By NorthShore – Edward-Elmhurst Health

When it comes to fashion, Barbie has always been an icon.

She’s got an outfit and accessories for every occasion — including outrageously high heel footwear. Always.

Of course, it’s easy for her to pull off, with her specially shaped feet and all. But her wardrobe, shoes in particular, isn’t exactly practical for real life.

In this this Q&A with Edward-Elmhurst Health Podiatrist Eric Meshulam, DPM, you’ll get real-life advice to keep your feet healthy and pain-free.

1. How much pressure do high heels put on the ball of your foot, and is it damaging?

A: High heels can put a significant amount of pressure on the ball of your foot, and this could be damaging after long periods of time. The higher the heel, the higher amount of pressure that will occur along the ball of your foot.

2. What kinds of foot problems can result from wearing high heels?

A: There are a wide variety of problems that can arise from wearing high heels. We also need to consider if the toe box of the high heel shoe is narrowed/tapered, as this could create issues. 

A common problem I encounter with my patients that wear high heels is a neuroma, or an inflamed nerve along the ball of the foot. We have a bunch of nerves that course along the bottom of the foot and merge together in between the bones in the ball of the foot. If a significant amount of constant pressure is applied to these nerves, they can become enlarged and painful. A lot of patients will relate a clicking sensation in their foot or a sensation of walking on a pebble. This is the nerve being enlarged and rubbing against the bones in the foot. Patients may also relate a burning or tingling sensation that radiates to the toes.

Another condition that could result from wearing high heels is metatarsalgia, a term that basically means the metatarsal heads, or the bones along the ball of the foot, become inflamed due to the constant repetitive trauma from the pressure. This constant inflammation of the metatarsal bones could also lead to stress fractures.

Continually wearing high heels that have a narrow toe box can cause squishing of the forefoot. Unfortunately, this squishing of the forefoot can result in bunion and hammertoe deformity.

Wearing high heels on a constant basis could lead to a very tight Achilles tendon, since your feet are constantly in the downward direction which decreases the ability of the Achilles tendon to stretch.

3. Are sandals better for your feet than heels?

A: Sandals are not necessarily better for your feet than heels. It all depends on what type of sandal and what type of heel you decide to wear. A flat sandal with no support can be just as damaging as a high heel dress shoe. I would recommend sandals with arch support and a supportive heel counter with strapping to hold your foot in place. 

4. What types of shoes should we wear for walking or running?

A: When walking long distances or running, high heels and sandals should be avoided. I would recommend a good supportive tennis shoe. One way to determine if your shoe has adequate support is to try to bend the shoe along the midportion/midfoot. If it bends very easily, this is a shoe to avoid. Supportive tennis shoes I would recommend include Hoka, Brooks, Asics and New Balance. Every foot is different, and some people may tolerate shoes differently than others.

5. What causes fallen arches, and how can this condition affect foot health and shoe choice?

A: There are a lot of different reasons people develop fallen arches. One reason could be genetics. Some people are just born with very flat feet and hypermobility. Another reason could be due to arthritis and weakening of the posterior tibial tendon. This tendon helps re-create the arch in your foot, but if it continues to be overworked it can weaken over time, reducing your arch. If this tendon stops working, the arch will collapse, which will eventually cause arthritis and increased pain. This is why it is so important to protect your feet with good supportive shoes to diminish the chances of injuring your tendons and bones in your feet.

6. What steps should we take to keep our feet pain-free and healthy?

A: Listen to your feet and when they’re in pain, reconsider the type of shoes you’re wearing. Also, if you notice a change in your feet or a deformity, I recommend an appointment with a podiatrist.

Limiting the amount of barefoot walking can be quite beneficial, especially with patients that suffer from flat feet. Stretching and regular exercises help strengthen your feet and should be performed daily.

Custom orthotics can be another option for chronic foot pain as they help control your arch and heel.  Orthotics reduce the amount of abnormal motion and will stabilize your feet.

While dolls can pull off daily high heels, it’s a different story in real life. Keep these tips in mind for healthy, pain-free feet.

The team of experts at NorthShore Orthopaedic & Spine Institute includes fellowship-trained orthopaedic foot and ankle surgeons who have undergone rigorous, specialized education focused on complex conditions and advanced treatment options. Learn more.