High-heels may lead to heel and ankle pain

Study finds no corresponding pain in men

Women should think twice before buying their next pair of high-heels or pumps, according to researchers at the Institute for Aging Research of Hebrew SeniorLife in a new study of older adults and foot problems.

The researchers found that the types of shoes women wear, specifically high-heels, pumps and sandals, may cause future hind-foot (heel and ankle) pain. Nearly 64 percent of women who reported hind-foot pain regularly wore these types of shoes at some point in their life.

"We found an increased risk of hind-foot pain among women who wore shoes, such as high-heels or pumps, that lack support and sound structure," says lead author Alyssa B. Dufour, a graduate student in the Institute's Musculoskeletal Research Program.

Published in the October issue of the journal Arthritis Care & Research, the study is one of the first to examine the association between shoe wear-beyond just high-heel use-and foot pain. The researchers, who analyzed foot-examination data from more than 3,300 men and women in The Framingham Study, say past shoe wear among women is a key factor for hind-foot pain. They found no significant link between foot pain and the types of shoes men wear.

While foot pain is a common complaint in the U.S. adult population-foot and toe symptoms are among the top 20 reasons for physician visits among those 65 to 74 years of age-relatively little is known about the causes of foot pain in older adults. Women are more likely than men to have foot pain; however, it is not known if this is due to a higher prevalence of foot deformities, underlying disease, shoe wear, or other lifestyle choices.

From a list of 11 shoe types, study participants were asked about the one style of shoe they currently wear on a regular basis, what they regularly wore during five age periods in the past, and if they experience pain, aching or stiffness in either foot on most days. Nearly 30 percent of women and 20 percent of men reported generalized foot pain, which is in line with other foot-pain studies. Ms. Dufour's team, however, found a significant association in women who reported hind-foot pain and past shoe wear that included high-heels and pumps.

The shoe types were classified as "poor" (high-heels, pumps, sandals and slippers), "average" (hard- or rubber-soled shoes and work boots), and "good" (athletic and casual sneakers). More than 60 percent of women reported wearing "poor" shoes in the past, compared to only 2 percent of men (13 percent of women said they currently wear "poor" shoes).

When we walk, a significant biomechanical shock is delivered to the foot each time our heel strikes the ground. "Good" shoes, such as sneakers and other athletic footwear, often have soles and other features that soften this shock and protect the foot. The heel and ankle take the brunt of this shock, which may be why women who wear high-heeled shoes often report pain in this part of the foot.

"Young women," says Ms. Dufour, "should make careful choices regarding their shoe types in order to potentially avoid hind-foot pain later in life."

Scientists at the Institute for Aging Research conduct rigorous medical and social studies, leading the way in developing strategies for optimizing individuals' strength, vigor and physical well-being, as well as their cognitive and physical independence, in later life. Hebrew SeniorLife is a 105+-year-old organization committed to maximizing the quality of life of seniors through an integrated network of research and teaching, health care and housing.

Wear Properly Fitting Shoes

Poor fitting shoes can cause a number of foot problems for diabetics and non-diabetics alike. They can cause bunions, corns, calluses, hammertoes and other disabling foot problems that are a significant public health risk in the United States. More than 43 million Americans have foot problems, many of which are serious enough to warrant medical attention.

Alyssa B. Dufour, a graduate student in the Musculoskeletal Research Program at the Institute for Aging Research of Hebrew SeniorLife and the lead author of a recent study on shoe wear and foot pain, suggests the following tips for making sure your shoes fit properly:

• Comfort-rather than style or fashion-should rule shoe selection.
• Judge shoes by how they fit, not by the size marked on the box; shoe sizes vary by brand and style.
• Have both feet measured when you purchase shoes; foot size increases with age.
• Fit shoes to your longest foot; most people have one foot that is larger than the other.
• Avoid high-heels and shoes with pointed or tapered toes.
• Fit shoes at the end of the day when your feet are their longest.
• Try on both shoes and walk a few steps to make sure they are comfortable.
• When the shoes are on, wiggle your toes to ensure that you can move them freely.

Ms. Dufour says to keep in mind this basic principle: your shoes should conform to the shape of your foot-your feet should never conform to the shape of your shoes.

Source: Hebrew SeniorLife Institute for Aging Research