Can high heels damage our feet?

Very excited to have a little guest blog from our friends down at PodMed in Double Bay.  We treat alot of women with foot & lower limb problems…. when discussing aspects of their rehabilitation the wearing of high heels is often a question that comes up… So we asked the podiatrists…. they are at the end of the day experts when it comes to feet!

I am asked this questioned nearly every day by women who present with all kinds of different foot pain. There is a common misconception out there that high heels are the primary cause of most foot pain and deformity in women. Yes, I can guarantee you that if your foot is squeezed into a high-heeled shoe eight hours a day, at some stage foot pain and deformity will be the end result. High heeled shoes can do a lot of irreparable damage to the feet and ankles. However when used in moderation some of the pitfalls can be avoided. Many of my patients wear high heels on the odd occasion and as long as it’s only for a couple of hours at a time at a party or out to dinner; it’s generally not a problem. Of great concern to us is the number of young teenage girls presenting in our clinic showing early onset deformities as a result of high heel wearing. Parents need to discourage their teenage daughters from wearing high heels at any time. The developing and immature foot structure does not cope at all well with the excessive forces placed on the foot by the high heeled shoes. High heels put the anatomical structures inside your foot into an unnatural position. With each step the toes are squashed inside the shoe. The pointier the shoe and the higher the heel the more pressure placed on the toes. It’s important not to under estimate the damage this can do to the foot in the long term. Habitual long-term high heel wearers routinely present with problems like clawed toes, bunion formation, metatarsalgia and nerve damage. Foot structure will have some bearing on how resilient the foot structure is to the adverse effects of high heels but as I like to say, footwear is designed to protect your feet, not to hurt you. If your high heels are hurting you, take them off because they have already been on too long. ‘If the pain persists…..see your Podiatrist’. High heeled shoes shift an unnaturally large amount of force onto the forefoot with every step. The natural heel to toe transition is altered and the force moves too quickly from heel to the forefoot where the high loading remains for the duration of the steps. It is the increase in time that the foot is overloaded with every step that does as much damage as the pressure itself.

The postural position high heels places the body has historically and is still considered aesthetically appealing to the human eye. In the leg, the calf muscles protrude more in high heels giving the impression the legs are strong and slender. At the knee, it is bent when the heel is lifted up. Usually with a 3 inch heel, the pelvis is tilted forward 10-15 degrees which leads to a “sexy” curvature in the spine. This makes the buttocks protrude 25% and also lifts the bust (see picture below). That is how a sexy and wavy body posture is obtained and explains why 3-inches high heel is apparently more popular and loved by most women. However, it is also due to these minor postural adjustments that can have negative effects on the body after a long period of time.

imagesUZ8FBV1EWhat steps can you take to minimise the effects of high heels?

Heel height: Wearing a shoe with a lower heel can certainly help. By lowering the heel you can take some of the pressure of the foot structure but you can also help reduce the negative postural effects on knees, hips and low back. Lowering the heel can also reduce the stiffness in Achilles tendon’s and calf muscles that habitual high heel wearers suffer. If the Achilles and calf muscles shorten too much then wearing flat shoes or walking barefoot becomes almost impossible.
Insoles: Insoles or customised orthotics can prove to be a wonderful way to manage foot pain on a daily basis. However, it is best to discuss what type of insoles or orthotic might be right for you with your local Podiatrist.
Wearing well-fitted shoes: When a shoe fits very well it will generally be comfortable for eight hours or one hour. It is important to select the right type of shoes for right occasion. You wouldn’t wear your high-heeled shoes for exercising i.e. a long walk, a run or to the gym. Nor would you choose to wear your exercising footwear or comfortable casual shoesout to dinner or to a cocktail party (unless you had to). Alternating between flats and heels can sometimes prove difficult (see ‘wearing a lower heel’). However, providing that the difference in the heel height between the flats in the heels it’s not too extreme, alternating between the two is a fantastic way to go. Try to make sure that the flats still have some small amount of heel raise in them. Most foot types appreciate a small amount of heel raise in their flats and this makes the transition from high-heeled shoes into to flattish shoes much easier.

Also it is best to buy high heels in the afternoon when your feet are at their largest. Therefore when your legs and feet expand, the shoe size is correct and the toes aren’t cramped.

Stretching: Most of us have been wearing shoes with some form of heel raise in them from a very young age and this somewhat shortens the Achilles tendon’s and calf muscles. For this reason, stretching is very important. Stretching is even more important for long-term high heel wearers because their Achilles tendon’s and calf muscles can become extremely short and tight. To walk normally and without having to make unnecessary compensations is not only important to have a good range of motion in your calf muscles but also in the other important muscles of the leg, thigh and hip. High-heeled wearers typically have very tight planter flexers in the bottom of the foot, short calf muscles, tight hamstrings, quadriceps, ITB’s, hip flexors, gluteals and over time the body over compensates and muscle imbalances and postural issues often arise.
Thanks to Sarah Bongioletti from Pod Med Podiatry Centre for her words of wisdom.

Check out their website HERE

 

 

Tibialis Posterior Tendonitis

Tibialis posterior dysfunction is one of the most common overuse injuries found in the foot & ankle.

The tibialis posterior muscle originates high in the shin from the back surfaces of the tibia and fibula. It tracks down along the inside border of the tibia, passes around the inside of the ankle and terminates via two attachments in the foot.  The main insertion (and that of interest to this particular injury) is into the tuberosittib posty of the navicular.

The tibialis posterior is an extremely important stabiliser of the foot & ankle. It functions to produce inversion at the ankle and also plays a major role in maintaining and supporting the medial arch.

Tibialis posterior tendonitis occurs when there is excessive strain put upon the tendon as it inserts into the navicular.

Why?

  • As an overuse injury through years of wear and tear associated with high impact activities such as running
  • Acutely as a result of sudden increase in training volume or intensity OR the use of inappropriate footwear

Athletes with poor foot biomechanics such as flat or pronated feet, tight calves and poor pelvic stability are at more risk of developing tibialis posterior dysfunction.

Signs & Symptoms:

  • Pain: felt along the inside of the foot
  • In acute cases there can be visible swelling on inside of the foot
  • Pain aggravated by high impact activities such as running & jumping
  • Crepitus may be felt along the length of the tendon.

A thorough physical examination by a physiotherapist will usually be sufficient to diagnose tibialis posterior tendonitis. In cases where diagnosis is in doubt an MRI may be required to rule out other potential pathologies.

Treatment:

Initial treatment must focus on unloading the tendon and allowing it to rest. In severe cases where simple weight bearing activities are painful a short period in a walking boot may be warranted. Icing and anti-inflammatory medications may also be suggested by your health care provider.

Physiotherapy management can involve:

  • Soft tissue massage to tight surrounding muscles, particularly the calf.
  • Electrophysical therapy to reduce inflammation & assist with pain relief.
  • Dry needling to reduce inflammation
  • Taping of the foot to unload the tendon
  • Advice regarding orthoses, shoe inserts & appropriate footwear
  • Activity modification
  • Exercise prescription of appropriate strengthening exercises

In chronic cases or those that have not responded to conservative therapy further intervention may be required. Options can include corticosteroid injections and surgery.

Have a wonderful week! 🙂

What is a Morton’s Neuroma?

They say doctors make terrible patients… I think physio’s do too and I have several reasons why; firstly we have an inability to take our own advice (most of the time); secondly we usually fail to get treatment on our problem areas because let’s be honest the last thing you want to do at the end of a long days work is have to treat your colleague… and thirdly is the case of too much knowledge being a potentially dangerous thing,. Naturally as humans and also medical practitioners I think we are programmed to think the worst and then work our way backwards. Makes sense, rule out the worst possible diagnosis immediately which leaves your mind at ease to focus on the other potential problems that may be occurring.

Recently I was out enjoying a Sunday jog on the famous Bondi to Bronte coastal track when my two middle toes started aching and tingling. I kept running, it got worse, I kept running, by the end my jog was a hobble and surprise surprise for the rest of the day my foot was killing me. By 8pm that night I had convinced myself that I had a stress fracture (always jumping to the worst case scenario) I had visions of a walking boot, no running, no gym… Over the coming days I monitored my symptoms, it wasn’t behaving like a stress fracture, the pain was very intermittent, it didn’t throb at night, and by far the worst thing was bare feet on the bathroom tiles = nightmare. I took a week off running and slowly it improved but my toes felt cold, achy and occasionally tingly. It was by far the most irritating feeling I have ever experienced I just wanted someone to yank on my toe and make it go away.

Anyway cutting to the chase I knew now it wasn’t a fracture but saw the Doc, got an MRI and as I suspected I had a Morton’s Neuroma in between by 2nd and 3rd toe.

What is a Morton’s Neuroma? I’m so glad you asked as I’m sure this personal account has had you on the edge of your seats….

A neuroma is a growth that arises within the nerve cells. A Morton’s neuroma is the name given to an inflamed nerve between the metatarsals at the ball of the foot. It most commonly occurs between the second and third toe and is caused by irritation and compression of the intermetatarsal nerve. Patients will often present with pain and/or numbness in the involved area that can radiate into the toes. Symptoms are usually aggravated by weight bearing activities such as running, however if the neuroma is very large simply walking can be enough to cause pain.  Image

Your physio or doctor will usually be able to make a diagnosis based on your history and symptoms, however further investigation such as an x-ray or MRI may be warranted to rule out the presence of a stress fracture.

Why do people get this injury? Like most overuse injuries certain people are often predisposed to developing this problem as a result of biomechanics; with pronated feet (flat feet) being one of the main risk factors. Other things include wearing too tight fitting shoes which can cause chronic compression of the nerve sheath.

What does the treatment involve?

First thing is first REST from aggravating activities. So running, jumping etc. Ladies this may also mean popping the stilettos away for a while as the excessive forefoot loading can compress the nerve further. Your physiotherapist can provide local treatment which may involve soft tissue massage to tight muscles both within the foot ad into the calf / shin; dry needling can also be effective. Management also needs to involve a proper biomechanical assessment looking at why you have developed the problem in the first place. Foot alignment, size, footwear etc all play an important role in an injury like this. Some people may require referral onto a podiatrist to be fitted with orthotics.

Steroid injections and anti-inflammatory medication can provide short term relief. This should be discussed with your doctor.

If any of this sounds familiar I would advise getting it checked out. Don’t be a bad patient like me and let it linger on!

Happy Monday

What is plantar fasciitis?

I have just returned from two AMAZING weeks in Hawaii. Now for those of you who know me you will be highly aware that I am not very good at lounging around doing nothing. So yes while I did soak up alot of sun,  my days were also packed full of exploring, walking, running up dormant craters and bike riding.

This proved difficult when halfway through our adventure my travelling partner developed acute foot pain or plantar fasciitis. Most probably the result of too much walking in bad footwear (ie thongs).  Lucky for him travelling with a physio can be handy and we were able to get it under control pretty quickly!

Plantar Fasciitis is a problem I deal with regularly and is commonly seen as an overuse injury in runners. As an acute injury (as was the case for us) this is quite straightforward to manage BUT as a chronic problem which is usually how we see it it can prove an extremely stubborn problem to treat, taking weeks to even months to get under control.

What is plantar fasciitis?

The plantar fascia is a thick band of connective tissue spanning across the sole of the foot from  the base of the heel bone (calcaneus) to the udnersurface of each of your toes. Its job is basically to support your arch. Inflammation or irritation of this fascia at its attachment to the heel bone is termed plantar fasciitis. In many cases of plantar fasciitis there is often the prescense of a heel spur (small bondy growth on the calcaneus). The heel spur usually doesn’t actually cause pain and can be found in an asymptomatic foot.

Patients will normally complain of pain directly under the heel that can in cases extend into the arch of the foot. Pain is often worse with the first few steps of a morning, and is aggravated by long periods of weight bearing.plantar fasciitis 1

What to do?

Seek some sort of medical advice as early as possible. The earlier you start to manage plantar fasiitis the easier your road to recovery.

Treatment will include massage/soft tissue releases to the tight surrunding muscles such as your calf. Local treatment to the most painful tender spot (usually directly below the heel) to help with reducing inflammation, advice regarding footwear and you may be given certain exercises or stretches to do at home.

There are certain factors that can predispose individuals to developing this problem, for example flat or pronated feet, tight calves, poor pelvic stability etc etc. These will all be important things your physiotherapist should address to ensure you make a full recovery.

If you are suffering from symptoms such as those mentioned above and you would like to make an appointment with one of our physiotherapists contact us on (02) 9328 3822

You do not need a referral to see a physiotherapist!