Behind the design | The Healthier Option for High Heels

27 Sep 2021

High heels – they are a style of shoe many women love to wear, although often our feet and legs will protest!

Academics have been studying the effects of high heel shoe wearing for decades. In addition to potentially making our feet sore, high heels may contribute to pain and dysfunction from the feet right up to the lower back due to changes in joint and soft tissue loads, muscle activity and walking pattern 1-6.

We’re not here to debate the potential negative effects of high heel shoes – we know they are not great for your feet.

But we’re also not here to tell you to stop wearing heels – life is too short to not wear styles you love!

Instead, we got to work and developed our unique Podiatrist designed forefoot support curves in our open toe high heel footbeds – to offer a healthier, more comfortable high heel option.

Keep scrolling to learn more

1. Why do high heels hurt the balls of my feet?

We have all experienced that pain under the balls of our feet from wearing high heel shoes. But why do high heels result in this forefoot pain that doesn’t occur when wearing flat shoes?

When we wear shoes with a high heel, our foot is placed in a plantar flexed position (in this context, simply meaning standing on ‘tip toes’)7-10. To keep your balance in this position, your center of mass (body weight) needs to shift forward7, 8, 11, 12. This leads to increased pressure under the forefoot, particularly the inner side of the forefoot and the base of the big toe8, 10, 13-15.

What’s unique about our high heel footbed design is that it provides extra cushioning in these areas under the forefoot and is specially shaped with the aim to help pressure distribution. Keep reading below to learn more about the support footbed found in our high heels!

2. Support and cushioning where it's needed in a high heel - the forefoot!

HELP DISTRIBUTE FOREFOOT PRESSURE USING STRATEGIC CURVES

The shape of our footbed is one of a kind - unique to FRANKIE4 - featuring our soft convex curve design.

The soft gentle curvature is designed with the aim to help distribute pressure more evenly across the forefoot, aiming to help reduce high pressure points.

The soft convex curve was designed to help the metatarsal heads (the bones within forefoot) to feel less loaded. The key is not only our unique curves, but also the materials and varying densities we use in our dual and triple density footbeds.

We use more cushioning under the first toe joint as evidence shows that wearing high heel shoes causes an increase in pressure under this area 8, 10, 13-15. This biased cushioning is where it is most needed when the foot is placed into a high heel position – under the ball of the foot.

PROVIDE CUSHIONING AND COMFORT USING A CLEVER COMBINATION OF MATERIALS

Studies have demonstrated positive effects in the use of forefoot padding in high heeled shoes, finding that they reduced peak pressures and increased comfort 16. The properties of the materials used in forefoot padding are also important, as this affects the shock absorption capabilities 16. While some materials are better at reducing peak pressures, others contribute to greater perceived comfort 16 and for this reason, it has been suggested that using a combination of materials for pressure reduction, comfort and cushioning is ideal 16.

The research tells us that using a total contact insert or full length footbed can improve pressure distribution in the foot, reduce ground reaction forces and ultimately increase comfort and stability in high heel shoes 10, 15, 17-19.

Our high heel footbed is triple density (3 different materials with varying softness) to provide a combination of support and cushioning with a gentle arch slope to help encourage better distribution of pressure under the foot, to promote a feeling of stability and contribute to that soft feeling under foot.

3. How high is 'too high'?

Discomfort and pressure under the forefoot generally increase with heel height 8, 10, 22. Even a small increase in heel height (around 3cm to 4cm) can increase peak pressure in the medial forefoot (inner side of the forefoot) by up to 40% 8 and increase knee joint loads by up to 30% 1.

Whilst , we transparently note that high heels aren't good for your feet, at least with our range women can opt for a more comfortable option of heels without having to feel they compromise on their style.

Our range of low, mid, and high heels gives women a choice of heel height to tick their boxes.

Higher heel height changes the way that we walk and how our muscles function (see ‘ more information ’ below for more details), from the feet and ankles all the way up to the lower back. When the foot is in a high heel shoe, the ankle in particular is placed in an unstable position 9. This explains why it is not just the forefoot where we might feel the pain of high heel shoe wearing.

Optimizing stability is thus important in our designs, and heel base size is very important.

Smaller heel base size increases pressure in the forefoot and has been reported to feel less stable than walking in a shoe with a wider heel base 20. Whereas, a broader base of support has been shown to redistribute the plantar pressures, improving comfort and contributing to a greater feeling of stability 20, 21.

This is why FRANKIE4 open toe heels have been designed with a stable heel base that allows the heel to take its fair share of the load. Secure straps around the foot and ankle are also a feature of our designs, ensuring you feel as secure as possible in your chosen heel height.

4. Let's talk 'arch support' in high heels

The position of your foot when wearing a high heel shoe is like being in the ‘push-off phase’ of walking, with the toes at a flexed angle (dorsiflexed). This naturally creates a tightness in the supporting structures under the arch of the foot (called the Windlass Mechanism)23. You can bend your toes back or stand on tippy toes to see this ‘Windlass effect’ for yourself. Notice how a high arch forms - generally speaking, this is how high heels position your feet.

In this raised heel position, (for most) the foot is excessively supinated (rolled outward) increasing the arch position and reducing stability in the ankle 9, 12.

For this reason a substantial amount of arch support is usually not required in a high heel shoe. It's why our FRANKIE4 Sole HeroTM High Heel Footbed is designed to provide a very gentle arch contour – not too much, not too little.

The footbed in our heeled styles aims to provide a better foundation for the foot when it is placed in this high heel angle. Our gentle arch support, and triple density materials help promote comfort and a feeling of stability.

Nicole Merrick, Physiotherapist

B. Podiatry, B. Physiotherapy

Caroline McCulloch, Founder

B. Podiatry, B. Physiotherapy

Sara Taylor, Podiatrist

B. Podiatry (Hons)e

The Effects of High Heels on the Foot and Ankle

When looking at a foot positioned in a high heel, it’s not hard to imagine how pain might be generated throughout the foot and ankle.

The literature tells us that wearing high heels changes the position of the foot and increases plantar pressure7-12. When the foot is in a high heel shoe, there are also changes to the position and stability of the foot and ankle joints9, 12. With the toes pressed into a dorsiflexed position in a high heel shoe, the Windlass Mechanism occurs and the arch is lifted23. The ankle is also placed in a plantar flexed, inverted and internally rotated position9. Without appropriate support, this contributes to increased pressure in the forefoot8, 10, 13-15 and reduced stability12, 18, 24, potentially leading to pain and an increased risk of injury24-26.

To offer a healthier option for high heels, our designs aim to decrease pressure points under the forefoot, to minimise instability at the foot and ankle and increase overall comfort under foot.

The Effects of High Heels on the Calf Muscles and Ankle Joint

Our soft tissues adapt to repetitive loading over time and both structural and functional changes to the muscle and tendons around the ankle may occur due to prolonged wear of high heels27. Long term high heel wearing contributes to shortening of the calf muscles, along with increased size and stiffness of the Achilles tendon, potentially contributing to reduced ankle mobility3, 27. Habitual high heel wearers may also be more vulnerable to muscle fatigue, particularly in the calf muscles, leading to an imbalance of muscle activation patterns and abnormal distribution of pressures24.

The position of the foot in a high heel is significantly different to that of a flat. There is an increase in plantarflexion of the talocrural joint (ankle joint) and supination of the subtalar joint (just below the ankle joint) when the foot is position in a high heeled shoe11, 24. These altered joint positions require changes to muscle activity to stabilise the joints11. Increased activity in the soleus muscle of the calf and the peroneus longus muscle (position on the outside of the calf) have been demonstrated in high heel gait3, 11 and may also contribute to calf muscle fatigue.

There are also changes to the ligaments which support the ankle joint and contribute to stability5. The anterior talofibular ligament (ATFL) is an important stabilizer of the ankle joint and the one most commonly injured in ankle sprains 5. The strain and tension on the ATFL increases in high heeled shoes to almost 6 times that of flat shoes. This suggests an increased risk of ankle injuries in high heel shoe wearers5. This is supported by epidemiological research which suggests injury rates from high heels to be as high as around 18 per 100,000 women, with most injuries occurring as sprains and strains to the foot and ankle26.

We pride ourselves on crafting a healthier option for women who love high-heels. If a day on your feet, or a long walk is on the agenda, why not take a look at our one-of-a-kind flat styles, then swap back into your FRANKIE4 heels when high heel height is on the agenda. To put simply, sharing the time you spend in high heels with flatter styles is sensible advice.

The Effects of High Heels on the Knee Joint

Walking in high heeled shoes changes the biomechanics of the lower limb and with it, the loading pattern at each joint also changes1, 28. So, what does this mean for the knee?

During high heeled gait, peak power and joint work production are higher at the knee compared to wearing flats28. Step length, step width and walking velocity all experience negative changes in high heeled shoes, along with changes to joint range of motion and power generation throughout gait29. Joint reaction forces and knee flexion angles are increased as heel height increases, with the medial (inner side) knee and the patellofemoral joint (knee cap joint) absorbing considerably more load in a high heeled shoe1, 3, 6. In fact, patellofemoral joint stress can increase by almost 90% when wearing high heels compared to that of flat shoes6.

Greater compressive and mechanical load at these areas are thought to be related to biomechanical changes in high heels, such as reduced step length3. This chronic compressive loading over the long term may have deleterious effects on musculoskeletal health, potentially increasing the risk of medial knee osteoarthritis and patellofemoral pain3, 6.

Women have loved wearing high heels for hundreds of years now, which isn't surprising considering there is no denying how a pair of high heels can make us feel. It's why, as a brand, it doesn't make sense to tell women not to wear high heels considering our goal is to improve the quality of life of women.

The Effects of High Heels on the Lower Back

Many women spend their working week walking and standing in high heel shoes. High heeled shoes are a known contributor to foot pain, with up to 50% of women complaining of recurrent nontraumatic foot pain30. But it is not only the feet that suffer. Almost 60% of women who regularly wear high heels have reported lower back pain31 related to their use.

When positioned in a high heeled shoe, our centre of mass moves superiorly (higher) and further forward than when wearing flats14, 31, 32. This changes the position of our lower spine and the lumbosacral angle14, 32, creating a less stable posture and potentially increasing compressive forces at the lower spine31. Associated changes to lower back muscle activity are then required to maintain postural alignment, increasing the work of the lower back extensor muscles14, 31, 32. This may explain the discomfort and fatigue experienced by habituated high heel shoe wearers31, though the long-term effects of high heels on the lower spine are not really known.

We pride ourselves on crafting a healthier option for women who love high-heels. If you are suffering Lower Back pain why not take a look at our one-of-a-kind flat styles, designed to support you from the ground up.

Relevance and Reflection

As outlined above the negative effects of wearing high heels are well documented. At FRANKIE4 we believe that the design of the shoe should be able to mitigate some of these unfortunate effects of high heel wearing on women’s feet.

FRANKIE4 heels have been designed with key features to support and cushion the forefoot, and to help distribute load through the arch and heel. The wide, stable heel base, and secure fastening straps around the foot and ankle help mitigate potential ankle instability due to the plantarflexed position of the ankle. It’s also important to remember that many of the deleterious effects outlined above relate to long-term use of high heels. At FRANKIE4 we aim to give ladies the choice of a range of comfortable heel heights to suit every occasion, as well as flats to rest those hard-working legs on more casual days!

Disclaimer: The contributors to this article make every effort to make sure the information provided is accurate. All content is created for informational purposes only. The information regarding our products is not intended to replace professional or medical advice relevant to your circumstances. Discontinue use if you experience discomfort and seek advice from your health care professional.

References

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