Tuesday, December 30, 2008

From chocolate to bunion night splints

Perhaps like me you were lucky enough to score a pair of chocolate heels for Christmas. Mine were a delicious pink poco dot but had I been in Kuala Lumpur on December the 20th at a dinner at Malaysia’s YTL Cameron Highlands Resort with Jimmy Choo there the chefs brought out a collection of shoes crafted entirely of chocolate to honour their celebrity guest. There was a pair of open-toed pumps decorated with edible gold leaf; intricately tooled stilettos in dark couverture; and dainty buckled sandals in milk chocolate filled with white chocolate truffles. The Penang-born designer has enjoyed a fabulous career creating shoes for UK and Hollywood celebrities, although it is almost eight years since he sold his ready-to-wear business Jimmy Choo Ltd along with his name. The controversial sale of his company, which he set up in 1996 with society princess and former Vogue UK accessories editor Tamara Mellon is water under the bridge now. Jimmy keeps busy by making bespoke designs under the label Jimmy Choo Couture, and limits himself to only “a few pairs a week.” His shoes retail from £750 a pair. The celebrated shoe designer also works closely with the British Council to promote UK design education internationally and also a busy ambassador for Footwear Education at the London College of Fashion. Jimmy’s skills are heavily sought after and he intends to launch master classes in haute shoemaking sometime in the near future. Watch this space. Although there is much criticism of high heeled shoes and their potential effects on bad posture there remains remarkably little objective data to support this. Now a scientist from Manchester Metropolitan University in the UK is about to change all that with a new study. Researchers at Institute for Biomedical Research into Human Movement and Health are appealing for volunteers who regularly wear heels of two inches or higher to take part in a study on their effects on the human body. It is hoped the research will determine if there are any health risks caused by wearing stilettos regularly. The intention is to measure the length of the calf muscle in people wearing and not wearing heels. When the muscle contracts this usually means the muscle is weak and the hypothesis is wearing high heeled shoes can shorten the muscle. The study will look at the effects of different types of shoes and study the walking ability of dozens of women using ultrasound and MRI scans to study muscle structure. Something which is a bit of a myth is the lay association between wearing high heeled shoes and hallux-abducto valgus (deviation of the great toe). This is frequently and quite misleadingly referred to as a bunion which is a skin lesion called a bursitis (an inflamed fluid filled sac) which lies in the tissues and sits over the first metatarsal phalangeal joint. This is usually on the medial side of the foot over the area of the big toe joint. Aggravation of the skin due to shearing stress between the foot and shoe will eventually cause the anatomical bursa (there to protect the joint beneath) to become damaged and inflamed. For many this results in painful symptoms which are associated with ill fitting shoes. However hallux-abducto valgus has little to do with shoes in its causation despite claims to the contrary. Unlocking the forefoot is part of the normal process which gives greater ground contact, the mechanism responsible for this is the pendulum action of the heel as it rocks from side to side during walking. Often when the locking mechanism of the foot is delayed due to gravity the forefoot remains splayed during phases of propulsion causing pathological turning forces to partially dislocate the digital joints. Usually the process is painless and occurs over a prolonged period of time but when secondary osteoarthrosis (wear and tear) arises then pain may result. In some case hallux abducto-valgus deformity can be gross but most adult bipeds will present with some degree of subluxation (partial dislocation) of the digital joints with the vast majority painless. Obviously accommodating odd shaped feet becomes a challenge especially where there is no symmetry and the common tendency is to wear tighter fitting shoes and when conditions apply this may cause acute friction over the hallux-abducto valgus resulting in a painful bunion. Quid pro quo. Shoes which support the heel’s pendulum action help reduce the disease causing turning effects on the forefoot an appropriate foot orthoses can also help. Shoe styles which are backless and or offer no heel cradle provide less support to hypermobile (unstable) feet and when combined with an elevated anatomical heel causes the forefoot to broaden. Subsequent instability to the forefoot may result in subluxation of the toe joints. Backless, heeled shoes should only be worn for short periods when people have hypermobile. There are other causes of the deformity, hallux abducto valgus, but to date no baby has ever been born with the condition. This is part due to the ossification timetable and small bones are not fully developed in the new born. Subsequently most authorities belief the condition is a likely to be caused by poor posture over a prolonged period. Shoes may contribute as an exciting factor but do not present the primary cause of hallux-abducto valgus. The downside to the anatomical anomaly is that it is irreversible and whilst there are many orthopaedic procedures to reduce and correct the deformity palliative bunion night splints are not likely to correct established hallux abducto valus. Sorry Posh.

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