Recently, my 16-year-old daughter came home with what she described as the "cutest" high-heeled shoes. For so many reasons (I am her father), I was unhappy to see them. What I said to her reflected my vague understanding that high-heeled shoes distort the spine and affect her health in some negative manner. Now it is time to put together the facts. Are fashion-conscious women sacrificing their health, safety, comfort and agility for the sake of style?Very few of us are born with foot problems; most conditions are felt to arise from simply not taking proper care of our feet. Women are four times more likely than men to have these issues, which is most likely due to the shoes they wear. According to the American Orthopedic Foot and Ankle Society, we take an average of 10,000 steps per day. High heels shift the focus of each of those 10,000 steps so that most of the pressure ends up on the ball of the foot and on the bones at the base of the toes, whereas "flat" shoes spread the weight over the entire foot. A three-inch heel (anything over two inches is considered high) creates three to six times more stress on the front of the foot than does a one-inch heel. Women account for roughly 90% of the nearly 800,000 operations every year for bunions and hammertoes. The most immediate result of wearing high heels is a change in the center of balance and a loss of agility. It is much easier to fall, and injuries occur more frequently. When walking in high heels, the foot is fixed downward, making it difficult to push off the ground with very much force. The hip flexor muscle, located in the upper front thigh, must work much harder and longer to propel the body forward. If these muscles are constantly overused, they can shorten and a contracture can occur. That, in turn, may lead to a flattening of the lumbar (low-back) spine. The normal s-curve of the back is designed to act as a shock absorber, reducing stress on the vertebrae. The resulting backward shift of the head and mid-spine leads to muscle overuse, back strains, and sciatica. Knee problems are twice as common in women then men. High heels may be partly responsible, as they cause the knees to stay flexed (bent). This position puts a constant strain on the inside of the knee, a common site for osteoarthritis. High heels limit the motion and power of the ankle joint. The calf muscles are shortened, which causes them to lose power when pushing off the ground. This in turn can increase the pull of the Achilles tendon and lead to tendonitis. When the feet are put into a downward position, there is also a significant increase in the pressure on the bottom of the forefoot. The pressure increases as the height of the shoe heel increases. High heels with narrow toes may lead to a thickening of nerve tissue, which causes a lump on the underside of the foot, or a neuroma. A neuroma is typically found between the third and fourth toes, and leads to toe pain and numbness. Bunions are a bony swelling at the base joint of the big toe. This leads to the big toe curving toward the other toes, with the bump often becoming swollen, inflamed, painful and unsightly. The skin on the foot can also be affected. A narrow, pointed toe box can lead to corns, calluses and blisters. Note that on a baby or a toddler's foot, the toes tend to spread apart. On an adult's foot, the toes tend to be squished together. If the shoes you are wearing compress your feet or shift your body out of alignment, you can bet that you will run into trouble of some sort. To save your feet and body, my recommendation is to wear high heels only rarely, and even then a heel height of only one and one-half inches. Your feet and body will thank you - and our orthopedists and podiatrists will have far more free time on their hands. I wish you good health and attractive (even if less fashionable) footwear. Dr. Alan Frischer is former chief of staff and current chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

********** Published: March 26, 2010 - Volume 8 - Issue 49