Heel Thyself


- Aired Sun Apr 14, 2013
- Aired Sun Apr 14, 2013

Health and Wellness: Heel Thyself Transcript

Welcome to Take Care, a weekly conversation on Health and Wellness produced by WRVO Public Media. I’m Lorraine Rapp and I’m Linda Lowen.

They hurt. They make walking difficult and they pinch our feet. High heels may seem like a small price to pay for beauty but even Sarah Jessica Parker, the iconic fashionista from Sex in the City recently admitted high heels have caused her permanent damage.

Our next guest says women can still wear high heels if they make smart choices. Dr. Neal Blitz is the Chief of Foot Surgery and Associate Chairman of Orthopedics at Bronx-Lebanon Hospital in New York.

Dr. Blitz developed the bunionplasty procedure; essentially plastic surgery for bunions. He is an authority on foot and ankle surgery and maintains a private practice in Manhattan.

HOST: Welcome to Take Care Dr. Blitz.

Dr. BLITZ: Thank you. It’s a pleasure to be here.

HOST: You know some women wear high heels every day to work, some a couple of times a week and than there is the person that just gets dressed up for a wedding or special occasion and they just endure some pain for a few hours. But the question is many people would agree high heels, depending on how high the heel is, can be very, very uncomfortable.

We know that, but the question to you right now is: “Wearing high heels, can it be actually damaging long term both to the foot or/and to the spine?”

DR. BLITZ: High heels are not good for your feet in general. They are unnatural to the foot and they cause your foot to sort of destabilize over time.

HOST: What actually takes place? I mean, I know the angle looks very unnatural and you can tell by watching some women walk down the street and their posture and their gait are really off. It looks uncomfortable, but I never knew if they were throwing their back off. What exactly is taking place anatomically?

DR. BLITZ: What high heels do is they cause a shortening of the Achilles tendon and that is the tendon behind the ankle and that ultimately destabilizes the foot and leads to bunions; hammertoes; flat feet; plantar fascitis; metatarsalis, which is pain in the ball of the foot and Morton’s Neuroma, which is a nerve between the third and four toes.

HOST: Dr. Blitz when you talk about the foot is destabilized. When we typically walk, a normal walk, a normal gait and normal stance, where is the weight landing on the foot and how is a foot destabilized with high heels?

DR. BLITZ: Typically when you walk without heels you walk on heel to toe. When you are walking in high heels, the foot is put in a pointed position and first off that puts more pressure on the ball of the foot. In general, in order just to walk, your ankle is not able to move in its normal excursion. What happens is you have to do a steppage-like gait. I say it’s like a horse-like gait because you have to sort of gallop and lift your entire leg up and that’s what makes that noise that most people hear when they are wearing high heels.

What’s interesting is that shortening of the Achilles tendon is medically termed equinus. Equinus comes from horse-nature and horse-like. I’m not saying that women are trying to be more horse-like by wearing high heels; but, it is that shortening of the Achilles tendon that causes all the problems in the foot.

HOST: That’s the look that women believe gives them that “I want to have longer-looking legs.” Women have that ingrained into them whether you call it culture or from magazines or from the media.

In terms of that shape women want, what about the angle that we experience through the arch and also what about the size of the heel? I’m not a frequent high-heel wearer and I saw a mother with terrible bunions, so I think that gave me a life-long belief to be careful about the shoes you wear.

What about the heel size? Does that make a different? Obviously I would think it’s more destabilizing for the foot to land on a stiletto heel than it is a big, chunky, wide heel.

DR. Blitz: That’s absolutely correct! A stiletto heel is more difficult in general because you have to balance on a smaller peg so to speak as opposed to a chunky heel, making a chunky heel better.

As far as heel height, a good rule of thumb is that you are going to put 25 percent more pressure on the ball of your foot with each inch. If you’re going to wear 1 inch, expect to have 25 percent more pressure. If you’re going to wear 2 inches, that’s 50 percent more pressure on the forefoot. And, if you wear 3 inch heels, that’s 75 percent more pressure on the forefoot.

What happens over time, if you think about it, is that your forefoot where the bunion region is and the ball of the foot starts to destabilize in that area and you start getting ligament ruptures, hammertoes that are claw-like toes women get that they find so unsightly. Also knobby soft tissue pads on the top of the toes along the knuckles and also the bunion.

I will tell you that I have a lot of women that typically find me to have corrective bunion surgery with the bunionplasty procedure, which I developed, because their feet have become so destabilized by the high heels that they need the reconstructive surgery. On top of that, they want to get back to wearing high heels and have the bunion surgery to wear the high heels again.

HOST: I know that bunions are a combination of what shoes you wear and a hereditary factor. Can people that see other women in their family avoid it by wearing comfortable shoes? What advice do you give people that are trying to avoid even developing bunions?

DR. BLITZ: If your grandma has bunions there is a good chance that you could develop bunions. There is hereditary associated with bunions; but, shoe care definitely plays a role. Again, we know a high heel destabilizes the foot and sort of unlocks the arch so to speak and allows more flexibility in the foot and leads to bunions.

HOST: Dr. Blitz, is there a safe way to wear high heels? You go and do this bunionplasty on your patients and then they come for their follow up wearing high heels. Do you scold them or do you have a guideline people can follow? Moderate wearing or is it number of hours? Is it how many times a week? What’s your advice?

DR. BLITZ: What I tell a lot of women here in New York who like to wear high heels – one for fashion and two for their job – is to limit the time in their high heels. If you commute to work wear sensible shoes and sneakers while you are on your way to work. When you are at work, then you wear your heels. When you are sitting at your desk, take your heels off. You really want to avoid the damaging effects of the heels.

HOST: Dr. Blitz, you have written publically about something that is completely unknown to me. You call it the “high-heel hang-over.” When I wear high heels it’s on a limited basis, literally for a wedding is the only time that you will see me in high heels. The pain that I experience is right then and there so I take off the shoes. But, you say there is something called a “high-heel hang-over” in which you get more acute pain the next day. Can you talk about that?

DR. BLITZ: The high-heel hang-over is a term that I coined. What that is the painful feet are bruised after a night or a day of wearing heels. There are some people whose feet just get so used to wearing heels that they just become numb to it. For the average person, their feet are just killing them again. This is what I’m told from the patient. I’m a guy. I’ve never worn heels so I don’t know.

HOST: Good to know!

DR. BLITZ: People always ask have you walked in my shoes. The answer is “No, I haven’t!”

There are six things that I usually recommend for people who have a “high-heel hang-over.”

The first thing is stretching and yoga. Why yoga and stretching? Because remember the high heels over time shorten the Achilles tendon and that’s what I’m trying to relate today. You are going to shorten that tendon in the back of your ankle. If you could counteract that, you are going to prevent a lot of long-term damage. The things you want to do are stretching yoga poses and downward dog is excellent.

The second thing we recommend for a “high-heel hang-over” is to soak your feet in a mineral bath. You ask what exactly is a mineral bath? First off, a mineral bath is two things – it feels great when you love to take baths in general and just to relax. You want to soak them in epsom salt although epsom salt is not a mineral bath. Epsom salt is the mineral salt of magnesium sulfate and that is absorbed through the skin and the magnesium is used to build and repair tissue and it is used in over 300 symptomatic reactions. So, it’s really good locally, right where you need that healing property.

The third thing I recommend is to pamper your feet. What I mean by that is get a pedicure, keep your feet callus free, and keep your toenails well trimmed because if you are wearing pointy-toed shoes you can windup with a terrible ingrown toenail.

The fourth thing I recommend is to moisturize your feet because high heels cause pressure points and those pressure points can cause skin breakdown and calluses and you want to keep the skin supple.

The fifth thing is deep massage. That, in general, is going to relieve anxiety in the foot and also so those intrinsic muscle spasms that happen in the foot just from trying to maintain that abnormal position.

The last thing I recommend, number six, is to wear sneakers. Let your feet rest and recover.

HOST: Thank you so much Dr. Blitz. This was very interesting, enlightening and enjoyable. I think you give us an approach where we can keep the high heels in the closet and know what to do to avoid having terrible pain and injury that we usually associate with high heel use.

Thank you so much!

DR. BLITZ: Thank you!

HOST: Dr. Neal Blitz is a foot surgeon who pioneered the bunionplasty procedure and has a private practice in Manhattan.

PLEASE NOTE: The information presented on Take Care is offered for educational and informational purposes only and should not be construed as personal medical advice. You should consult your personal physician or caregiver regarding your own medical care.

heel thyself

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