April 18, 2001

INTELIHEALTH FEATURE-

So you gave up on stiletto heels because those wide-heeled, boxy-toed pumps are sooooo much more comfortable? That might be so, but if the heel is high the shoes are still bad for your knees, according to a study from Harvard Medical School.

D. Casey Kerrigan, M.D., who found in a 1998 study that narrow-heeled shoes can put strains on the knees that could lead to osteoarthritis, now says in a new study that wide-heeled shoes are no better.

Dr. Kerrigan, principal author of the study published in the April 7, 2001, issue of The Lancet, a medical journal, said she realized after completing the earlier study that wider-heeled shoes needed to be studied too.

"People wearing wide heels may think they're sensible, but they're not," she said. Although wide heels might be less likely to cause bunions or hammer toes, the women actually might face increased risk of knee problems because they may wear the shoes longer since they are more comfortable, she said.

The study found that walking in both wide-heeled and narrow-heeled shoes increases the normal varus torque of the knee — by 26 percent and 22 percent, respectively — compared with walking barefoot.

In this case, varus torque means the effects of weight applied off to the side of the knee rather than directly over the joint, said Dr. Kerrigan, an associate professor of physical medicine and rehabilitation at Harvard. Wearing high heels "increases the torques that would place greater forces on the medial or inside part of the knee," she said.

"By increasing those forces on the inside of the knee, you will probably increase the likelihood of osteoarthritis," she said. "There's already a tendency to develop osteoarthritis on that side of the knee, but this just exacerbates it."

Knee osteoarthritis, a painful condition caused by deterioration of cartilage, is twice as common in women as in men, she said.

The study calculated torque using a six-camera, video-based motion analysis system and other measuring devices embedded in a laboratory walkway to record 20 women as they walked barefoot, wearing wide-heeled shoes and wearing narrow-heeled shoes. The women wore their own shoes, which had an average heel height of 2 ¾ inches. Narrow heels averaged about 3/8 inch wide and wider heels about 1 ¾ inches.

Bill Boettge, president of the National Shoe Retailers Association, said he did not think the research would have any impact on the shoe-buying habits of women.

First, he cited the steady downward trend in purchases of dress shoes as casual dress has become more popular in the workplace. Association statistics show dress shoes, which includes all heel heights, dropped from 35 percent to 26 percent of the women's shoe market between 1989 and 1999.

"We don't have the era of the '70s and the '60s and even the early '80s when women were wearing 3-inch heels for most of the day," he said.

Because they are wearing heels for shorter time periods and for reasons other than work, he said, "I think it's possible to dismiss a report like this by saying either it won't happen to me or I don't wear them that much, maybe dancing on Saturday night."

Besides, he said, "they love the way it looks and their husbands or boyfriends give them compliments when they wear it. People like compliments."

Still, Dr. Kerrigan said she hopes women will simply stop wearing high heels. She believes that future research will likely confirm that wearing high-heeled shoes for even short periods of time increases the risk for knee osteoarthritis.

"As a rehab doctor I especially appreciate how truly disabling knee osteoarthritis is," she said. "There's just very little effective treatment for knee osteoarthritis once you have it."

Used with permission of the copyright owner. All rights reserved. This article is not intended to provide advice on personal medical matters or to substitute for consultation with a physician.