For years orthopaedic surgeons specializing in foot and ankle care have been warning women about the perils of wearing high heels. High heel wearers risk foot injury, muscle imbalance, bone deformities, knee and ankle joint problems, bunions, hammer toes and more. Now a new study featured in the November issue of Foot & Ankle International (FAI), the official scientific journal of the American Orthopaedic Foot & Ankle Society (AOFAS) details the biomechanical changes that occur in feet during high heel wear and the correlation between the heel height and amount of pain, pressure and strain it puts on your feet.

The study measured plantar pressure and soft-tissue thickness simultaneously using a load cell, a device which detects foot pressure, and a linear-array ultrasound transducer. Twenty one healthy men and women participated in the study. Measurements were taken with each participant standing barefoot on wooden blocks of 2 cm, 3 cm, and 4 cm in height placed below the heel. The study results revealed a significant increase in pressure on the metatarsal heads (the ends of the metatarsal bones that connect to the toes) as the heel height was raised.

This increased pressure contributes to pain, callous and bony deformities. The study authors suggest limiting heel height to no greater than 2 cm (.8 inches) as well as the use of padding at the ball of the foot can significantly reduce discomfort and risk of injury to the metatarsal heads.

Chung-Li Wang, MD, PhD, an AOFAS member and co-author of the study adds, “This study demonstrates the close association between heel height, plantar pressure and soft tissue compressibility. This is helpful in the prevention of pain and damage to your feet from inadequate heel height.” For those who like to wear high heel shoes, Dr. Wang offers the following advice, “Frequent removal of the shoe, unloading her/his foot, choosing a shoe with wide toe box, and adding a pad under the metatarsal head could be helpful in reducing discomfort.”