pressure. However, the body has a natural fat pad located at the ball of the foot that is supposed to protect the metatarsal bones from shear stress and the shock caused by walking. For some patients, this fat pad may begin to start wearing out and become thin. This is often times noticed in aging patients; however, those who wear heels on a regular basis may also experience this thinning, which is referred to as fat pad atrophy. With wearing stilettos, there is this increase in pressure due to the heel being significantly higher than the ball of foot, so instead of the body’s weight being redistributed between heel and ball, the majority of stress is put on the ball. This increase in pressure can lead to a condition called metatarsalgia. Metatarsalgia is characterized by pain that is localized to the ball of the foot.
• Decreased stability: Ankle sprains and fractures are one of the most common injuries that occur with wearing stilettos. The stiletto shoes do not provide a lot of stability on the sides of the foot nor ankle. The sides of the ankle are supported by ligaments, which are very strong. Despite these ligaments being present, the ankle is especially at risk, since a miss-step may cause an ankle sprain or fracture, due to there being no shoe to help provide additional support with the ligaments to prevent the injury.
• Crammed toes: It has been found that women will more commonly have toe deformities, such as bunions, than men. This has been attributed to shoe gear. Bunions are characterized by a big toe bump and the big toe may be crossing over to the outside and pushing on the second toe. With the narrowing toe box of stilettos, the shoe holds the foot in this position, which is why women who wear stilettos regularly may have an increased risk of developing bunions than those women who do not. Additionally, the narrow toe box will prevent the toes from moving, as they should. One of the most important criteria for having a normal and comfortable walking is to have the big toe joint be able to bend. Without the proper joint range of motion, walking may be abnormal appearing and painful. This lack of range of motion at the big toe joint is called hallux limitus.
• Abnormal position of the entire body while walking: Many women know and realize that being able to walk in stilettos well and to make it look natural takes skill. The entire body must be engaged in order to prevent falling or an excessively wobbly walk. The core must be held tightly and the spine must curve. This curve in the spine that stilettos may cause a patient to have is called lordosis. In addition, due to the strain that this type of shoe causes, many patients will complain of knee pain and hip pain.
Stilettos are one of the worst types of shoe gear that a woman can buy. While the shoes look nice, and may make a woman feel more confident, be aware that there are many foot problems that are associated with these shoes. In fact, according to the American Podiatric Medical Association, 87% of women will experience foot pain and injury due to the poor shoe gear alone!
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American Academy of Podiatric Sports Medicine