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Sports Medicine
Sports Medicine: Ouch! High Heels Hurt
By Dr. Neil McLaughlin
May/June 2011
For the Washington Running Report
Over the past 20 years, one of the biggest challenges in our practice is the ongoing battle to get our patients (primarily women) out of high heels. No matter how much pain they might experience, they will not let go of this fashion trend. In fact, it is not uncommon to have a patient show up for an appointment in work clothes with sneakers on—only to break under interrogation, and admit she left her high heels in the car.
Now we have proof of the damage wearing high heel shoes are causing runners.
Ever wonder why your calves may feel tight after kicking off your high heels? According to Marco Narici and his colleagues at Britain's Manchester Metropolitan University and at the University of Vienna, wearing high heels can lead to shortened calf muscle fibers and thicker, stiffer Achilles tendons. The findings were noted in Journal of Experimental Biology, (July 2010).
One group in the study wore two-inch or higher heels five times a week for two years and a control group wore only flat shoes. Using Magnetic Resonance Imaging (MRI), the researchers noted both groups had calves of similar size, but the shape of the calf in each group was different. Assuming this was due to muscle fiber length, they used ultrasound imaging to confirm their hypothesis: individual muscle fibers were shortened in the high heel shoe wearing group.
Next they tested the strength of muscle contraction in the two groups, but did not find a measurable difference. They theorized that the increased thickness and stiffness seen in the Achilles tendon was compensating for the shorter muscle fiber length.
The problem for a runner is that having shorter muscle fibers and thicker, stiffer tendons will lessen the body's ability to store and release energy, and thus hinder performance. Further research needs to be done to see how much performance and energy release is ultimately affected and to determine the potential for higher incidence of injuries in the altered tissues.
Other problems related to long term wearing of high heels include decreased ankle flexion (dorsiflexion) leading to less impact absorption on contact, thereby increasing stress to the foot, ankle, and lower legs. Decreased dorsiflexion is a noted cause of numerous injuries including stress fractures, Achilles tendonitis, and other muscle tendon injuries. The increased pressure on the forefoot, due to the steeper angle, can also influence bunion formation and progression, as well as neuromas.
Wearing high heels also has an impact higher up the kinetic chain. The increase in pelvic tilt—the higher the heels, the more the pelvis rotates forward—increasing stress on the Sacroiliac joints (SI) and lumbar spine.
For the runner with an already compromised spinal alignment or imbalance, wearing high heels can exacerbate the condition further or impede recovery from any of the above noted injuries.
Recently, there is an alarming trend for the heels to go higher and higher, even at the expense of being able to walk normally. (There are some pretty comical gaits witnessed in the shopping mall these days!) There are numerous reasons to lose the heels. Your body will thank you and your running will be much more enjoyable and, we hope, injury free.
Dr. Neil McLaughlin is a Certified Chiropractic Sports Physician. He practices at the Commonwealth Chiropractic Center of Reston, VA. For more information, call 703-742-7856 or www.cccreston.com.