When Patients Insist On Wearing High Heels

Jenny L. Sanders, DPM

While podiatrists strongly advise patients to avoid wearing high heels, the reality is many patients will continue to wear them. With this in mind, this author emphasizes patient education on ensuring optimal fit and support, reviews key features to promote better stability, and discusses helpful shoe modifications.

Every podiatrist understands the potential for foot and ankle problems that are created when women wear high heels. Bunions, hammertoes, metatarsalgia, corns, calluses, neuromas, ankle sprains and ingrown toenails are all conditions we treat that are directly caused by or, at the very least, made worse by tight-fitting, high heeled shoes.

   Unfortunately, even though we strongly advise patients to avoid wearing high heels, our words fall on deaf ears. The minute our female patients walk out of our office, their sensible shoes come off and the towering stilettos go back on their feet.

   In an effort to at least meet our patients halfway, it is important that we are able to teach women how to make better choices when purchasing high heels and also how to improve the fit of these otherwise ill-fitting shoes. The following provides a foundation and some tools for you to share with your patients who insist on wearing high heeled shoes.

   We all realize the last of the shoe determines the size, shape and certain style features of the shoe.1 Most patients understand that shoe sizes vary from manufacturer to manufacturer but there is a common misconception, especially among women wearing high heels, that sizing and fit within a brand are consistent and uniform.

   For example, patients will often say, “I can only wear Nine West” or “I can only wear Steve Madden shoes” because they believe that all other brands of high heels do not fit their foot correctly. Nothing could be further from the truth. With any given brand, there will usually be some shoes that fit and others that do not fit. Our job is to educate patients about this fact and guide them toward styles or features appropriate for their particular foot type.

Educating Patients About Changing Foot Sizes

It is surprising how many women have their feet measured and sized as teenagers and never have them measured again. It is not uncommon for a woman to be wearing a size 7 when the actual current measurement is size 9. This is especially true if a woman has had children or gains or loses a significant amount of weight.

   Equally surprising is when I ask patients what size shoe they wear, I often will hear them say a size 9 in athletic shoes and size 8 in high heels. Wearing shoes smaller than their measured foot size is one of the worst offenses I see women make when wearing high heels. If they consistently have to go smaller to keep a high heel on, there is something wrong with the design of the shoe.

   Another area of misunderstanding is that of shoe size increments. Women are often shocked to learn that when they are correctly measured, they are one to two sizes longer than they thought they were. However, explaining to them that there is only 1/3 inch for each full size increase and 1/6 inch for each half size increase goes a long way to calming anxiety about having larger feet.2

Why Heel-To-Ball Is The Only Measurement That Matters With High Heels

The Brannock Foot-Measuring Device was patented in 1927 and is still the gold standard for foot measuring today.3 It determines both heel-to-toe and heel-to-ball or arch length.

   Ninety percent of the women I see in my office are wearing the wrong size shoe, especially when it comes to high heels. Why? They are relying on heel-to-toe measurements. Unfortunately, heel-to-toe measurements are impossible to use as a guide due to the variability of toe-box lengths. When fitting high heel shoes, the only measurement that matters is heel-to-ball.


I found this article particularly interesting as I am sure others have. That little trick with the toe comb I had not thought of. Thank you.

Do high heels really "cause" bunions?

The biomechanics of bunions are directly related to hypermobility in the midtarsal joint stemming from instability of the subtalar joint. So how does wearing high heels — which if anything supinate the foot — lead to bunions?

I think prolonged use of flip-flops leading to mild equinus (no stretching of the calf muscles) is a stronger influence of bunion formation then high heeled shoes.

Please explain your position biomechanically.

I have maintained that shoes act as a catalyst to either speed up or slow down the progression of a deformity. But to cause a deformity is more do to with inherent biomechanical makeup and how we accommodate to the ground reactive forces.

Lyle Nali, DPM

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