Your footwear can influence injuries and long-term issues in your ankles and feet.
Dr. Jason Bariteau, Assistant Professor of Orthopaedic Surgery Emory University School of Medicine Associate Residency Program, Director of the Department of Orthopaedic Surgery, and Director of Foot and Ankle Research Emory University School of Medicine, discusses how your high heels may be harming you.
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Ankle, Foot & High Heel Related Problems
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Learn more about Jason Bariteau, MD
Jason Bariteau, MD
Jason Bariteau, MD grew up in a small town just outside of Albany, New York. After completing his undergraduate degree in Biology at College of Saint Rose, he then pursued his medical degree at Upstate Medical University in Syracuse, NY where he graduated Magna Cum Laude. Following completion of his medical training he developed his surgical skills during his orthopedic surgery residency at Brown University. He then subsequently completed two advanced orthopedics fellowships; the first at Brown University in orthopedic trauma and the second at Baylor Medical Center in Dallas Texas under the tutelage internationally known Foot and Ankle Surgeon James W Brodsky MD. He currently resides in Atlanta, GA with his wife and three children.Learn more about Jason Bariteau, MD
Transcription:
Bill Klaproth (Host): High heel shoes can cause a number of ankle and foot problems yet; most women aren’t willing to give their high heels the boot. So, what can you do? Here to tell us more about ankle, foot and high heel related problems is Dr. Jason Bariteau, a specialist in foot and ankle and a Board-Certified Orthopedic Surgeon at Emory University. Dr. Bariteau thank you for your time. So, what are the risks and the potential harm that high heel shoes can cause?
Jason Bariteau, MD (Guest): I think there are a number of them. One of the big things we talk about is developing deformities of the toes like a bunion or a hammertoe. High heels certainly contribute to that. I think other things that women often present to my office with is overload of their metatarsal bone which is a bone sort of right behind their toes which is also known as metatarsalgia. That can often cause pain and limitations. And then the heels themselves often make the shoe a little bit unstable and often we see ankle sprains and ankle fractures from heel related issues.
Host: Well I was just going to ask you, are most of these issues due to wear and tear or are these problems due to slips and falls?
Dr. Bariteau: Well I think it’s a combination. I think the chronic issues like heel pain, plantar fasciitis can often be associated with a lot of time in heels or the metatarsalgia and the overload and definitely the forefoot deformities like a bunion and a hammertoe, the heels definitely contribute but sort of the acute injuries that we often see from patients, they are out, they are having a good time and they step wrong on their heels that can really exacerbate those ankle sprains or ankle fractures that we see and those acute injuries sometimes require acute surgery.
Host: So, acute injuries. Let’s get into those in a little bit. First, let’s talk about other things though that might happen with high heel shoes such as pinched toes, blisters, nail problems. You see all of those kinds of things too, is that correct?
Dr. Bariteau: Yeah, definitely. We definitely see that especially when someone hasn’t worn their heels for a while and then tries their heels again or has an injury or there is swelling; they can definitely squeeze the toes, they can definitely cause blisters. We even note that some patients can develop nail bed problems or nail changes. A fungal infection can either be more prone if you are in your heels more which is also known as onychomycosis and these nail and skin issues can be irritating and then there’s obviously those deformity type problems that we talk about that develop over time, the bunions, the hammertoes which also, because once you get those deformities and go into your heels which are tighter; can often exacerbate those skin issues. You know you get corns and calluses on the top of the hammertoe or sort of significant issues on the inside of the bunion in those high heeled shoes.
Host: So, for these non-acute injuries, the ones you were just talking about; how do you generally treat those?
Dr. Bariteau: Well I tell the patient first try to use their heels only when they absolutely need to. I try to tell them to wear them to the special occasions, church on Sunday, an important meeting at work, a wedding you are going to. Wear your heels when you need to, when you wan to look nice when it’s presentable. But just doing your everyday activities, if you can avoid being in those super high heels and wearing a flat-type shoe or a shoe with a good wide toe box I think is better. We then talk about trying to find the right type of heel. A heel that is more of a wedge than a true high heel. Something with enough room for the toes. I think there’s lots of options. More of a strappy or sandal type shoe can also be helpful than a true hard sort of hard leather type can also reduce some of those symptoms.
Host: Well that’s really good advice and then for the more acute injuries, those ligament and tendon injuries, sprained ankles that you were talking about; how about treatment for women suffering from those problems.
Dr. Bariteau: Yeah, so I think the biggest thing with those is not so much treatment but trying to do prevention. If you are prone to ankle sprains; trying to avoid getting into your heels unless you absolutely have to, practicing wearing your heels. As crazy at that sounds; when you get a new shoe if it’s a high heel you are not used to; practice wearing it, wearing it so that your balance is good. You want to avoid doing it when you are sort of in a crowded room or somewhere where you are not familiar with the environment because you are more likely to twist it and then sort of once you have those sprains and injuries; it is often seeing a surgeon like me or another orthopedist type specialist to make sure there isn’t anything that needs to be done acutely and then initially after those injuries, you probably want to avoid being in your heels if you can walk on it just because they are more likely to have a second injury if you are back in those heels too soon.
Host: So, sticking with prevention and I often see women who will be wearing tennis shoes to work but they are carrying their high heels, or they leave their heels at work. Is that another good way to do it, only wear them when you have to wear them?
Dr. Bariteau: I think that’s great. We know that sort of for some of the deformities that develop it is sort of a dose related response in the sense that the more you are in your heels and the more the toes have those sort of unusual stresses on them; the more likely you are to develop those bunions, those hammertoes. So, I think that’s a great idea if you only need them for certain times through the day and you can be in that flat shoe or that sneaker type shoe; it’s much less likely to both cause you the acute exacerbation and pain but also prevent some of those long-term issues that we often see in patients.
Host: So, Dr. Bariteau a couple of times you have mentioned deformities. So, for women who just can’t say no to high heels; do they face long-term deformities then?
Dr. Bariteau: Yeah, I mean we definitely know that women’s shoes dramatically increase the risk of bunions. A bunion is a sort of a malalignment of the bones on the inside of the foot. Classically, it’s thought of as a growth on the inside, but it’s really not. It’s just the toes are malaligned and the number one contributing factor we know of is shoeware. Women’s shoes are just not designed with a big enough toe box and oftentimes the heel contributes pushing that toe into a malaligned position and sort of the more they are in their heels, the more they are in those shoes with that narrow toe box; the more likely they are to develop those deformities and then that hammertoe deformity or that curling of those lesser toes has those same kind of issues because as you can imagine, the toes getting pushed into the shoe just by gravity and the toes begin to curl up and once those muscle imbalances develop, the patients often develop permanent deformities of their toes.
Host: Wow. Okay, that’s really interesting. So, let me ask you this question. For someone wearing high heels and is developing foot problems; does that then lead up the body to people having trouble with their knees and hips? Does this cause other health problems as well?
Dr. Bariteau: Well I think it’s – I don’t think we can directly relate high heels to sort of knee and hip issues, but I think what’s likely happening is oftentimes if they are in their heels a lot, they develop some toe and foot deformities and if those toe and foot deformities create an inability to sort of exercise normally, sort of walk with a typical pattern; those can certainly exacerbate some underlying hip or knee issues that pop up for those types of patients.
Host: Well this is really interesting. Making notes right now for my wife. Thank you Dr. Bariteau. So, when shopping for high heel shoes you kind of mentioned this a little bit, but maybe you can kind of go over this one more time. When shopping for high heel shoes, are there certain guidelines or things women should follow?
Dr. Bariteau: I would say try to wear the lowest possible heel as looks stylish and is a shoe that they are comfortable with, as wide a toe box as possible. I always tell that soft leather or strappy and sandal type shoes are better than the hard, tight leather type shoes. And think about something that’s as comfortable as possible when they are wearing it so that they can get as much enjoyment out of their shoes as they can and try to limit the amount of sort of secondary problems that pop up.
Host: Can I also say for a man who is a specialist in foot and ankle, having the last name Bariteau is very fitting.
Dr. Bariteau: My residents point it out to me all the time and there was one of my senior staff members who called me Dr. Toe for quite a few years in practice. I have definitely heard that before, but my patients point it out too.
Host: I love it. Well if you could wrap it up for us then Dr. Bariteau. What else should we know about foot and ankle problems associated with high heel shoes?
Dr. Bariteau: I think we should know that patients, it’s really the amount of time you are in your heels, trying to make as good a choice as possible with shoe ware. Only wearing those heels when you absolutely need them. Make sure you are comfortable when you are wearing them and make sure you have at least some time to practice in them. And then if those acute injuries pop up or those chronic problems develop; don’t hesitate to reach out to us, because those are problems we see all the time.
Host: What a very interesting subject and great tips and thoughts for us Dr. Bariteau. We really appreciate your time today. For more information please visit www.emoryhealthcare.
Bill Klaproth (Host): High heel shoes can cause a number of ankle and foot problems yet; most women aren’t willing to give their high heels the boot. So, what can you do? Here to tell us more about ankle, foot and high heel related problems is Dr. Jason Bariteau, a specialist in foot and ankle and a Board-Certified Orthopedic Surgeon at Emory University. Dr. Bariteau thank you for your time. So, what are the risks and the potential harm that high heel shoes can cause?
Jason Bariteau, MD (Guest): I think there are a number of them. One of the big things we talk about is developing deformities of the toes like a bunion or a hammertoe. High heels certainly contribute to that. I think other things that women often present to my office with is overload of their metatarsal bone which is a bone sort of right behind their toes which is also known as metatarsalgia. That can often cause pain and limitations. And then the heels themselves often make the shoe a little bit unstable and often we see ankle sprains and ankle fractures from heel related issues.
Host: Well I was just going to ask you, are most of these issues due to wear and tear or are these problems due to slips and falls?
Dr. Bariteau: Well I think it’s a combination. I think the chronic issues like heel pain, plantar fasciitis can often be associated with a lot of time in heels or the metatarsalgia and the overload and definitely the forefoot deformities like a bunion and a hammertoe, the heels definitely contribute but sort of the acute injuries that we often see from patients, they are out, they are having a good time and they step wrong on their heels that can really exacerbate those ankle sprains or ankle fractures that we see and those acute injuries sometimes require acute surgery.
Host: So, acute injuries. Let’s get into those in a little bit. First, let’s talk about other things though that might happen with high heel shoes such as pinched toes, blisters, nail problems. You see all of those kinds of things too, is that correct?
Dr. Bariteau: Yeah, definitely. We definitely see that especially when someone hasn’t worn their heels for a while and then tries their heels again or has an injury or there is swelling; they can definitely squeeze the toes, they can definitely cause blisters. We even note that some patients can develop nail bed problems or nail changes. A fungal infection can either be more prone if you are in your heels more which is also known as onychomycosis and these nail and skin issues can be irritating and then there’s obviously those deformity type problems that we talk about that develop over time, the bunions, the hammertoes which also, because once you get those deformities and go into your heels which are tighter; can often exacerbate those skin issues. You know you get corns and calluses on the top of the hammertoe or sort of significant issues on the inside of the bunion in those high heeled shoes.
Host: So, for these non-acute injuries, the ones you were just talking about; how do you generally treat those?
Dr. Bariteau: Well I tell the patient first try to use their heels only when they absolutely need to. I try to tell them to wear them to the special occasions, church on Sunday, an important meeting at work, a wedding you are going to. Wear your heels when you need to, when you wan to look nice when it’s presentable. But just doing your everyday activities, if you can avoid being in those super high heels and wearing a flat-type shoe or a shoe with a good wide toe box I think is better. We then talk about trying to find the right type of heel. A heel that is more of a wedge than a true high heel. Something with enough room for the toes. I think there’s lots of options. More of a strappy or sandal type shoe can also be helpful than a true hard sort of hard leather type can also reduce some of those symptoms.
Host: Well that’s really good advice and then for the more acute injuries, those ligament and tendon injuries, sprained ankles that you were talking about; how about treatment for women suffering from those problems.
Dr. Bariteau: Yeah, so I think the biggest thing with those is not so much treatment but trying to do prevention. If you are prone to ankle sprains; trying to avoid getting into your heels unless you absolutely have to, practicing wearing your heels. As crazy at that sounds; when you get a new shoe if it’s a high heel you are not used to; practice wearing it, wearing it so that your balance is good. You want to avoid doing it when you are sort of in a crowded room or somewhere where you are not familiar with the environment because you are more likely to twist it and then sort of once you have those sprains and injuries; it is often seeing a surgeon like me or another orthopedist type specialist to make sure there isn’t anything that needs to be done acutely and then initially after those injuries, you probably want to avoid being in your heels if you can walk on it just because they are more likely to have a second injury if you are back in those heels too soon.
Host: So, sticking with prevention and I often see women who will be wearing tennis shoes to work but they are carrying their high heels, or they leave their heels at work. Is that another good way to do it, only wear them when you have to wear them?
Dr. Bariteau: I think that’s great. We know that sort of for some of the deformities that develop it is sort of a dose related response in the sense that the more you are in your heels and the more the toes have those sort of unusual stresses on them; the more likely you are to develop those bunions, those hammertoes. So, I think that’s a great idea if you only need them for certain times through the day and you can be in that flat shoe or that sneaker type shoe; it’s much less likely to both cause you the acute exacerbation and pain but also prevent some of those long-term issues that we often see in patients.
Host: So, Dr. Bariteau a couple of times you have mentioned deformities. So, for women who just can’t say no to high heels; do they face long-term deformities then?
Dr. Bariteau: Yeah, I mean we definitely know that women’s shoes dramatically increase the risk of bunions. A bunion is a sort of a malalignment of the bones on the inside of the foot. Classically, it’s thought of as a growth on the inside, but it’s really not. It’s just the toes are malaligned and the number one contributing factor we know of is shoeware. Women’s shoes are just not designed with a big enough toe box and oftentimes the heel contributes pushing that toe into a malaligned position and sort of the more they are in their heels, the more they are in those shoes with that narrow toe box; the more likely they are to develop those deformities and then that hammertoe deformity or that curling of those lesser toes has those same kind of issues because as you can imagine, the toes getting pushed into the shoe just by gravity and the toes begin to curl up and once those muscle imbalances develop, the patients often develop permanent deformities of their toes.
Host: Wow. Okay, that’s really interesting. So, let me ask you this question. For someone wearing high heels and is developing foot problems; does that then lead up the body to people having trouble with their knees and hips? Does this cause other health problems as well?
Dr. Bariteau: Well I think it’s – I don’t think we can directly relate high heels to sort of knee and hip issues, but I think what’s likely happening is oftentimes if they are in their heels a lot, they develop some toe and foot deformities and if those toe and foot deformities create an inability to sort of exercise normally, sort of walk with a typical pattern; those can certainly exacerbate some underlying hip or knee issues that pop up for those types of patients.
Host: Well this is really interesting. Making notes right now for my wife. Thank you Dr. Bariteau. So, when shopping for high heel shoes you kind of mentioned this a little bit, but maybe you can kind of go over this one more time. When shopping for high heel shoes, are there certain guidelines or things women should follow?
Dr. Bariteau: I would say try to wear the lowest possible heel as looks stylish and is a shoe that they are comfortable with, as wide a toe box as possible. I always tell that soft leather or strappy and sandal type shoes are better than the hard, tight leather type shoes. And think about something that’s as comfortable as possible when they are wearing it so that they can get as much enjoyment out of their shoes as they can and try to limit the amount of sort of secondary problems that pop up.
Host: Can I also say for a man who is a specialist in foot and ankle, having the last name Bariteau is very fitting.
Dr. Bariteau: My residents point it out to me all the time and there was one of my senior staff members who called me Dr. Toe for quite a few years in practice. I have definitely heard that before, but my patients point it out too.
Host: I love it. Well if you could wrap it up for us then Dr. Bariteau. What else should we know about foot and ankle problems associated with high heel shoes?
Dr. Bariteau: I think we should know that patients, it’s really the amount of time you are in your heels, trying to make as good a choice as possible with shoe ware. Only wearing those heels when you absolutely need them. Make sure you are comfortable when you are wearing them and make sure you have at least some time to practice in them. And then if those acute injuries pop up or those chronic problems develop; don’t hesitate to reach out to us, because those are problems we see all the time.
Host: What a very interesting subject and great tips and thoughts for us Dr. Bariteau. We really appreciate your time today. For more information please visit www.emoryhealthcare.