tag:theconversation.com,2011:/us/topics/bunions-9061/articlesbunions – The Conversation2021-06-11T10:10:48Ztag:theconversation.com,2011:article/1625702021-06-11T10:10:48Z2021-06-11T10:10:48ZFashion for pointy shoes unleashed a wave of bunions in medieval England<figure><img src="https://images.theconversation.com/files/405715/original/file-20210610-18-hsj9av.jpeg?ixlib=rb-1.1.0&rect=0%2C154%2C1840%2C1074&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/d/dd/Medieval_shoe.jpg">Marieke Kuijjer/wikimedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The 14th century saw the arrival of an abundance of new styles of dress and footwear in Europe, coming in a wide range of fabrics and colours. Among these new fashion trends were “<a href="https://fashionhistory.fitnyc.edu/poulaine/">poulaines</a>” – rather eccentric-looking medieval shoes with a lengthy pointed tip. </p>
<p>The archaeological and the <a href="https://www.bloomsbury.com/us/shoes-9781472531001/">historical record</a> suggests that this new fashion item was widely adopted by England’s medieval society and that, by the late 14th century, almost every type of shoe was at least slightly pointed, even in children. <a href="https://theshoeman647325124.wordpress.com/2020/02/19/the-history-of-poulaines-long-toed-shoes/">Shoe pointiness</a> would eventually became so extreme that in 1463 King Edward IV <a href="https://www.amazon.co.uk/History-Costume-West-Francois-Boucher/dp/0500279101">passed a law</a> limiting toe-point length to less than two inches within London.</p>
<p>The adoption of this latest flavour of footwear was not without its risks. <a href="https://doi.org/10.1016/j.ijpp.2021.04.012">Our research</a>, conducted on medieval human skeletal remains from Cambridge in England, shows that hallux valgus of the big toe – commonly know as bunions – was surprisingly widespread at the time. </p>
<p>Seeing as <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/acr.23154">modern clinical research</a> has shown that the development of bunions is often linked to wearing tight, ill-fitting footwear, our study suggests that people in late medieval England paid a high price for footwear fashion – in bunions and broken bones.</p>
<h2>A build-up of bunions</h2>
<p>A <a href="https://www.britannica.com/science/bunion">bunion</a> is a minor deformity of the big toe. It angles the toe outward from the foot, with a bony protrusion forming at its base. By far the most common <a href="https://search.informit.org/doi/abs/10.3316/informit.553827823333931">contemporary cause</a> of bunions is constrictive boots and shoes – with high heels often blamed for today’s bunions. </p>
<p>It seems that shoes contributed to bunions many centuries ago too. Of the 177 individual skeletal remains we examined in our study, at least 18% had bunions. But when we dated the skeletons, we found that only 6% of people who’d been buried between the 11th and 13th centuries – long before the pointed shoe was in vogue – had suffered from bunions.</p>
<p>However, 27% of those buried at the height of the pointy-shoe fad (in the 14th and 15th century) had been hobbled by longstanding hallux valgus. It seems clear that the increasing pointiness of shoes unleashed a plague of bunions across medieval society.</p>
<h2>Class differences</h2>
<p>A further fascinating discovery was that hallux valgus was not equally common in all sections of society. Our evidence suggests it was most common in the <a href="https://www.britannica.com/topic/Augustinians">Augustinian friars</a> and those wealthy inhabitants of the town who could afford to buy a plot in the friary cemetery when they died. </p>
<p>It was less common in poor inhabitants of the town, and least common in a nearby rural farming population. This would suggest that those with plenty of money could afford the fashionable pointed shoes that deformed their feet, while the poor, who wore round-toed shoes or went barefoot, were mostly protected from developing bunions.</p>
<p>Medieval records show how the church in Rome was unimpressed by monks and friars in spending money on fashionable shoes, gloves, hats and belts and repeatedly ordered them to <a href="https://www.jstor.org/stable/10.1086/510887">dress simply</a>. However, study of the feet of the Augustinian friars in Cambridge shows they ignored the requests from Rome when it came to matters of the sole.</p>
<h2>Broken bones</h2>
<p>Far from being a mild inconvenience, our study also found that individuals who’d suffered from bunions and were over the age of 45 were significantly more likely to fracture a bone as the result of a fall than were other adults of the same age who didn’t have hallux valgus. </p>
<p>This is explained by the important role the big toe has in maintaining upper body stability. When the big toe is laterally deviated (a characteristic of bunions) balance and stability while walking can be <a href="https://academic.oup.com/ptj/article/90/1/110/2737678">negatively affected</a>. These findings are consistent with today’s <a href="https://www.sciencedirect.com/science/article/pii/S0268003309002010">clinical research</a>, which shows that hallux valgus is an independent risk factor for falls, especially in older adults. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/405877/original/file-20210611-23-89dk3.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Shoes with elongated points" src="https://images.theconversation.com/files/405877/original/file-20210611-23-89dk3.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/405877/original/file-20210611-23-89dk3.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=799&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405877/original/file-20210611-23-89dk3.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=799&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405877/original/file-20210611-23-89dk3.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=799&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405877/original/file-20210611-23-89dk3.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1003&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405877/original/file-20210611-23-89dk3.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1003&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405877/original/file-20210611-23-89dk3.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1003&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Modern-day pointy shoes by Comme des Garçons.</span>
<span class="attribution"><a class="source" href="https://collection.maas.museum/object/532757">MAAS Museum</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Decades after their resurgence as the rock-and-roll era’s <a href="https://shoeiq.com/winklepickers/">winklepickers</a>, it appears that pointy-toed shoes are once again back à la mode. In 2015, the Japanese fashion label Comme des Garçons introduced a spectacular, elongated shoe at <a href="https://www.vogue.com/article/pointy-toe-shoe-for-men">Paris Fashion Week</a>, heralding another spike in the sales of pointy shoes. </p>
<p>But if the feet of medieval monks are anything to go by, the wearers of today’s pointy shoes should perhaps approach the footwear with caution. It appears that bunions had a negative impact on medieval people’s mobility and balance, increasing their risk of falls and broken bones. The same may well be true for today’s proponents of the pointy shoe.</p><img src="https://counter.theconversation.com/content/162570/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Piers Mitchell has received funding from The Wellcome Trust for this research. </span></em></p><p class="fine-print"><em><span>Jenna Dittmar has received funding from The Wellcome Trust for this research. </span></em></p>The English paid a high price for medieval fashion: in bunions and broken bones.Piers Mitchell, Affiliated Lecturer in Biological Anthropology, University of CambridgeJenna Dittmar, Research Fellow, Department of Archaeology, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/820652017-08-28T04:52:54Z2017-08-28T04:52:54ZExplainer: what is a bunion and do I need to get mine treated?<figure><img src="https://images.theconversation.com/files/180965/original/file-20170804-17911-163olz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bunions are more than just a cosmetic issue. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>While most people don’t like the sight of bunions, they’re much more than a cosmetic issue. A bunion can cause pain and impact physical function, as well as <a href="https://www.latrobe.edu.au/news/articles/2011/article/study-finds-bunions-more-common-in-women">affecting general health</a>, mental health and social function. Limitations on what footwear can be comfortably worn due to bunions reduces social activities and physical activities.</p>
<p>Scientifically named hallux valgus, a bunion is an enlargement of the inner portion of the joint at the base of the big toe. The enlargement is due to a misalignment of the big toe joint and, in some cases, there is additional bone growth caused by inflammation. The misalignment causes the big toe to point outward towards the other smaller toes. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=500&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=500&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=500&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=628&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=628&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=628&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bunion can also occur in the fifth toe. This is called a bunionette, or ‘tailor’s bunion’.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>What are the symptoms?</h2>
<p>Symptoms can include the joint becoming inflamed with redness, tenderness, and pain. This is due to a small fluid-filled sac called the bursa, which is adjacent to the joint, also becoming inflamed. This is called bursitis.</p>
<p>A deeper joint pain may occur in later stages of the deformity if localised arthritis develops. Over time, the deformity will increase, although the symptoms may not increase.</p>
<p>The pain of bunions and the difficulty finding comfortable footwear impacts on <a href="http://lermagazine.com/article/bunion-research-focuses-on-patient-quality-of-life">people’s ability to exercise</a>, resulting in reduced physical and mental health. There are also effects on self-image, with patients being uncomfortable with others seeing their feet.</p>
<h2>Who is affected?</h2>
<p>A <a href="https://www.latrobe.edu.au/news/articles/2011/article/study-finds-bunions-more-common-in-women">recent Australian study</a> found a surprising 36% of participants had this condition, with women and older people more likely to be affected. </p>
<h2>What are the causes?</h2>
<p>There are a few factors that can lead to bunions including a genetic component. They are caused by faulty foot structures such as <a href="https://theconversation.com/what-are-flat-feet-in-children-and-are-they-something-to-worry-about-60365">having flat feet</a>, excessively flexible ligaments, or abnormal bone structures that lead to the development of bunions.</p>
<p>The <a href="http://onlinelibrary.wiley.com/doi/10.1002/acr.22040/full">Framingham Foot Study</a> found bunions and lesser toe deformities are often inherited in white men and women of European descent. </p>
<p>Shoes also play a significant part, including shoes that are too narrow or <a href="https://theconversation.com/health-check-how-high-heels-harm-and-how-to-make-it-better-22498">wearing high heels</a> for prolonged periods, hence women being over-represented.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Wearing shoes that are too narrow can cause bunions.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Do bunions need to be treated?</h2>
<p>Not all bunions <a href="http://www.healthline.com/health/bunion-removal#overview1">need to be operated on</a>. Conservative treatment is recommended first and then if this doesn’t alleviate the condition (you are unable to walk more than a few blocks and medication and rest don’t reverse the swelling and pain) you may be advised to have surgery. </p>
<p>The severity of the deformity will dictate the extent of the surgical procedures required. There are a number of surgical techniques currently practised. </p>
<p>Bunionectomy is the removal of the inflamed fluid sac from between the skin and bone. Osteotomy is the repositioning of the metatarsal, the big bone in the toe that’s affected. The surgeon may hold the repositioned bone in place with screws, wires, or a metal plate. In severe cases, an artificial joint will be used to replace the existing badly damaged joint. This procedure is called arthrodesis.</p>
<p>Newer minimally invasive surgical techniques are <a href="http://journals.sagepub.com/doi/10.1177/1071100716656440">showing positive results</a> for mild to moderate bunions. The <a href="http://www.jointhealth.com.au/articles/minimally-invasive-bunion-correction-surgery-a-game-changer-in-forefoot-surgery">advantages to this approach</a> to osteotomy compared to traditional osteotomy are that healing time is minimised and scarring is decreased. The tissues that cross the big toe joint are not damaged in the newer approach, which means there is no joint stiffness after surgery. </p>
<p>If surgical treatment isn’t advised, there are still things you can do to alleviate the condition.</p>
<p><strong>Choice of footwear</strong>: your choice of footwear is important. Shoes that are flat, supportive and give you plenty of width for your toes are the best choice. Orthotics may also ease the condition.</p>
<p><strong>Exercises</strong>: a podiatrist can recommend specific exercises to treat your symptoms of bunion. These might include going barefoot around the house as this activates the muscles in your big toe joints.</p>
<p><strong>Medication</strong>: anti-inflammatory medication may help, and some people receive steroid injections, such as cortisone. These injections reduce the inflammation, and may relieve pain temporarily. Caution is advised as there are many side effects such as infection and bleeding, especially if used frequently and at high doses.</p>
<p><strong>Maintain a healthy weight</strong>: this reduces the pressure on your foot joints.</p>
<p><strong>Padding</strong>: use of over-the-counter pads can relieve the pressure on your bunions.</p>
<h2>What should I do for my bunion?</h2>
<p>The best way to find the right treatment for you is to ask your general practitioner or a podiatrist for their advice. The information in this article is general in nature, and your specific case will have to be examined.</p><img src="https://counter.theconversation.com/content/82065/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Lausberg does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A bunion is an enlargement of the inner portion of the joint at the base of the big toe. Does it need to be removed?Sarah Lausberg, Sessional Academic - Health Promotion, Public Health, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/224982014-02-24T03:30:23Z2014-02-24T03:30:23ZHealth Check: how high heels harm and how to make it better<figure><img src="https://images.theconversation.com/files/42024/original/tcw59d36-1392859177.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Keep your high heel-wearing to less than three days a week.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/luschei/2789923505/sizes/o/">Ed L/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>High-heeled shoes are thought to characterise femininity and beauty, making the wearer feel self-assured and elegant. But they also alter alignment of the feet, legs, and back, and can have long-term effects on posture and health. </p>
<p>Feet suffer considerably inside high-heeled shoes. The higher the heel, the more the foot slides inside the shoe and the greater the pressure and friction under the heel, the ball of the foot, and the big toe. </p>
<p>Friction is damaging to the skin causing a burning sensation and blisters and, over time, it leads to the development of hard skin and corns. This stress can also cause deeper soft tissue problems in the foot, such as a neuroma (thickened nerve). </p>
<p>As heel height increases, body weight shifts towards the inside border of the foot and under the big toe. Over time, this increased pressure on the big toe may cause it to be forced towards the second toe. </p>
<p>Damage to the big toe joint in the form of bunions (hallux valgus) has been associated with prolonged wearing of high-heeled shoes. And women who frequently wear high heels commonly have a larger forefoot area and a longer big toe.</p>
<h2>Balance and posture</h2>
<p>High-heeled shoes are less stable than flat shoes, and they make the whole body more unstable because they raise the height of the body’s centre of mass. They make it more difficult to maintain a symmetrical posture, and this may affect balance. </p>
<p>In order to stand upright and walk in high-heeled shoes, the ankle joint must be extended and this is the joint’s least stable position. </p>
<p>Wearing high heels regularly (at least three days a week) changes the normal movement of the ankle joint. The upwards and outwards movement of the foot at the ankle joint <a href="http://jeb.biologists.org/content/213/15/2582.abstract">becomes restricted</a> because the calf muscle becomes shorter and the Achilles tendon becomes broader and stiffer.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/42012/original/tncp4639-1392856503.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/42012/original/tncp4639-1392856503.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/42012/original/tncp4639-1392856503.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/42012/original/tncp4639-1392856503.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/42012/original/tncp4639-1392856503.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/42012/original/tncp4639-1392856503.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/42012/original/tncp4639-1392856503.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">High heels shorten the calf muscle to make an attractive leg shape but can lead to problems when trying to walk in flat shoes.</span>
<span class="attribution"><a class="source" href="http://www.flickr.com/photos/combustionchamber/3518073931/sizes/o/">combustionchamber/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>And as the stabilising muscles on the outside of the lower leg have to work harder to balance the unstable ankle, they become fatigued and the risk of ankle sprains increases. </p>
<p>One appeal of high-heeled shoes is that they shorten the calf muscle to make an attractive leg shape, but these changes to muscle, tendons, and joints cause discomfort when high-heel wearers try to walk in flat shoes.</p>
<h2>Increased stress on muscles and joints</h2>
<p>Every step we take sends a shock wave up through the feet and legs to the spine, and walking on the hard, narrow heel of a high-heeled shoe increases this force. </p>
<p>The unnatural position of the foot in high heels means it’s less able to act as a shock absorber and the knees have to bend more to absorb the increased force. This increased stress on the knees, and overloading of the knee joints, increases the risk of joint degeneration and arthritis. </p>
<p>And the increased force through the body means the lower back muscles have to work harder to protect the spine, keep it upright, and maintain balance. </p>
<p>High-heeled shoes tip the body forwards and interfere with normal coordination of muscles that stabilise the lower spine (abdominal muscles, erector spinae, and gluteus maximus). This change in the pattern of muscle activation can lead to <a href="http://www.ncbi.nlm.nih.gov/pubmed/22311060">muscle overuse and repetitive strain injuries</a>.</p>
<p>In younger women, high heels tilt the pelvis forwards and this increases curvature of the lower spine (lumbar lordosis). Excessive curvature (hyperlordosis) may cause long-term lower back problems. </p>
<p>In middle-aged and older women, the lower back is less mobile and high heels tend to make the spine flatten. </p>
<p>As the normal curves of the spine are altered by high-heeled shoes and the body is bent forward, more energy and muscle activity is required to maintain balance. This additional strain on the back can lead to overload of the spine; a survey of 200 young women found that 58% of those who wore high heels <a href="http://www.sciencedirect.com/science/article/pii/S0169814101000385">regularly experienced low back pain</a> while wearing these shoes. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/41995/original/5g2b2nq4-1392854203.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/41995/original/5g2b2nq4-1392854203.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/41995/original/5g2b2nq4-1392854203.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/41995/original/5g2b2nq4-1392854203.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/41995/original/5g2b2nq4-1392854203.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=463&fit=crop&dpr=1 754w, https://images.theconversation.com/files/41995/original/5g2b2nq4-1392854203.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=463&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/41995/original/5g2b2nq4-1392854203.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=463&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">These are high in more ways than one, maybe best to leave them hanging there.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/chrisgold/7532831600/">Chris Goldberg/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>Muscles higher up the spine in the neck, are also affected by high-heeled shoes. The higher the heel, the more these small neck muscles are activated and this can lead to muscle fatigue, cervical spine problems, and pain.</p>
<h2>Mitigating harm</h2>
<p>Women who love high-heeled shoes are unlikely to stop wearing them, even if they become aware of the problems they may cause. </p>
<p>So here are some suggestions to reduce the harmful effects of high heels:</p>
<ul>
<li><p>choose a shoe with moderate heel height, no higher than five centimetres, and a fastening over the instep;</p></li>
<li><p>wear high heels for short periods of time, and take a pair of flat shoes or runners to change into if you have to walk a long distance during the day;</p></li>
<li><p>choose a shoe with a wide heel base, or a wedge heel, to <a href="http://www.worldscientific.com/doi/abs/10.1142/S0219519411004563">reduce the load</a> under the front of your foot;</p></li>
<li><p>avoid running in high-heeled shoes as pressure under the foot increases considerably when running, even at low speed;</p></li>
<li><p>use a <a href="http://www.ncbi.nlm.nih.gov/pubmed/16390637">shoe insert to reduce pressure</a> on the forefoot and heel; and</p></li>
<li><p>do calf muscle stretching exercises every day to maintain ankle flexibility.</p></li>
</ul><img src="https://counter.theconversation.com/content/22498/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Robinson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>High-heeled shoes are thought to characterise femininity and beauty, making the wearer feel self-assured and elegant. But they also alter alignment of the feet, legs, and back, and can have long-term effects…Caroline Robinson, Lecturer in Podiatry, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.