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In the news, over the last few weeks, has been the topic of whether our footwear, namely flip flops and high heels, are hazardous to our health. But  before we go into that, let’s take a look at the history of both.

The particular type of flip flops that we are familiar with go back to the Ancient Egyptians 4000BC. They were also worn by the Masai of Africa, in India, China and Japan. Our style of flip flops were bought back to the United States after World War II by the soldiers.

Some historians suggest that high heels have been around as early as 3500 BC. There has been depictions of high heels that could be seen etched in murals on Egyptian temples and tombs. They were not only worn by women, but men also wore them. It is said that medical professionals have been warning high heel wearers about the dangers of such shoes for the same amount of time, according to Gerald McGwinn, epidemiology professor in the UAB School of Public Health.

Flip Flops

Flip flops are not designed for prolonged use or walking long distances. They should only be worn casually and for shorter periods of time. Flip flops lack the support that a walking or running shoe provides. And for those of you who keep bringing those same ones back out year after year, experts warn that you should replace them often, despite the fact that you believe them to be comfy and “broken in”. They actually say you should replace them every few months. For some of us who live in areas of seasonal changes, that means replace them when that Summer season re-emerges. And for those of you who enjoy “Summer” weather all year round, then listen to the experts.

Wearing flip flops can cause lower leg pain and changes in stride (according to research presented at the 55th annual meeting of American College of Sports Medicine). Statistics show a significant decrease in vertical (straight down) force in flip flops vs sneakers. This decreased force may explain anecdotal evidence that flip flop wearers alter their normal gait and may shed light into why some experience lower leg pain. Flip flops also make feet roll inward, stretching ligaments and tendons, which pull toes out of alignment and causes pain and bunions. Flip flops hurt feet as much as high heels because they offer no support or protection to the feet.

High Heels

New research  finds injuries related to heels nearly doubled in the U.S. in a recent 11 year period. U.S. emergency rooms treated 123,355 high-heeled related injuries between 2002 and 2012 say researchers from the University of Alabama at Birmingham. More than 19,000 of those injuries occurred in 2011 alone.


What are some other injuries associated with high heels? When wearing high heels, in most cases, 80% of your weight is on the toes. The study also found that sprains and strains to the foot and ankle are the most common complaints (most of these were patients in their 20s and 30s). Discomfort in the lower leg, ankle and foot are common. Wearing heels inhibits the movement of the ankle muscles and reduces step length and overall range of motion. They can also cause people to lose their balance, which could lead to other injuries if they fall down.

A study published online recently by the Journal of Foot and Ankle Injuries reported that more than 80% injuries are to the ankle and foot. Slightly less than 20% involve the knee, trunk, shoulder or head and neck. About 1 in 5 of these accidents resulted in a broken bone, according to the study.

According to the American Osteopathic Association: 1 in 10 women wear heels at least 3 days a week and 1/3 have fallen while wearing them. Researchers estimate the average high heel can start to cause pain after just 1 hour 6 minutes 4 seconds of wearing it. Twenty percent start to feel pinching after only 10 minutes of slipping on a heel. Fifty-nine percent report toe pain as a result of uncomfortable shoes. Pain in the ball of the foot was reported by 54%. Studies show that women who wear high heels daily tend to be younger and are more likely to wear uncomfortable shoes. Younger women are more likely to experience blisters and pain in the arches of the feet than older women. Older women are more likely to experience corns, calluses and bunions. Statistics show high heels is one of the biggest factors leading to foot problems in women with up to 1/3 suffering permanent problems as a result of prolonged wear.

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  • Blisters 55%
  • Cracked Heels 45%
  • Corns 24%
  • Ingrown Toenails 20%
  • Joint Problems 11%
  • Bunions 13%

Frequent wearing of high heels sets one up for long-term issues. Extended wear and continuous bending of the toes into an unnatural position can cause a range of ailments from ingrown toenails to irreversible nerve damage to leg tendons. A narrow toe box that is present in high heels can lead to bunions and that above stated nerve damage. Extended wear is also linked to overworked or injured leg muscles, osteoarthritis of the knee, plantar fascititis and lower back pain. Also, over time, high heel wearing can shorten the muscles in the calves and in the back, leading to pain and muscle spasms. The shortened Achilles tendon happens once the heel is pointed upwards, it tightens up. Stretching it again or switching to flats can be very painful. With repetitive wear, you can develop unhealthy patterns that can persist even when you’re not wearing high heels.

What constitutes a “high heel”? A shoe with a heel height greater than 2 inches. When the heel is 2 inches or higher, the foot slides forward in the shoes, forcing the toes into that unnatural shape of the shoe and redistributing your weight incorrectly. Increased weight on the toes causes the body to tilt forward and to compensate, you lean backwards and over-arch your back. “The change to the position of the spine puts pressure on the nerves in the back and can cause sciatica, a condition where the nerves become trapped, triggering pain and numbness as far down as the feet, ” says Dr. Natalie A. Nevins, an osteopathic physician from Hollywood, California.


Image Credit: Simply Chiropractic Tampa

Some of you non-high heel wearers may be asking the question, so why do women wear high heels if they can do harm? Some of the reasons include: to have legs that appear longer, sex appeal and to add height. According to a survey, 72% of women wear high heels, with 34% wearing them daily. 82% of those surveyed prefer high heels, 73% wear them to complete their professional attire; 54% feel they look sexier and more attractive in heels; 48% say to enhance their legs and to appear taller 39%. One study says taller people make more money. The Australian study asserts that “taller people are perceived to be more intelligent and powerful”. Adding a fabulous pair of heels into the mix could be enough to help you climb the next rung of the career ladder.

Ok, ok, now the million dollar question. Do we have to give up wearing our high heel shoes? Of course not! But to avoid problems that develop over time we can follow these routines:

  • Choose sensible heels (low heels- 1 inch or less, with a wide heel base or a slightly thicker heel will help to spread the load more evenly; narrow stilettos provides very little support)
  • Wear soft insoles to reduce impact on the knees
  • Make sure the shoes are the right size (prevents foot from sliding forward, putting more pressure on the toes; pick a shoe with a wide enough toe box to allow the toes to wiggle)

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  • Wear heels on days that require limited walking or standing
  • Alternate shoe choices throughout the day or from one day to another (high heels one day, comfy flats the next day); Don’t wear the heels all day (carry comfy shoes to change into if feet start to hurt)
  • Do Stretches Daily

Don’t let style get in the way of your ability to stand or step pain-free. “Your feet are, quite literally, your base of support. If your feet aren’t happy, nothing above them will be,” says Dr. Nevins. “Take a closer look at your shoe selection and take small steps now to prevent big foot problems later”.

The information in this blog post is for informational purposes only. For medical advice you should contact your personal physician, podiatrist or other medical professional for advice and/or treatment.