Wednesday, June 27, 2018

Condemnation of the heel: A Cautionary Tale

Independent research would confirm the turning effects on the knee caused by wearing high heels are less than when flat sensible heels are worn. By itself this does not mean either heel style causes problems but in those susceptible to osteoarthrosis (arthritis), then a high heel may reduce the incidence if worn early. Changing heel heights would tend to exacerbate existing osteoarthritic changes in the susceptible and although it may make sense to reduce the height of heel, this should be done with caution. Many people have tight tendo Achilles and the extra stretch in the absence of a heel can lead to traumatic injury. Now the argument goes prolonged wearing of high heels can cause adaptation of the tendon which gets shorter. So a sensible precaution would be to wear high heels for only short periods. The idea of sensible heels came during the late 1930s, when physical culture prevailed and the populous could no longer afford two pairs of shoes i.e. one for work and the other for recreation. So the working shoe was glamorised by being accessorized as well as associated with recreation. This was usually marathon dancing or physical recreation. The term "politically correct" could be used to describe the sensible heel because in the Commonwealth, lower heels were considered patriotic (saving raw material for the war effort), and in Nazi Germany, high heels were branded "Jewish" and unpatriotic. There is much propaganda from the time to support this. The influence of sensible shoes in post war podiatry ands orthopaedics was probably related to the many soldiers who joined the professions. Their patriotism promulgated the myth.

Several years ago, I undertook a literature review of podiatric journals for the last 100 years and compared the styles of shoes advertised within. Many were endorsed by the profession. What constitutes ‘sensible footwear’ changed with fashion mores and footwear recommended prior to the late 1930s, are quite contradictory to those post this time. A clear expert dichotomy there. So heels were good then bad. This was culturally played out in Hollywood where the heroine wore a styled shoe with a lower heel and the Jezebel, well anything went, as long as it was strappy and had a heel. Later in 1952 the Louis heel was replaced by the ‘Cobbler’s delight’, the stiletto.

Marginalisation of the population based on clothing is age old and probably has its origins in the reason why we wear clothing in the first place – decoration. When we started to cover up it became important to highlight the difference in sex, easy enough to discriminate naked but confusing otherwise. Obviously the more senior wore the most expensive clothing and shoes came with the territory. They were after all ‘well heeled.’ In Egypt sandals were worn known to be worn by the Kings and Queens and the Ankh is thought to represent a flattened sandal and of course this is arguably one of the oldest symbols known to exist.

Sexualisation of feet adornment is explained by the Theory of Displacement i.e. cover the genitalia and feet and heads became male and female. So hair styles, hats and face decoration as well as leg covering and shoes all became important indicators of gender as procreation was the primary motivation for existence, discriminating between pre pubescent and post menopausal women became critical. We see the same compartmentalisation today. “Mutton dressed as lamb,” is a common phrase which indicates our present society’s distaste for the blue rinse crowd competing in the mating game. All the more likely in the chemical age. Podiatrists and orthopaedists contribute to this by condemnation of heeled shoes in ladies of a certain age. The foreboding usually comes in the form of scare mongering about falls and postural defects etc, etc. In the past medical procrastination for the evils of wearing high heels have been exposed as utter nonsense. Now obviously conditions apply and everyone can cite anecdotal examples of heels and painful episodes but in the general population there is no significant association. Without doubt style styles should match physical activities and prolonged reliance on inappropriate foot gear would lead to fatigue and repetitive stress events but that is all you can be said about heeled shoes.

In ancient China when foot binding prevailed the connection between the feet and pelvic musculature was thought to be the reason for the atrocious custom. Walking on small arched feet toned up the pelvic floor. Heels today may do the same. So as part of continence training, older women may benefit from wearing heeled shoes. Worth a thought.

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