Foot health

Towering shoes can lead to terrible feet

Diane Ares has worn high heels all her life, and she is the proud owner of a towering collection, with a pair to match every outfit.

But Ares’ feet have paid the price for her fabulous footwear. She has had three surgeries, and needs yet another operation to correct lingering issues with her toes.

“I want to get out of this pain,” said Ares, 77, of Miami Beach. “I can’t stand it anymore.”

Like women everywhere, Ares’ love of fashion has led her down a difficult path, full of pain and frustration.

“Foot and ankle problems in women are more common than in men,” said Dr. Thomas San Giovanni, an orthopedic surgeon and foot and ankle specialist at Doctors Hospital’s Center for Orthopedics and Sports Medicine in Coral Gables.

San Giovanni, whom Ares has now turned to for treatment, said he sees four times the number of such foot problems in women than in men.

“Women’s shoewear is obviously a lot different than men’s shoewear,” he said, “and it does put a lot more stress on the foot than men’s shoes do.”

In fact, the higher the heel, the more stress it places on the forefoot.

“It is estimated that a one-inch heel is 20 percent increased stress to the forefoot [than flat shoes], and two inches is 60 percent, and three inches is 75 percent increased stress, compared with a shoe that is flat,” San Giovanni said.

Tight shoes are also a culprit, as they tend to force the foot into an irregular position and can promote deformity, he said.

Women’s feet are subject to an array of different ailments. Among the most common: bunions, called hallux valgus; hallux rigidus — an early arthritic condition of the big toe that causes a painful, stiff big toe with restricted motion; and hammertoes, which are a joint contracture of the second to fifth toes, that causes them to be semi-flexed or crooked and tends to cause pain on the top of the toes and near the ball of the foot, San Giovanni said.

Another problem for women is posterior tibial tendon dysfunction, which is pain along the inner ankle and foot, in combination with a collapsed arch, San Giovanni said.

“It is often under-diagnosed,” he said, “and the tendon tends to stretch out, and the arch collapses, and it changes the mechanics of the foot.”

Dr. Steven Steinlauf, an orthopedic surgeon with a subspecialty in foot, ankle and leg problems, who is on staff at Memorial Healthcare System in Broward, said women may also experience neuromas, or pinched nerves in the foot; metatarsalgia — pain under the ball of the foot; or inflammation and instability of the metatarsal phalangeal, where the toe meets the foot.

Women’s shoewear also can lead to tightness of the Achilles tendon, he said.

“If you’re constantly wearing high-heeled shoes, it leads to a shortening of the Achilles tendon and tends to give you all of these different issues,” said Steinlauf, who is also a clinical assistant professor at the University of Miami Miller School of Medicine.

For women, pain is usually the initial symptom of foot problems, and then gradual deformity.

As women age, the problems tend to worsen. Bunions may appear as early as adolescence, because of a hereditary predisposition, and may become more pronounced over the years, especially when coupled with improper footwear, San Giovanni said.

Hallux rigidus also worsens with time. “Most women usually don’t run to the doctor right away,” San Giovanni said. “They live with it for a while and then when it gets bad they come in.”

Indeed, it is after their 40s that many women seek help for foot problems. Most women with conditions like metatarsalgia, and hammertoes are in their 40s, 50s and 60s, Steinlauf said.

“The foot takes a heck of a beating as you age,” Steinlauf said.

Obesity can also lead to foot problems.

“People who do not take good care of their feet, using improper footwear, are overweight, do not stretch their Achilles routinely, and do not have a healthy lifestyle tend to have more problems with their feet,” Steinlauf said.

A first, yet perhaps unpopular, remedy for women is to wear shoes with a moderate heel, of two inches or lower, that are wide enough that they do not squeeze the toes, Steinlauf advises. He also recommends doing exercises to stretch the Achilles tendon for as much as 20 minutes each day.

Doctors have an additional arsenal of treatments, with many non-surgical options.

After evaluating the foot issue and its cause, doctors say they can help alleviate pain with orthotics or padding, as well as anti-inflammatory injections or physical therapy.

“Surgery is reserved for when non-operative treatment fails or non-operative treatment would prove ineffective to even try,” San Giovanni said.

In fact, surgery can lead to complications, as it did for Ares, who was previously treated elsewhere.

“Everyone wants the magic bullet, and they go to doctors that give them surgery,” Steinlauf said.

“Only go to a surgical option when all else has failed and your quality of life is bad and you are in pain.”

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