Feet, Shoes, Women, and Heels

The average person takes 8,000 to 10,000 steps a day. Most people take their feet for granted. Foot pain is not normal. Feet are often the place where health warnings can be found. They are often where the first signs of circulatory disorders, diabetes, arthritis, and other systemic diseases are seen.

One in every six persons has trouble with their feet. Foot related problems have kept one in five people from taking part in sports, work, and/or leisure activities. 80% of all foot problems occur on women.

In today’s society, many women wear high-heeled shoes. Studies show that 88 percent of American women cram their feet into shoes that are too small, too narrow, too pointy, with heels too high.

About 80 percent of Western women report foot pain. Women admit high heels make their feet hurt, but they tolerate the discomfort in order to look more stylish, taller, and more professional.

Shoes have been implicated as being responsible for the majority of foot deformities and problems that physicians encounter in women.

glass shoes

Although shoes have been worn for thousands of years for the main purpose of protecting feet from the environment, recent studies have implicated shoes as the principle cause of forefoot disorders in females.

Americans (mostly women) spend an estimated $2 billion a year on surgery related to footwear. More than 90 percent of foot surgeries in America are performed on women. Women have about 90 percent of the nearly 800,000 annual surgeries for neuromas, bunions, and “hammer toes”.

Women are their own worse enemies when it comes to foot problems. Dress shoes, in particular, cause the most problems for women. The most beautiful shoes are not necessarily the one that are the best for our feet. The problem with most women’s show styles is that they all are more narrow than a bare foot, and the front of the shoe is tapered, which forces the toe joints to buckle. Over 90% of foot problems in women are self-imposed and related to footgear. At least 85% of elective surgery for bunions, hammertoes, and neuromas are performed on female patients. Most women will squeeze their foot into a shoe that is too small.

Studies show that 90% of women wear shoes that are at least a size-and-a-half too small. The result is obvious, bunions, hammer toes and pain.

HISTORY
The first human being stood upright about 1 million years ago. The unshod foot seems to have had minimal problems. Throughout history, members of human societies have gone barefoot, and those societies seemingly had a low incidence of foot deformities and pain.

Initially shoes were made in the shape of the foot and were sandals. Over time, shoes became decorative items and symbols of status and vanity. As the shape of shoes changed, they became deforming forces on the foot and the source of pain.

GENDER DIFFERENCES
Females are different from males in structure and biomechanics. The foot in the female tends to have a narrower heel in relationship to the forefoot and overall is narrower than a male foot relative to length.

Females tend to pronate their feet more and have smaller Achilles tendons than males, both factors having implications for shoe fit.

Aside from an occasional toe ring or painted nails, the biggest variant between women’s and men’s feet is the relationship between the heel and the forefoot, or the “ball” of the foot. Women tend to have a narrower heel in relation to what’s called their “ball girth”, or the circumference of the ball of their foot.

Women have smaller feet than men. Women have thicker ankles and calves, higher arches and narrower heels. A woman with the standard foot size common to men and women would have about three quarter of an inch greater calf circumference, and that would be about a quarter of an inch higher.

Women’s ankles are about one-quarter inch closer to the ground, and men’s big toes are a little thicker.

Differences in foot size tend to emerge as early as three years old. Children’s feet grow proportionally about 8 to 10mm a year until adolescence, which typically starts around 12 in females and 15 in males. After this time, males have a more rapid growth spurt than females. Men’s feet are both longer and wider than women’s feet. Men’s feet also spread more when they stand.

That is why it so important to walk around when a person tries on shoes.

Women’s bones are thinner and the ligaments may be looser, leading to more flexibility.

As a person ages, their feet continue to get longer and wider. It also loses the fat pads that provide cushioning. All of these factors lead to a change in shoe size a person gets older, yet most people continue to buy a standard size forever. Most women will buy a shoe that does not fit comfortably, simply because they like how the shoe looks on the foot. Shoes don’t let joints move normally the toes and don’t let the muscles work to full advantage.

Hammertoes are about six times more common in females than in males.

Men will have more problems with tendon tears and fractures. Men are diagnoses with ruptured Achilles tendons about five times more often than females. This is likely a result of “weekend warrior syndrome”. Osteochondroma, which is a growth of bone under the toenail that grows outward and causes pain, is also seen more in young males.

People are very emotional about shoes and shoe sizes.

Many shoe manufacturers don’t know what a woman’s foot is really like, and those that do know aren’t telling.

Sports shoes are the most likely to be designed to conform to the anatomy of a woman’s foot.

Even here, however, there is no way to be sure that companies which studies women’s feet incorporate everything they have learned.

Most shoemakers base women’s shoes on a last, the form on which the shoe is made, that is a scaled-down version of a men’s last.

Women are not men with smaller feet. Researcher Peter J. Cavanaugh of Penn State University and graduate student Roshna E. Wunderland examined data on the anatomy of men’s and women’s feet. Their findings are reported in the April 2001 issue of the American College of Sports Medicine journal, Medicine and Science in Sports and Exercise. It’s the first journal article to publicly list sex differences in feet.

In our society, women generally choose shoes that are not good for their feet to walk around in on a daily basis.

One study found almost 90 percent of women were wearing shoes that were smaller than their feet, by an average of one half inch.

Women’s shoes tend to be narrow in the forefoot, cramping the toes and causing bunions. Women commonly complain that their shoes are too loose in the heel. So a shoe that fits in the back of the foot might be to tight in the front.

Matching the shape of the shoe to the shape of the foot would cut the number of injuries.

It would be a public service if the bigger sports companies would make their anatomical data public so other manufacturers could use it.

Companies are loath to do that. They figure they paid for what they know, they get a competitive advantage from it, and they will keep it.

Feet are getting bigger as the decades pass – and shoes aren’t keeping pace.

The average American woman wears a size 9 today. That compares with a size 5½ or 6 in the 1960s, according to the Professional Shoe Fitting Manual, a shoe-size training book by podiatric historian William Rossi.

Men’s feet have grown, too, but not as much as women’s, according to the national Shoe Retailers Association. The average American man wears a half size larger – a 10 or 10½ – compared with 20 years ago.

This widening and lengthening of feet is part of a head-to-toe expansion nationwide. Americans overall are simply getting bigger.

Adults are about an inch taller and close to 25 pounds heavier than in the 1960s, according to a recent report from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

Podiatrists say that a larger girth, combined with daily plodding over hard surfaces such as concrete and shopping mall floors, forces the foot to flatten and lengthen.

Wedging feet into too-small shoes can lead to all manner of foot-related problems such as hammertoes, corns and bunions.

There are technically 28 measurement points on the foot, but most people don’t take the time to get fitted properly.

If the shoe is too small, the foot pronates, or rolls over, against the ground. The longer the foot is in this confined space, the greater the chance for problems to occur.

Low-heeled shoes provide greater stability, more protection for the feet, and greater comfort.

Surprisingly, flat shoes are not the ideal for overall foot and leg health. Low heels of one-half to three-quarters of an inch are optimal for both the front and back of the foot.

Mid-heels or heel that are between 2 and 2½ inches with regular soles (no greater than a quarter of an inch) should be treated like high heels. Mid heels have the same effect as high heels do in every way, only milder.

Humans are plantigrade animals, which means that we stand on the whole foot, and not just on the ball of the foot or the toes. Plantigrady is not too common among mammals, and reflects the primitive (closer to the ancestral type) condition more similar to that which is seen in reptiles.

The human foot still shows the tell-tale signs of our tree dwelling ancestry. But, its shape has changed to facilitate walking on the ground.

In general, people carry approximately four to six times their body weight across the ankle when climbing stairs or walking on steep inclines.

A 2-½ inch high heel can increase the load on the forefoot by 75%.

As foot length increases, forefoot width increases to a greater extent than heel width.

Several authors have reported the harmful effects of shoewear and the greatest factor is a shoe that is improperly fit.

Wearing high heels leads to changes in load distribution beneath the foot and can be detrimental to foot structure.

High heels (higher than two inches) are nearly impossible to properly fit with orthotics.

The belief that wearing high-heeled shoes increases lumbar lordosis is firmly ingrained in clinical folklore.

With higher shoes, your feet tend to slip forward.

A stable heel is also important to the well-being of the foot and ankle.

Common high heel injuries include sesamoiditis (inflammation and swelling), neuromas (nerve damage), metatarsalgia (pain in the ball of the foot). Less frequent but all too common high heel-related injuries include ankle sprains and even bone fractures of the foot.

Such common maladies as bunions or hammertoes are accelerated by ill-fitting or excessively high heels.

Walking in these shoes will change your gait pattern, which can affect your legs and back. Such longer term conditions as arthritis in the toe and ankle joints can be exacerbated by excessive wearing of high heels.

Women with a higher arched foot have more tolerance for a higher heel.

Bunions are hereditary, but they can get aggravated when trendy shoes and heels are worn.

Older women have more trouble with their feet than younger ones; fat pads on the bottom of the feet tend to deteriorate in the aging process.

Orthopaedic Fast Facts
In 2000, more visits to physician’s offices were made for musculoskeletal conditions than for any other reason. Musculoskeletal conditions include injuries to the bones, joints, muscles, ligaments or tendons and conditions such as arthritis or osteoporosis.

Musculoskeletal disorders cost the U.S. $215 billion yearly.

Approximately 13 million visits were made to physicians offices due to foot, toe, and ankle problems in 2000.

At least 15% of patients with diabetes will develop foot problems, many of which can be prevented.