High heels can be harmful. Here are tips for happier feet

Marilyn Monroe may have once said ‘I don’t know who invented high heels, but all women owe him a lot’, but she had obviously never been sent home from work by her employer for refusing to wear them. Seeing as I don’t have a part-time job as a drag artist, I can’t vouch for the discomfort that wearing them entails, but I do know that I have seen many women in my surgery over many years suffering from the consequences of their high heels habit, sometimes permanently.

To understand why high heels might not be all they’re made out to be you have to look at our anatomy. When you squeeze your feet into a favourite pair of Louboutin heels, your foot slides forward as your toes are forced into the unnatural shoe shape. This causes body weight to be distributed incorrectly and so tilts the body forward. We compensate for this effect by leaning backwards slightly and overarching the spine, creating a posture that puts strain on the knees, lower back and hips. In addition, calf muscles may shorten, and tendons thicken with long-term wearing of high heels. These effects have been shown to occur in studies using electrical testing of muscles, finding that the low back, knee, hip, calf and foot muscles all have to work harder when wearing a high-heeled shoe than a flat one.

So, if you’re addicted to your Jimmy Choos, do you have to give them up and shuffle around in slippers all your life? Well, the good news is no — all you need is some common sense, aiming to wear high heels for special occasions, or on days that require limited standing or walking. Other general tips include:

— When possible, wear sensible heels, such as shoes with a heel that measures an inch and a half or less, with a wide heel base (a slightly wider heel spreads the load more evenly) and try to avoid heels more than three inches high since these can cause shortening of the Achilles tendon.

— If you can, try to wear soft impact-absorbing insoles to cushion any impact on your knees.

— Make sure your shoe size is correct — wear shoes that allow you to wiggle your toes — and, when buying shoes, buy them in the afternoon when your feet are at their largest.

— Alternate your choice of shoes from one day to the next.

— Remember to stretch your leg muscles before and after putting high heels on. I always suggest stretching twice daily anyway, by standing on the edge of a step with your shoes off. With your weight on the balls of your feet and your heels hanging over the edge, drop your heels down and gently stretch the heel tendon up and down. You can also try to pick up a pencil from the floor with your naked feet as this helps to work and stretch the foot tendons.

Just to add insult to injury as well, those flat shoes you’re now eyeing up warily are not always as safe as they can appear. Many of them have a pointed toe box at their front, causing toes to be squashed into them and forcing the big toe outwards. This can trigger the formation of bunions and it’s no surprise to me that about 90 per cent of the operations undertaken to correct this problem are carried out on women, and that bunions are rare in populations that do not wear shoes.

Leonardo da Vinci wrote that the human foot is a masterpiece of engineering and a work of art. In that respect he was right, although I doubt he ever wore a pair of bright red six-inch heels in his studio. However, a little bit of common sense with your footwear still allows for happy feet and high(ish) fashion to live happily together.