Are high heels as bad for you as smoking? Biomechanist and foot expert Katy Bowman thinks so. She realizes that is a bold statement, but she stands by the analogy. “The cigarette was once very fashionable. It was very alluring. It was sexy,” says the author of Every Woman’s Guide to Foot Pain Relief: The New Science of Healthy Feet. “Now we look differently at people who smoke. I think within our lifetime we’re going to start seeing a high heel as a reflection of low self-esteem.”
At five foot six inches Bowman no longer wears heels. In fact, many of her shoes have “negative heels,” where the shoe slopes downward from the ball of the foot.
In the book, she explains how “positive-heeled” shoes are causing chronic health problems, from nerve damage to arthritis. “The heel is quickly becoming the most researched component of footwear, as this particular part has the ability to radically change the geometry of the human body,” she writes. “Just placing a little wedge under our foundation causes compensatory actions in the ankle, knee, hip and spine, and can knock our natural gait pattern off kilter—and it does this in an instant!”
She claims this misalignment may also contribute to osteoporosis, because it tilts the body forward and decreases the weight put on the hips. This reduces the signal the body needs to build bone, so the part of the hip most sensitive to bone loss builds less bone. “All because of your footwear choice,” the author writes.
For lifelong wearers of heels, chances are your calf muscles have shrunk. “That’s why I say don’t just throw away your heels,” Bowman says in an interview. “You’re going to have to do an exercise training program and buy a heel that’s a little bit shorter.” An abrupt switch from high heel to flats may rip the Achilles tendon, she warns.
In the book, Bowman writes about a female news anchor she saw interviewing a doctor about the health risks of wearing heels. The anchor was adamant she would never give up her heels. “I couldn’t help but think that this attitude of knowingly doing harm to one’s own body is, let’s face it, really stupid. The science is there. The research is there. The pain is there. The visits to the doctor are there.”
In Manhattan, podiatrist Dina Tsentserensky confirms most of her clientele are women suffering chronic pain after wearing too-tight shoes like pointy high heels. Customers ask if their baby toe can be amputated so they can fit into narrower shoes, or if they can make their feet smaller. “We can’t reduce the size of the foot, but we can make the foot more narrow,” says Tsentserensky. Several times a week, women pay the clinic, NYC FootCare, $1,750 for a “toe tuck,” where they straighten the baby toe and thin it out by shaving the bone down.
“Ew! Elective removal of foot parts speaks volumes to how poorly people understand the role of feet in balance, pain-free walking, and knee and hip function,” Bowman responds in an email. “Sacrificing healthy tissue for the sake of a fashion trend means that, as a culture, we haven’t moved beyond the days of foot-binding and other self-mutilation.”
Bowman urges women to go barefoot at home as much as possible. For outside, there are “barefoot shoes” that are completely flexible and flat. “Just to come out of a two-inch wedge and put on a nice little new barefoot training shoe that’s cute, you’ve done a huge service to your knees and hips and your feet and all the nerves that come from the sacrum to the toes.”
Avoid flip-flops, mules and slide-on sandals, which require a gripping action with the toes to keep them from flying off. “This gripping action is the same muscle pattern that deforms toe joints into the ‘hammertoe’ position,” she writes.
Women often tell Bowman they are too short to go without heels, but she doesn’t understand that. “Can you not reach the ATM machine? What is your height truly interfering with?”
In the book she says, “Just say ‘No!’ to harmful shoes and ‘Yes!’ to beautiful shoes that not only complement you and your outfit but also the long-term function of your human machine.”