Killer heels

They may lend you an extra few inches and an air of sophistication, but the long-term effects of high heels can be serious. So look before you leap into your six-inch stilettos Words: Sarah Roe Illustration: Susan Roan

THEY go up and down with the changing tides of fashion and they are responsible for some of the sexiest walks in history. Most men love them and many women collect them obsessively, but in reality, sore feet is the least of the problems high heels could cause you.

Osteoarthritis strikes around 1.5 million people in Britain each year. The majority of them are women and the causes could lie in our choice of footwear. Recent research in America indicates that both stilettos and more comfortable block heels increase pressure around the knee joint, putting them at greater risk of developing the condition in later life.

Dr Casey Kerrigan of Harvard Medical School asked 20 women who habitually wear high heels to parade on a ten-metre platform, first wearing stilettos, then in block heels - both seven centimetres high - and finally barefoot. Sensors and cameras under the walkway measured the level of compression in the women's knees with each type of shoe. Kerrigan found that the inward twisting force on the knee increased by 26 per cent in block heels over the force measured while walking barefoot, compared with 22 per cent in stilettos. This force in turn upped compression on the insides of the knee joints, which are particularly prone to osteoarthritis.

While there are no precise figures on the distribution of the disease in Britain, in America statistics show that women are twice as likely to have osteoarthritis in the knees than men. Many women wear block-heeled shoes during the day, because they feel more comfortable than narrow heels, but ironically they could be doing long-term damage to their bodies in the process.

Professionals have known for some time that stilted footwear can put unnecessary pressure on the joints. The foot is designed to walk by placing the heel down first, followed by the toe, but high shoes alter the heel's position and upset this natural rhythm, so that the whole foot tends to clump down at the same time, usually on hard pavements, jarring the body. In the long term that can lead to aches and pains in the foot, knee, hip and lower back.

"Wearing high heels undoubtedly strains the joints of the knee - and even to a certain extent the hip - and alters the posture, as it tilts the pelvis forward," says Edinburgh-based osteopath Paul Barratt. Long-term use of high heels can change the body so much that it feels more comfortable to wear the heels than abandon them. Some of Barratt's patients come to him complaining of back and joint pain when they give up their fashion shoes, as their bodies have adapted to the new posture.

At the British Orthopaedic Association Dr Madeleine Devey agrees that footwear can be a risk factor in developing osteoarthritis, but points out that other reasons such as genetics and weight gain also contribute. She stresses that the condition's over-representation in women may be partly because women live longer than men and the disease occurs more frequently in older people. "I think it's a simplistic answer just to put it all down to high-heeled shoes - although that is probably a contributing factor," says Devey. "There must be people who wear high heels who don't get osteoarthritis of the knee and people who've never worn them who do. Footballers, for example, tend to get osteoarthritis of the knee."

She also points out that the research failed to look at different heights of heels, only comparing the effect of walking in high heels with walking barefoot.

But even if the link with osteoarthritis is not fully proven there are plenty of reasons to abandon your heels. In another American study, Michael Coughlin, clinical professor of orthopaedics at Oregon Health Sciences University, analysed 3000 operations for deformities of the forefoot over a 15-year period and found that 87 per cent were carried out on women's feet, which he concluded was due to squashing the feet into high-heeled shoes.

Bunions and bunionettes, hammer toe and neuromas - a painful thickening of a nerve that runs between two toes - were all much more prevalent in women. In Scotland the statistics are similar. "Bunions are about three times more common in women than men, which is attributable to shoes," notes Edinburgh-based chiropodist George Rendall.

But the news is not all bad for fashion victims. Experts agree that heels and dainty slippers are fine in moderation, but suggest that for everyday use women bring their feet back down to earth.

So what is the ideal shoe? Rendall pauses for a moment and sums up: "A shoe should be stable. Your daily wear should have no more than an inch and a half heel and you should be able to hold it onto your foot with a lace or a strap."

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