According to newspaper reports, Lady Gaga the Oscar Nominee, pop star and diva has sore feet and needs to see her podiatrist. The poor girl (32 years young) was complaining of shooting pains in her Achilles tendon (tendinitis) and noticed she was developing bunions. Not only that, the elfin singer appears to have cracked heels and painful corns. Her podiatrist has advised a change in footwear (stereo typical response) and to try wearing lower heels, at least during the day. Easy to say but very difficult when you are a performer.
A bunion describes an adventitious bursitis (fluid filled sack) which forms over a vulnerable joint subjected to excessive shearing stress. This will often arise in conjunction with Hallux (abducto -dorsi) valgus, a bony deviation of the great toe which appears to drift laterally towards or over the lesser toes. The resulting prominent joint (big toe joint) is difficult to fit into regular shoes and friction between the foot and shoe results in shear and with repeated trauma, the formation of a bunion.
A popular misconception is a bunion is the same as hallux (abducto-dorsi) valgus. Whilst both may be painful, discomfort is more usually associated with the latter when osteoarthritis (wear and tear) causes joint deterioration.. Not all cases of Hallux Valgus are however, painful.
Contrary to popular belief, shoes do not cause Hallux Valgus but instead may excite secondary problems such as a painful bunion. The most likely cause of a prominent forefoot is partial dislocation (subluxation) of the metatrso-phalangeal joints due to rearfoot instability during phases of weight bearing. The heel rocks from side to side (inversion and eversion) in a pendulum motion as ground reaction forces a turning effect on the heel. The subtalar joint is complex and capable of tri-plane motion, i.e. supination and pronation. This helps the forefoot lock and unlock as the foot goes through stance phase. The position of the heel is critical during certain phases and when not properly aligned leaves the forefoot unstable causing it to splay. The rolling action of the heel during walking causes tensile stress (tearing stress) across the skin surface of the heel. In certain cases where the skin is dehydrated this may cause the skin to fracture and fissure (skin cracks).
A good fitting shoe may help with foot mechanics and a firm heel counter can provide a useful restraint. Open back shoes promote foot instability and when the heel is elevated as with high heel shoes or platforms, the incidence of heel fissures increase. The clinical presence of hallux valgus confirms joint subluxation (partial dislocation) across the forefoot with resuktant lesser toe deformities i.e. buckled toes. Stiffness and changes to the small toe joints can leave prominent knuckles and with limited shoe volume, repetative shearing may result in skin pathology i.e., corns and callus.
Reliance on elevated shoes for some people may cause adaptive shortening of the tendon Achilles. Under these circumstances stretching the tendon during physical movement will cause painful tendinitis. Whilst this may logically explain the cause of Lady Gaga’s reported ailments, it is important to bear in mind not all high heeled divas suffer these ailments and in every case their needs to be a predilection.