The Irish Times Health Supplement caught up with Anne McGoldrick, Director of Medical Services of The Physio Company to find out how high heels are giving sports injuries a run for their money in casualties…
WE’RE ALL familiar with the term “fashion victim”. Formerly used to describe a shopper in thrall to the latest trend, this may perhaps now be applied more literally to the hoards of teetering women who are taking a tumble in the name of fashion.
Lately it would seem that stylish women are increasingly willing to risk life and limb by perching precariously atop a pair of skyscraper heels. The danger intensifies when dancing and alcohol are introduced into the mix and sadly it seems that even after you’ve kicked off the heels after a night out problems can still arise.
A report in the Australian Daily Telegraph last April described how ambulance paramedics operating in the southeastern state of New South Wales are reporting a rise in emergency calls from women who have sustained ankle fractures, dislocated knees, head injuries and broken wrists caused by falling from their towering shoes.
These are now more prevalent than sports injuries, it would seem. Australian podiatrists and chiropractors have also seen “dramatic” increases in chronic injuries from excessive wearing of extreme heels. Elsewhere, a recent US study established that women who regularly wear high heels may be at an increased risk of developing osteoarthritis of the knee, also known as degenerative joint disease. The findings, which were presented at the annual meeting of the American Society of Biomechanics, confirmed that the higher the heel the greater the risk.
So what is the situation here in Ireland? Are we also paying too high a price for our heels? According to Anne McGoldrick, practising chartered physiotherapist and medical director of both the Drumcondra Physiotherapy Sports Injury Clinic and the Physio Company, we undoubtedly are.
“There’s definitely an upward trend here in Ireland, particularly during the summer months. The reason for this seasonal variation is obvious really,” says McGoldrick. “It’s the backless and strapless type of shoe that women are more inclined to fall off.”
The type of injuries that McGoldrick most commonly sees women present with are “fractured wrists and hands but also dislocated shoulders from grabbing onto rails as they are falling”. Sometimes patients are reluctant to admit what has happened. “We see them in the post-traumatic stage and very often they present with an injury that has been treated, a dislocated shoulder for example,” says McGoldrick. “It’s only when they’re questioned that it transpires that the fall was as a result of wearing heels.”
Many of the injuries happen the morning after the night before. She advises women “not to jump out of bed” if they’ve been wearing heels the previous night. “Your calf muscles will have contracted, particularly if you’ve been dancing and you can easily tear them,” she says.
It seems that two distinct types of injury or damage are occurring: serious falls that may require a trip to A&E and also the plethora of non-traumatic injuries to knees, calves, ankles and feet.
Walking in high heels is an acquired skill. Without proper support, the ankle and foot move in a turned-out position that weakens the support given to the ankle making it easier to sprain. Ankle sprains can cause pain and sometimes swelling as a result of soft tissue damage around the ankle.
There are other risks too. The unnatural position of the foot when it is squashed into a shoe that is too narrow can also cause painful deformities such as hammer or contracted toe, bunions and Morton’s neuroma, a painful thickening of nerve tissue between the third and fourth toe.
In addition, the position that high heels force the wearer to adopt, with feet pointing downwards and pressure on the ball of the foot, can affect the posture. The natural S-curve shape of the back flattens and an added strain is placed on back muscles, causing back pain. Knee and hip pain may result from the additional work required from these joints to compensate for the position of the foot. Ultimately your ability to move your body forward may be noticeably reduced.
When women present at the clinic with injuries it is important to establish the cause. McGoldrick is clear that “we question them closely so that we can accurately and appropriately offer advice”.
An occasional devotee of heels herself, she offers the following very pragmatic advice: “Don’t hang up your heels, just listen to your body.” Specifically she advises that women “try to keep the heels under two inches for day-to-day wear. If you must go higher then wear them minimally.”
McGoldrick is realistic enough to realise that there are unrepentant women out there who will never be parted from their towering heels. She advises dedicated wearers to “maintain good calf muscle strength. Perform calf stretches at least twice a day and keep your core stability strong. That way you’ll minimise the risk.”
It may be the last thing on their minds when they hit the shops, but women keen to add a couple of inches should keep the health risks in mind as they flourish the credit card. McGoldrick believes that “people don’t think about which type of shoe is safest. Wedges and box heels are better than stilettos, where the heel has a very small surface area. “Leather stretches and has a bit of give in it and if your feet are two different sizes as many people’s are, fit the shoes to the larger foot.”
One fashion innovation that potentially offers the ideal solution comes in the form of “Flatforms”, best described as level platform shoes. Unlike platform heels, where the ball of the foot is much lower than the heel, Flatforms elevate the whole foot and replicate the comfort and safety of wearing flat shoes.
Perhaps we can add the inches yet avoid the damage and injuries after all.