Excessive reliance on high heels leads to shorter calf muscles, making it painful to walk barefoot or in flats. Image Credit: Supplied picture

My name is Kate Birch and I’m addicted to heels. There, I’ve said it. My four-inch (10-centimetre) heel habit is out in the open and I can move on… in my skyscraper stilettoes, of course. Thankfully, I’m not alone. Beyoncé is hooked on heels (“I love the super-high shoes that are out. I’m addicted”) while Eva Longoria admits to wearing them all the time, and always ones over four inches; she even does aerobics in them.

These days though, Eva’s and my four-inch habits seem positively pedestrian, with stilettos staggering to dizzying heights of 10 inches. Is that even legal?

A decade ago, the most popular red-carpet Jimmy Choo was the Smooth, a moderate 3.3-inches; today, it’s the Kalpa, just shy of six. In the past five years, fashion gurus have been falling over themselves to outdo one another in the high-heeled stakes. In 2008, after 30 years of sticking to five inches, Manolo Blahnik unveiled six inches.

The following year, six inchers hit the high street,
while high-end designer Christian Louboutin revealed an
eight-incher. And so it goes on.

And while the coming season is more about comfy chic – platform-free pumps, low-ish heels – there are some towering treasures to be had: Brian Atwood’s pre-Fall collection includes a dizzying duo – a 6.5-inch heel and 2.5-inch platform on a yellow lizard Mary Jane – while Prabal Gurung’s Fall 2013 footwear collection features
five-inch gold spindly heels.

Falling from a dizzying height

This high-end shopping list is enough to make podiatrists panic. And they have good reason. “We frequently see trauma injuries in our clinic, from sprained ankles to broken wrists and head injuries, not to mention detached toenails from people who have been stood on by a high heel,” explains founder and chief podiatrist of Dubai Podiatry Centre, Michelle Champlin.

A-list accidents due to silly shoes are nothing new (the most recent one involved British TV presenter Carol Vorderman, who broke her nose after falling down stairs in her towering heels), but there’s been an increase in the real world too.

Michelle cites a recent Australian study showing a significant increase in paramedic call-outs for footwear-related falls of women, many resulting in ankle fractures, broken wrists and dislocated knees.

We’ve all been there, of course. I’ve had my fair share of high-heel horrors – though more humiliating than harmful, with the loss of my Sergio Rossi heel in a Dubai roadside grille a particularly painful point in my shoe life.

OK, so heels may well be dangerous, but they make me feel good. Like actress Meg Ryan (“When I wear high heels, I have a great vocabulary and I speak in paragraphs. I’m more eloquent”) heels give me confidence, making me more fluid, funnier, fearless.

The footwear equivalent of red lippy, slipping on a
pair of ‘nines’ – industry shorthand for 9-centimetre (3.5-inch) heels – is quite simply the quickest beauty fix on the planet. Shoe queen and co-founder of Jimmy Choo Tamara Mellon admits a pair of stilettos make her feel “empowered and feminine”.

Much of this power comes from height, posture and body shape: your legs look longer, your feet slimmer, your curves more voluptuous, your back more arched and your walk and posture more feminine. And, apparently, high heels raise the buttocks around 20-30 degrees – a fabulous asset for older women, in particular, and necessary when you work in an office of stunning twenty-somethings.
I should know.

As Linda O’Keefe, author of Shoes: A Celebration of Pumps, Sandals, Slippers and More writes, “Physically, it is impossible for a woman to cower in high heels. She is forced to take a stand, to strike a pose… and added height provides psychological empowerment to the wearer.”

Doing damage

But while we in the heel-high club view the situation from five inches up, the experts see it from a ground level perspective and what is wonderful to us – lengthening
of legs and uplifting of bottoms – is equally destructive
to us, they say.

High heels force the wearer to alter the natural alignment of her body, thereby causing stress and strain in the feet, legs, knees and back. “Heels change your centre of gravity, pushing your pelvis forward, straining the lower back muscles and increasing spinal curvature,” says Michelle, explaining this is one of the main reasons why osteoarthritis of the knee is twice as common in women. “The frequent wearing of heels above two inches can result in long-term chronic problems,” she says. In fact, experts believe a day-long heel habit is not unlike smoking when it comes to long-term damage and suggest heels higher than two inches should carry a health warning.

And if that doesn’t send you running for your flip-flops, then the terrifying list of foot deformities common in habitual heel wearers might: deformed and thickened toenails; calluses under the ball of the foot; Achilles tendonitis; bunions (a large bump on the side of foot); hammer toes (the curling up of toes like a claw); and horror of all horrors, a new bone growing off another foot bone, also known as a ‘pump bump’. Those five-inch Pradas don’t look quite so pretty now, do they?

And if you don’t believe stilettos are to blame, think about actress Sarah Jessica Parker, who as Carrie Bradshaw in SATC, spent a decade working 18-hour days in soaring stilettos and who recently made a crippling confession that she had indeed developed a ‘pump bump’. And although SJP now shuns stilettoes, the irony of one of Carrie’s most infamous quotes (“I’ve destroyed my feet but it was worth it”) will no doubt have returned to haunt her.

She’s not the only A-lister thinking twice about her high heel habit, however. Victoria Beckham recently underwent surgery for a bunion, no doubt caused by her long-standing relationship with pointy-toed six-inchers. In fact, a recent study by researchers at The College of Podiatry in the UK revealed twice as many women as men report suffering from bunions, while Michelle explains that in countries where heels are common, the incidence of bunions among women is 30 per cent.

But if that’s not enough to bring you down off your high-heeled Hermès, then some staggering statistics (80 per cent of all corrective foot surgery is carried out on women, with 90 per cent of women experiencing foot problems*) or a sensible-shoe-wearing friend (we all have one) will try to burst your six-inch Balenciaga boot bubble.

My sensible shoe-wearing friend, who occasionally dons heels for special occasions, recently informed me of the varicose veins I’m likely to get by 45 and the arthritic knees I’ll have by 65 (by 65, twice as many women have arthritic knees**) adding in her sensible-shoe superiority that my feet will become, quite literally, shoe-shaped, or ‘Barbie shaped’ as they’re known in the industry.

Sliding off my sky-high Ferragamos, I realise they already are. My feet are unnaturally arched, a physicality that, owing to the shortening of the calf muscle, makes walking in flats difficult. “Excessive reliance on high heels shortens the Achilles tendons, leading to shorter calf muscles and eventually causing pain at the heel and rear of the ankle when trying to walk barefoot or in flats,” explains Michelle. No wonder that other doyenne of dangerously high heels, American entertainer Dita Von Teese, once admitted to constantly falling over in trainers because of her high-heel addiction.

Toe tucks and feet lipo

And yet despite the agony and potential ugliness and damage, we continue to suffer, it seems. The same UK College of Podiatry study reported almost half of women have suffered foot problems after ignoring the agony of uncomfortable high heels. No longer does the saying ‘if the shoe fits, wear it’ apply… but rather, ‘if the shoe looks fabulous, make it fit’. There are some women putting up with the pain and others taking drastic measures. Unwilling to accept the agony, and equally unprepared to sacrifice their high-heel habit, a number of women are instead fixing their feet to fit the shoe.
Echoing the original and sinister Grimm Brothers’ fairy tale Cinderella (stepsisters hacked off parts of their feet to fit into Cindy’s dainty glass slipper) women in the Western world have for the past decade been undergoing all manner of macabre surgical procedures.

NYC FootCare in New York features the Pinky Tuck. Otherwise known as a Toe Tuck, it involves the slimming-down of the pinky to fit the pump. Meanwhile, at Beverly Hills Aesthetic Foot Surgery in California, the trademarked Cinderella Procedure, a preventative bunion correction to make feet narrower to fit skinny stilettoes, is in high demand.

Cinderella wannabes can also get: a Loub Job, named after famed sky-high Louboutins, where fillers are injected into the balls of the feet so you can wear your Louboutins for longer; Foot Lipo, to slim down your toes; Foot Botox, to fix hammer toes and stop feet sweating; Toe Cleavage, to plump up the front of the foot via fat injection; Toe Shortening, to shorten overlong toes; and horror of all horrors, the removal of the pinky toe so the foot resembles the shape of the pointy front of a shoe!

But how many women are actually getting such procedures done? Business is booming, it seems. In the US, cosmetic foot surgery is a $45 million (Dh165 million) a year industry, while in the UK, the number of foot cosmetic procedures doubled from 2011 to 2012, with requests for filler injections in the toe pads, heels and balls of feet soaring by 21 per cent.

So I did my own mini poll among my friends and found even the most passionate Louboutin lovers were aghast at the thought of lopping off parts, or all of a toe… although a few did concede that a jab of collagen to cushion the ball would make walking in five inches easier.

And one high heel-clad chum asked, “Is putting your feet under the knife to fit the Ferragamo any different from a tummy tuck to fit into that LBD?”

Surgical director of NYC FootCare in New York, Dr Oliver Zong, who hit the headlines last year promoting his uber-popular toe-slimming procedures, thinks not… believing toe surgery to be no different than any other cosmetic procedure.

Many podiatrists and podiatry associations the world over, however, condemn the practice. Podiatric surgeon and member of the American Podiatric Medical Association, Dr Hillary Brenner, says, “I don’t think it’s ethical unless you’re having pain. You’re undergoing risks… it’s trauma to the foot.”

And certainly, the risks for long-term damage are greater and the rate of recovery slower, on foot surgery. There are thousands of stories of women undergoing unsuccessful ops, resulting in damaged nerves and a lifetime of pain.

“We would strongly advise against such cosmetic foot surgeries,” says Michelle. “The foot is a complex structure with 28 bones and 25 joints and we would always advise non-surgical intervention.”

Happy feet

So what’s the solution for ladies
who love their Louboutins but don’t want to end up with damaged, unsightly feet in desperate need
 of reconstruction?

Of course, every podiatrist from Denmark to Dubai would like their clients to wear sensible lace-ups with plenty of support, but as Michelle herself acknowledges, “That’s not going to happen. We live in the real world and high heels aren’t about to be banned.” But there is a compromise. Just like a balanced food diet, Michelle recommends following a balanced foot diet, mixing and matching your shoe types, varying your daily heel height and choosing a shoe to fit the role. “If you’re popping out for lunch, wear a flat sandal, if you’re going to the mall, opt for a closed, supportive shoe,” she says.

She also recommends cutting
back on your high-heel habit by,
for example, wearing flats on the way to an event or to work and changing into heels once there.

And when you do don heels, the UK Society of Chiropodists and Podiatrists advises limiting continual wear to a maximum of three hours.

When it comes to height, Michelle’s recommendation of
the maximum height of the heel
as two inches seems outrageous when the season’s must-haves are all five to six inches, but when you consider that the standard stiletto heel (3.5 inches) creates seven times
more stress on the forefoot than a one-inch equivalent, her argument is convincing.

We should also opt for a cushioned insole; a Mary Jane-style strap,
which lends support; a slight platform under the toe area, which helps minimise the angle and pressure on the toes; and a broader base at the heel, so choose a wedge over a stiletto.

“When walking, you place three times your body weight on the
foot, so wedges help distribute the weight more evenly than a stiletto,” Michelle explains.

Hmm… while not a wedge aficionado, I do concede that I need to fight my fetish, find some sensible substitutes, moderate my sky-high-heel-wearing habit. I may well be one of the high-heel club’s sole survivors (I’ve never experienced anything more than sore feet), but like SJP I’m not about to take any more chances.

So I’ve ditched my daytime skyscraper stilettoes, armed myself with a sensible shoe shopping list and I’m about to embark on a
high-heel diet.

But first, I must check out
Alaïa’s 4.5-inch laser-cut suede
ankle boot stilettos… I’ve heard they’re simply divine.