Footloose: high heels should not be a part of the work uniform

Back in my youthful days, I could wear heels all day and night without thinking twice about it. But now, my bones are older, my feet have put down too many steps, and my knees just can't handle the stilettos for extended periods of time. There is no way I could work in a job that requires employees to wear high heels all day, every day. I would require constant pain medication and an on-call physio.

Yet it is common in Ireland for companies to introduce dress codes for a number of reasons, including to promote professionalism or to stay on brand with its corporate image and some workplaces still force women to wear heels, despite how old-fashioned that seems.

Being forced to wear high heels in work hit the headlines a couple of years ago when a temp in accountancy firm PricewaterhouseCoopers, Nicola Thorp, was sent home from work because she was not wearing high heels. Thorp had argued that she would not be able to do her work effectively while wearing high heels and the 27-year-old refused to adhere to the high heel stipulation of between two inches and four inches requested by the temp agency Portico.

Thorp launched an online petition to make it illegal for a company to require women to wear high heels at work. It received over 150,000 signatures and was debated in parliament in the UK. However, calls to introduce a new law banning companies from telling women to wear high heels at work were rejected by the British government, with the Equalities Office saying existing legislation was "adequate".

Thorp did succeed in starting a conversation. Her story caused a media frenzy, and as a response Portico changed its policy to allow female workers to wear plain flat shoes or plain court shoes as they prefer.

Following the attention Thorp received, researchers at the University of Aberdeen looked into the issue of wearing high heels at work. They examined the physical damage and injury that can be caused, as well as the social and cultural aspects surrounding the wearing of high heels. It found large amounts of studies showed a link between wearing high heels and an increased risk of bunions, pain and injury. The researchers concluded that more needs to be done to stop women being forced to wear high heels at work.

Some people love wearing heels in the office. But that does not mean anyone should be forced to wear them. If you are an employer that insists on high heels, it is time to revisit that policy. A smart flat shoe can look just as professional as a high heel, and an employee will be much more productive if they are not in pain. When it comes to heels, employers need to stop being bossy boots and employees need to put the foot down. You can look well-heeled without high heels.

High heels can have health effects far beyond the feet

DULUTH — Serina Popoe never wears high heels.

"They hurt, and I'll trip," said the South Range woman.

During a walk around sunny downtown Duluth, Popoe, 42, wore flats, and Dana Bourdage wore 2-inch heels. Bourdage, 47, said she used to wear heels every day for work, but today, she's usually in flats because wearing them hurts her hips.

While there are claims that heels can improve posture and balance, local experts say that's not necessarily true.

"If you're talking about the aesthetics of posture, by being higher off the ground, it can actually improve your posture," said Dr. Curt Kristensen of Northern Foot & Ankle Associates. "In terms of biomechanical posture … that is not enhanced with heels. … From a functional standpoint, you're more at risk with injuries," he added.

There aren't really benefits to wearing heels, said Ryan Reinking, board-certified foot and ankle surgeon of Orthopaedic Associates of Duluth.

"Our feet have adapted, they were not built to pound the pavement and concrete surfaces, which is what we're on most of the day," he said. That's why a supportive shoe yields more benefits in general.

Many consider anything above an inch and a half a high heel, but any raise off the ground counts. A high heel is a shoe with an arch over 2-2½ inches, Reinking said.

And the shorter the shoe, the better, he said.

That's because high heels put the heel of the foot above the shelf of the toes. Short-term effects are increased pressure; rubbing; ingrown toenails; calluses; or neuroma, an enlarged nerve. More outcomes can be the development of hammertoes or bunions.

Prolonged wear can cause a shortening of the tendon or calf muscle. It can leave the wearer more prone to ankle sprains due to lack of support or Achilles tendonitis.

Wearing heels also affects areas outside the feet and ankles.

The paraspinal muscles in the neck, and girdles around your trunk and hips are working harder when the wearer is in heels on a regular basis, Kristensen said.

This also puts pressure on the kneecaps, which can lead, over time, to the early onset of osteoarthritis, according to Time magazine.

Longer-term effects may appear after long-term wear — five days a week for six months or longer, Reinking said.

Issues affect male clients through the use of western or steel-toe boots or Cuban heels. These tends to be supportive, Kristensen said, but there's often friction with a narrower toe box.

Heels come in child sizes today, but Kristensen said he tries to discourage children from wearing shoes that don't have a lot of support. Reinking recommends kids not wear heels until at least after the 11-15 age range.

Kristensen has recommended to some clients to retire their heels, and there has been reluctance. It's a habit for many, he said.

If heels are worn, he recommends a wider and deeper toe box. Lean against a wall, take your heels off at your desk, stretch. Consider metatarsal gel pads, girthier heels or taping the third and fourth toes together. Cleaning the inside of the heel can help reduce slips or injury, and using petroleum jelly on the feet to keep the skin supple and smooth can help, he said.

Avoid barefoot walking or flip-flops; some soreness can be avoided by avoiding flimsy shoes, Kristensen added. Also, loose summer shoes may cause you to grip the sole with your toes, which shortens your gait, leading to other foot and ankle issues, according to Time.

Get the right size heels, or it's going to hurt worse, said Popoe.

Added Bourdage: "Take them off as soon as possible."

"Avoid them as much as you can, and wear them in special occasions," Reinking said.

That's what Shawna Charles of Duluth does.

The 27-year-old has a go-to pair of 4-inch heeled booties reserved only for nights out. "I'm not that graceful," she said.

She has been wearing high heels for only two years, and she's more comfortable walking in them than she used to be.

Most people wearing heels have been doing it for a long time, she said, but: "Heels aren't for everybody, and that's OK. I don't think they're supposed to be."

Moderation necessary to avoid negative effects of high heels

CLARKSBURG — Warmer weather provides a great opportunity for dressing up, and for many women that includes slipping on a pair of high heels to complete the look. It also means millions of teenage girls are sliding into stilettos for prom.

Although occasional wearing high heels will likely only lead to lingering health problems in the event of a fall, consistently sporting the footwear can affect the feet, knees, hips and back, according to local health-care professionals.

"It affects the biomechanical walking pattern, the gait pattern, of the entire lower extremity," said Justin Brewer, a physician's assistant at the United Orthopaedic and Spine Center in Bridgeport.

The change in walking pattern can place stress on the inside of the knee joint, potentially causing arthritis over time, he said.

The likelihood for developing knee arthritis increases in by 20 percent in those who are overweight, Brewer said.

Others can be genetically predisposed to knee problems and knee arthritis. The risk also increases as the heel height increases, he said.

Studies have also indicated biomechanical stress on the hips and lower back, he said.

According to Clarksburg podiatrist Dr. Keith Newman, his two concerns for those who wear heels 2 inches or higher would be the effects from the increased load on the forefoot and the potential for adaptation of the Achilles tendon.

The Achilles tendon may shorten in individuals who wear heels as it adapts to the shortened position from the higher heeled shoe, he said.

"Some people will adapt over years or decades of use, and then they may not be able to wear flat shoes effectively anymore without pain," Newman said.

For those who want to minimize risk of developing complications from high heels, Brewer recommends limiting use.

"Everything in medicine and everything in life is moderation," he said.

Brewer said the people at his practice who seem to be most likely to have issues from wearing heels are those who are overweight or wear the shoes six to eight hours a day.

Those who are already experiencing pain from wearing heels should discontinue wearing them, he said.

Switching to low-impact exercises like biking, swimming or an elliptical machine will help keep reduce stress on the joints, he said.

"Losing weight, of course, will also help take the stress off the knee," he said.

Those who choose to wear the heels anyway should look for shoes with cushion for the metatarsal bones that connect to the toes.

Newman also recommended moderating the amount of time spent in high heels, but acknowledged that there are people who will wear the shoes regardless of the potential impacts on the body.

Those people "will want to make sure (the shoe is) well-cushioned, because you're pressing your luck over a number of years," he said.

Cushions can also be purchased separately that can be worn on the foot or placed into the shoe.

To help prevent shortening of the Achilles tendon, which connects the calf muscles to the heel bone, Newman recommended a calf stretching regimen. His favorite is a straight-leg calf stretch in which the individual lunges forward toward a wall while keeping the back leg straight with the heel flat on the floor.

He actually recommends these stretches for anyone. "I do them myself. I'm a strong believer," he said.

Of course, those experiencing pain can see their healthcare provider.

"We'll evaluate the patient, get an X-ray, see if they're starting to develop knee arthritis and see what kind of damage has been done to the knee joint," he said.