High Heel Edition
Christian Louboutin, Jimmy Choo, Manolo Blahnik, Miu Miu.
If these names don’t look familiar to you, then either you’ve never worn high heels, or, like me, you’re not very fashion saavy (I had to google search “high fashion shoe designers to make that list…)
During a normal gait pattern, our foot should strike the ground heel first, then roll over the mid foot to eventually push off of the toes and forefoot before coming off the ground to move forward for the next step. This pattern only really works if the surface on which you are walking is relatively level between the toe and heel. We can usually get away with a small rise under the heel without changing gait pattern too much (such as the increased height of cushioning in the heel of a running shoe), but when we start raising the heel too much, we can no longer maintain this normal heel to toe pattern. This is the case in a high heeled shoe.
When wearing high heels, or even cowboy boots to some extent, we are no longer able to achieve heel first contact because the position of the shoe does not allow us to pull our toes up enough for the heel to touch down first. This results in the heel of the shoe contacting the ground at about the same time as the forefoot. This changes the mechanics of gait so that even the ankle, knee, hip, and pelvis are moving differently than they should. For a short period of time this might just feel awkward, but over an extended period, this can lead to pain and injury.
This change in gait cycle can also affect you long term. During our normal gait cycle, our ankle motion ranges from just over 10 degrees of dorsiflexion (foot pulled up so your toes come closer to your shin) to about 15 degrees of plantar flexion (foot pointed down or away from you.) When wearing high heels, the shoes do not allow you to perform the normal dorsiflexion range of motion, often not allowing your ankle to come into any amount of dorsiflexion. This means that your calf muscles are in a shortened position. The calf muscles will tighten up very quickly if they are allowed to, so if you wear heels for large portions of most days, you will likely end up with calves tight enough that you actually lose ankle range of motion!
Another reason that wearing high heels is painful is that they cause you to walk with dramatically increased weight through the forefoot than we are used to or built for. The long bones of the forefoot were not meant to have increased weight on one end of them for prolonged periods. This can lead to bone bruising, nerve pinching, and even stress fractures.
Bob Cranny, PT