Why do high heel cause foot pain?
Saul Yudelowitz BSc (Hons)
To understand the reason for foot pain from high heels there are some facts we need to go over so that a more complete understanding can be obtained. First a muscle can contract in three different ways. Muscle is around 40% stronger when it contracts and lengthens at the same time, this is known as an Eccentric contraction. Most people know of the Concentric contraction, when a muscle contracts and shortens and some might know of Isometric when a muscle contracts but does not change its length.
Next we need to have a look at all the tissue at the bottom of the foot. The vast majority of manual therapists donít realize that there are four layers of muscle at the bottom of the foot, or what refers to the plantar muscles. Superficial to this we have the planter fascia which is not muscle but a mix of different types of tissue. The planter fascia has vessels, nerves and tendons deep to it and so one of its functions is to protect these structures. Third, there is no muscle in the human body that runs in a straight line. All muscles run at an angle to their line of pull. What this means is, if you exercise in a straight line, or just along the line of pull you are exercising in a dysfunctional manner, there go most of the exercise that are seen commercially!
We actually stand on a tripod; the foot is designed in such a brilliant manner that it allows two opposite physical attributes. First it can handle high levels of compression and high levels of tension. Please note that tension is the ability of a material, in the body tissue to undergo a lengthening while under load, or an Eccentric contraction! This tripod is the result of three different arches in the foot.
- The Medial Longitudinal Arch (MLA)
- The Lateral Longitudinal Arch (LLA) and
- The Anterior Transverse Arch (ATA)
The following is a basic description of where these originate and insert. The MLA is basically found to run from the Calcaneus (Heel Bone) and insert into the first three metatarsals (The joint formed by the toe and the foot). As a result this arch is found on the Medial aspect (Inner side as opposed to the outside) of the foot. The LLA runs from the Calcaneus to the forth and fifth metatarsals. As a result this arch is found on the outside of the foot. The LLA is not as pronounced as MLA, this gives the characteristic look of the inside of the foot being lifted off the ground. The ATA runs from the base of the five metatarsals from side to side. When it is said that people pronate, it refers to the MLA not being strong enough to maintain the tension placed through the tissue. This results in the inside of the foot touching the floor. It is inaccurate from an anatomical perspective to refer to the foot as pronating as this is a function of the hand. The correct description is eversion of the foot. It should also be noted that in normal gait (walking) eversion (pronation) should occur, however the main issue here is WHEN in the gait cycle the eversion occurs. This is one reason why orthotics has an over simplistic approach to a complexed issue, they donít allow eversion to occur thus setting up a host of other problems.
Now as mentioned earlier, tension placed on a tissue results in an Eccentric contraction. When woman wear high heel shoes there are a number of factors that contribute to foot pain.
First, as the heel is place some height above the ball of the foot this results in the metatarsals bearing a large amount of weight, something that they were not designed to do! Second high heels place a considerable amount of tension in the planter fascia, over time this tissue becomes weaker and results in a higher degree of eversion. Third, as the planter fascia becomes weaker it protective effects on the underlying nerves, vessels and ligaments decreases. There are different symptoms produced from different tissue. Compression of a nerve can be anything from a sensation similar to pins and needles to a sharp shooting pain. Compression of an artery results in the tissue in the vicinity going into a spasm to protect this structure. Ligament pain is typically felt when the muscle length changes as one moves and joint pain can be very painful in a specific area when compressed. While we donít advise most women to stop wearing their heels, there is stretching and strengthening exercises of the foot and leg muscles that will allow a women to wear her heels and not get pain. We can say that the typical stretching of the calve muscles WILL NOT help and could make matters worse in the long run. Here is why.
Any manual therapist that has half an idea of functional exercise will advise their patient to do integrative exercises. It is completely dysfunctional to isolate a muscle and strengthen it. There is only one exception to this rule. This is the main reason that machine based exercises in the gym cause an injury on the sports field. We apply the same rule to stretching. It is dysfunctional to stretch muscles in isolation. Stretching a muscle should be done in an integrated manner. We are excited to see that while we have been using this method for the last five years there is research coming out in respected journals which are moving in our direction. It is unfortunate, but a one size fits all approach does not work so, a description for everyone out there on how to stretch is unlikely to work. We have taught many athletes how to move correctly and as a result they have brought us their children to learn how to move correctly.
This article is aimed at getting you to think and ask questions, do not just believe anything that you read, this is what will lead to making informed medical choices. If you have any questions or would like to book in for treatment please feel free to contact us. The information contained in this Newsletter was prepared from medical and scientific sources which are referenced and are believed to be accurate and reliable. The information herein should not be used to treat or to prevent any medical condition unless it is used with the full knowledge, compliance and agreement of your personal physician or other licensed health care professional. Readers are strongly advised to seek the advice of their personal health care professional(s) before proceeding with any changes in any health care program
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