Higher the Heels and Greater the Dangers

X-rays show how high heels stretch the foot’s arch. Doctors say long-term use has painful consequences.

Tamiko Woolfalk rattled off her list of high heels, beaming as if they’re achievement awards.

Boots, pumps, booties, the red ones ... and the gray ones that she still needs to find a shirt to match.In all, she counted 30 pairs in her closet, with heels ranging from 2 to 5 inches high.

“Do they hurt? Absolutely,” said the Far West Side resident. “The worst is the burn on the balls of the feet. But it’s worth it.”

Stiletto-enthusiasts such as Woolfalk say foot pain is the price you pay for the confidence that comes with wearing high heels.

Physicians, however, say the price is steeper than that. More and more, podiatrists and orthopedic surgeons are educating women about the long-term consequences of wearing the wrong shoes, particularly high heels. Aside from foot, lower-back, neck and shoulder pain, they say, high heels also can lead to foot deformities. And recently they have been linked to arthritis.

A recent poll by the Society of Chiropodists and Podiatrists found that 25 percent of women who wear high heels every day are more likely to get arthritis. Other studies from various medical journals this year show that walking on high heels increases bone-on-bone movement in knee and hip joints, increasing the risk of osteoarthritis.

A study released in March by Finnish researchers concluded that women who wear high heels for 40 hours a week over two years walk differently from women who wear them 10 hours a week. Those habitual high-heel wearers take shorter, more-forceful strides and walk less efficiently, the study found.

Many women who wear heels every day develop tight Achilles tendons, which can cause back pain and make it more difficult for them to walk barefoot or in flat shoes. Other conditions include bunions, hammertoes, calluses and Haglund’s deformity, also called a “pump bump.”

A recent survey by the American Podiatric Medical Association found that 53 percent of women experience foot pain.

“It’s hard to think, in general, that people are so accepting of pain that they don’t question it. Foot pain is not normal,” said Dr. Lori DeBlasi, a Columbus podiatrist who works at Specialized Orthopaedics & Sports Medicine.

DeBlasi said she cringes when she walks through department stores and sees all of the high heels on display.

Woolfalk, 34, a patient-care coordinator in DeBlasi’s office, said that, despite seeing the many foot conditions at work, she maintains a strong fondness for her shoes.

They’ve taken her to nightclubs, where they’ve carried her feet across dance floors for hours at a time. For years, she has witnessed the attention garnered by elongated legs and slim calves.

“You can’t go to the club with sneakers — it’s about the height of the shoe, the sexiness of the calf. It’s a good time and a nice picture,” she said. “Nothing can change my mind about these shoes. ”In some cases, the loyalty to foot fashion goes to extremes. Some women go as far as amputating toes to fit into shoes. It’s called toe tucking.

There have been reported cases in New York City when women pay as much as $2,000 to have part of or all of a pinkie toe removed so they can better fit into pointy shoes.

“These are extreme cases, but it shows you this is the same as the Chinese foot-binding,” said Dr. Judith Smith, an surgeon in Springfield, Mo. “It is a fashion statement and a status symbol.”

Smith, a member of the board of directors of the American Orthopaedic Foot and Ankle Society’s outreach and education fund, performed a survey in the 1990s that found that 88 percent of women wore shoes that were too narrow, and 76 percent had some sort of foot deformity. Over a 15-year period, 87 percent of forefoot procedures were in women, according to her report.

Smith said she has had patients who were told their surgeries would be ineffective if they continued wearing high heels, yet they still did.

“There’s almost a disconnect there. They just can’t imagine life without these shoes.”

Woolfalk said she has worn her beloved heels less over the past few years but doesn’t plan to cut them out of her life. She said she hasn’t had any lasting consequences from her years of foot pain.

Predicting who will develop foot problems is like trying to predict which cigarette smoker might get cancer, Smith said. “Our job is to educate them on the problems that can arise.”

Some tips from medical professionals:

• If you must wear heels, stick to a wedge rather than a stiletto to maximize stability and keep your feet from rocking side to side.

• Try to keep heels to 1 to 2 inches high, and don’t wear them for more than a few hours at a time.

• Buy shoes at the end of the day, when feet are at their largest.

• Leave enough room in the toe of the shoe to slip in a finger.

• Buy shoes with good arch and heel support. Ballet flats and flip-flops can be just as harmful as high heels if they are too flexible and don’t support your feet.

High price of wearing heels

For a quarter-century, Catherine Ange has worked as a seller of high-end furniture at the Atlanta Decorative Arts Center. Before computers became a mainstay of the job, a typical day could find Ange bending down, standing on tiptoe or moving furniture across 22,000 square feet of showroom space — all while wearing shoes with a 3- to 4-inch heel.

“I thought, ‘I feel so good in these heels. I can sell anything. I am invincible,’ ” said Ange, 47, of Buckhead. Her feet, unfortunately, were not so resilient.

By the time she reached her 30s, Ange was feeling the pain — a sharp, stabbing pain in the ball of her foot. She tried alternating heels and flats, but soon even flats were uncomfortable. She went to a doctor for injections of anti-inflammatories. Eventually, the only thing left to treat her Morton’s neuroma — a condition that causes thickening and pain in the nerves between the toes — was surgery.

After four surgeries in three years, heels are a thing of the past. “It is no laughing matter when you can no longer wear your Chanel pumps,” said Ange, who mostly wears custom orthotic inserts in her boots or sturdy tennis shoes.

The kind of debilitating foot pain that Ange experiences is a common problem for high heel wearers, particularly women who have been wearing heels for many years.

About 25 percent of women older than 40 have severe foot problems related to shoe choice, said Katy Bowman, a biomechanics expert and author of “Every Woman’s Guide to Foot Pain Relief: The New Science of Healthy Feet” (BenBella Books, $17). The problems can range from short-term issues such as blisters and calluses to long-term structural damage to the feet or body, such as shortening of the calf muscles.

“There are a lot of people trying to work themselves out of foot pain,” said Bowman, whose book helps women understand the mechanics of the foot and explains how to transition from heels to more sensible shoes.

“We know barefoot is natural, but you can’t just take off your shoes and start running,” she said.

Bowman’s advice includes exercises to help ward off foot troubles — at least for a while, because some women seem unable to resist the lure of high heels.

“No matter what I say, they are going to [wear heels],” said Dr. Jay Spector, of Northside Podiatry, who advises wearing no more than a 2-inch heel ... ever. Serious foot pain related to high heels can develop in as little as one night or a few weeks, he said. If you must wear high heels, Spector said, wearing them for shorter periods of time, then switching to a shoe with a lower heel can help.

Margaret Lisi of Midtown, a marketing manager who’s in her mid-40s, learned just how quickly heels can hurt when a pair of new gray pumps did a number on her feet.

“I felt like my feet had been cut open,” said Lisi, describing the pain. “I walked out of my building to go home and didn’t even make it across the street. I took the shoes off and tiptoed all the way to my car.”

The next day, Lisi shoved her scarred feet into a pair of boots. “[My feet] were like little loaves of bread rising in the warm environment of my cowboy boots,” Lisi said.

Women may take such isolated experiences lightly, but anyone who consistently wears heels can experience more severe problems over time, said Dr. Jason Morris, of Primera Podiatry, a new practice opening in February that offers advanced podiatry services such as a laser center and medical foot spa.

“The most common problem for patients who wear high heels daily or more than two to three times per week is thinning of the fat pad at the ball of the foot,” Morris said.

The abnormal positioning of the foot in high heels creates pressure on the ball of the foot, which thins the protective layer of fat and leads to a painful condition called metatarsalgia, he said.

Morris uses a new treatment — an injection of the filler Sculptra — to replace the fat pad and plump the area. The treatment can last 12 to 18 months, he said.

Morris also has treated heel wearers for stress fractures and another problem, bunions, which are caused by weakening of ligaments that hold the foot bones together. Bunions are genetic, but wearing heels can speed their development, Morris said.

Bunion surgery landed Michele Caplinger, senior executive director of the Atlanta Chapter of the Recording Academy, in the operating room just over a year ago. After more than 20 years wearing 3-inch heels on a regular basis, Caplinger had developed painful bunions on both feet.

“The pain was gradual, but I would literally end up in tears an hour into wearing a pair of heels,” Caplinger said. “In my line of work, I have many events, and I have to dress up, so I was constantly in pain.”

She went to foot doctors at least once a year and all recommended surgery, but Caplinger was terrified. When Caplinger met Dr. Perry Julien, the pain had become unbearable. She consented to surgery and has since been pain free.

The experience made Caplinger more thoughtful about her footwear choices but not quite ready to leave heels behind. “I am back in heels,” she said. “I do find myself in better-made, more reasonable shoes. That is an easy choice to make when vanity is not a priority.”

Higher heels linked to increase in foot problems

St. Louis (KSDK) -- Your high heels may be doing more harm than you think.

Doctors say they're seeing more and more women coming in with foot problems because the high heel heights are soaring and there seems to be less support in some of those shoes.

Ten or 15 years ago, the problems were a lot easier to fix, but now doctors say women are set on wearing higher heel, so they're doing a lot more long term damage.

"The higher the heels the worse the problems," said Dr. Rick Lehman, an orthopedic surgeon. "As these new shoes come out the incidents of foot problems have gone through the roof."

Dr. Lehman said the high heels can cause bunions, plantar fasciitis and achilles tendon problems.

Dr. Lehman says if you're going to wear high heels, make sure to stretch your feet, wear a wide enough shoe and give your feet a break if they start to hurt.

Killing the pain of killer heels

ECCENTRIC superstar Lady Gaga’s recent interview with TV’s Paul O’Grady may have drawn gasps from audiences for many different reasons.

Perhaps her bald head, bold lyrics or bright green wig might have been startling to some but, for me, it was the towering heels in which she tottered across the stage which caused the biggest surprise.

For many decades now celebrities have been setting the trend in the fashion for “killer heels” and a quick trip to high street shoe shops will prove the point that new shoe styles seem to becoming higher and more daring than ever before.

Iconic French designer Christian Louboutin even hit the headlines this week for creating a pair of his famous red-soled eight inch stilettos which will now be auctioned off to raise funds for the English National Ballet.

And although these shoes would probably only ever be attempted by a ballet dancer at best, a visit to most UK town centres on a Friday or Saturday night will prove that young women are still opting for killer heels which can leave them hobbling and limping home after a long evening out.

But what impact does the wearing of high heels really have on a person’s feet?

Podiatrist Kerri Money, who works at PhysioPlus in Kingsthorpe, said she believed only a section of 18 to 23-year-olds really attempt to wear super high heels, but those who wear them routinely should be aware of their biomechanical impact on the body.

She said: “When you are in a high heeled shoe, your body has been made unstable so the shoe will affect the way you stand and walk. Your back will be more arched, your pelvis pushed forward and your calf muscles will shorten so your muscles will not be working as they should be.

“If your calves are often flexed they will stay like that, if you are in them all the time and go to a lower heeled shoe you are asking them to be in a position they are not used to.

“In low heeled shoes you can absorb the shock from the ground. If you are not doing that you are pushing the foot forward to absorb the shock, which isn’t what it has been designed to do. In high heels the centre of gravity is pushed forward and the balls of the foot are absorbing the hit of the ground and you are pushing off with them. That is a lot of work and can make the balls of your foot hurt.”

She continued: “We all like to wear heels sometimes but my advice would be to wear them only for short periods. I call them ‘car to bar’ shoes. If you are going out, you should go for thicker soles, the thicker the better. The more sole, the more cushioning there will be to help with shock absorption.”

Other tips from Kerri include trying to vary the types of shoes worn and opting for footwear with more straps, which offer more support.

She said: “Rotate between different shoes. If you are rotating different heels your muscles will work in lots of different positions.

“With more straps you will have more stability.

“With narrow, pointed shoes and high heels that is two negatives. If someone has a bunion and they are in a high heel their centre of gravity will have been pushed forward and they will be putting weight on a problem area.”

According to the NHS, the occasional wearing of high heels will not be harmful but damage can be caused if they are worn often during a working week, particularly when a person has to do a lot of walking or standing.

And poor footwear can have an impact later in life.

Helen Harman, falls practitioner for NHS Northamptonshire, said: “The impact of falling later in life is probably not foremost in the mind of fashion conscious young ladies. However, one of the highest risk factors for falling in later life is related to feet. Poor balance which can lead to severe falls can be a result of poor feet, possibly caused by footwear in earlier years.

“The Northamptonshire Falls Service routinely assesses feet and footwear as part of identifying the possible causes of a fall and aim to minimise falls risks. Advice is given regarding wearing well fitting supportive shoes.

“The effect of poor footwear can cause problems such as a corn, ingrown toenails, a callus or bunions.

“Frequently money is spent on appearance such as facials/makeup/hair styles but, despite our feet walking many miles over the years and being vital to wellbeing, they are often neglected.”

Extended wear of high heels can cause foot damage

High heels make you look great, improve your figure, and are the final touch to a fashionable look, but if high heels do wonders for your appearance, they don't do a lot for foot health.

Dr. Michael Nirenberg, a podiatrist at Friendly Foot Care in Crown Point, says he doesn't discourage women from wearing high heels occasionally. "Once or twice a week is going to do minimal damage to your feet," he says. "If you wear heels over a long period of time, then you can do permanent damage to your feet and your body."

Dr. Nirenberg says that although high heels make you look taller in the short term, in the long term they cause you to become shorter as your body adapts to the shoes. He says your back will begin to curve and your buttocks expand out and you end up the same height you were without heels.

High heels also put all your weight on the front of the foot, which compresses the toes and the ball of the foot, leading to injuries such as the unlovely bunions, hammertoes or painful pinched nerves called neuromas.

And don't think you can wear high heels until you begin having a problem. Studies have shown that if you wear high heels and stop wearing them, later on you're more likely to have foot problems.

"Constant wearing of high heels change the feet permanently," Dr. Nirenberg says. "They also change the way all your joints in your body are aligned. Heels, even the small ones, cause you to fall forward, and the body compensates by contorting the back and changing the positioning of the shoulders and neck, making you prone to herniated discs. You also use the joints and muscles incorrectly, because you're not walking in a natural way. The Achilles tendon also shortens and you'll have pain whenever you wear a flat shoe. You can lengthen that tendon over time, but it depends upon how long you've been wearing high heels. A podiatrist can help."

When wearing heels, Dr. Nirenberg says the lower the heel the better. The platform sole is better than stilettos because they spread the weight more evenly over the ball and heel of the foot. "The high heel inserts help, too," Dr. Nirenberg says, "because they spread the weight and provide cushioning. Shoes should not hurt, even high heels. Make sure yours is the right size, and if your high heels begin to hurt your feet, you've worn them long enough."

A Closer Look At New Developments In Diabetes

The prevalence of diabetes is increasing rapidly and is expected to reach epidemic proportion over the next decade. Recent research estimates that the number of people diagnosed with diabetes will rise from 23.7 million to 44.1 million between 2009 and 2034.1 The Centers for Disease Control and Prevention (CDC) further predict that up to one-third of U.S. adults could have diabetes by 2050 if Americans continue to gain weight and avoid exercise.2

Diabetes is associated with a myriad of complications with foot ulcerations being the most common. An estimated 15 percent of all patients with diabetes will develop foot ulcers.3 About half of these ulcers become infected and 20 percent of those patients will end up with some form of lower extremity amputation.3 With the prevalence of diabetes dramatically increasing, billions of dollars are spent in the field of diabetes research for the early diagnosis, prevention and management of this disease.

With that said, here is a closer look at current research in the field of diabetes and emerging methods of disease management.

What You Should Know About Biomarkers For Diabetes
Researchers are constantly studying biomarkers to help predict the possibility of developing certain diseases. Biomarkers can indicate a change in the expression or state of a protein that correlates with the risk or progression of a disease, or with the susceptibility of the disease to a given treatment.

Recently, researchers from the United Kingdom have reported that microRNA (MiR) can help identify people who are likely to develop type 2 diabetes even before the onset of symptoms.4 MicroRNAs are classes of approximately 22 non-coding nucleotide regulatory ribonucleic acid (RNA) molecules that play important roles in controlling the developmental and physiological processes.5 Specifically, microRNAs regulate gene expression including differentiation and development by either inhibiting translation or inducing target degradation. MicroRNAs can also help serve as diagnostic markers to identify those who are at high risk of developing coronary and peripheral arterial disease.


In a study of 822 people, researchers identified five specific microRNA molecules with an abnormally low concentration in blood in people with diabetes and in those who subsequently went on to develop the disorder.6 One molecule in particular, microRNA 126 (MiR-126), was among the most reliable predictors of current and future diabetes. MiR-126 is known to help with angiogenesis and regulate the maintenance of vasculature. Healthy blood vessel cells are able to release substantial quantities of MiR-126 into the bloodstream.

However, when endothelial damage occurs, the cells retain MiR-126 and subsequently release less MiR-126 into the bloodstream. A decrease in plasma MiR-126 can therefore be an indicator of blood vessel damage and cardiovascular disease. Researchers also found that levels of MiR were lower when they gave large amounts of sugar to mice with a genetic propensity to develop diabetes.6 The MiR test can directly assess vascular endothelial damage secondary to diabetes and has a fairly low cost at around $3 per test. Clinicians may possibly be able to use this in conjunction with conventional tests in the near future.

Plasma thrombin activatable fibrinolysis inhibitor (TAFI) antigen is another biomarker that may participate in arterial thrombosis in cardiovascular diseases and may be involved in the mechanism of vascular endothelial damage in patients with diabetes.

Erdogan and colleagues investigated the association of plasma TAFI antigen level in the development of diabetic foot ulcers in people with type 2 diabetes.7 Specifically, researchers determined TAFI antigen levels in plasma samples in 50 patients with diabetic foot ulcers, 34 patients with diabetes but without diabetic foot ulcers, and 25 healthy individuals. The diabetic foot ulcer group and the diabetic non-ulcer group were similar in terms of mean age and sex distribution.

The researchers found TAFI levels to be significantly elevated in patients with diabetes with or without foot ulcers in comparison to the healthy controls. However, there was no difference in TAFI levels between the diabetic foot ulcer group and diabetic non-ulcer group, or between diabetic foot ulcer stages.

As research in this arena continues, a new class of blood markers may give additional insight to screen people who are at a higher risk of developing diabetes and intervene before the symptoms and the broad spectrum of associated complications occur.

Can An Artificial Pancreas System Enhance Glucose Control?
The artificial pancreas is a technology that is best described as a closed loop glucose management system that is intended to afford patients with diabetes better glucose control while averting the hypoglycemic state.8 With the advancement of technologies, newer artificial pancreas systems consist of a real-time continuous glucose monitoring (CGM) system. This system transmits information every one to five minutes from an under the skin sensor to a handheld receiver that can be integrated into a pump. The device also has an insulin pump with a pre-programmed algorithm that calculates appropriate insulin dosages based on the glucose ratings.

A potential imperfection to this CGM system is that the system reads glucose levels from the patient’s interstitial fluid as opposed to the actual blood glucose levels. The interstitial compartment has a lag time of eight to ten minutes and can affect the glucose readings, especially postprandial readings.

The insulin pump is a beeper-sized device that is flexibly attached via a tube in the tissue just under the skin and will release as per patient requirement. Some partial “half-loop” solutions are available in Europe and the FDA has recently approved three of the closed loop systems. Meticulous testing is still needed before the system can go on the market.9

Emerging Insights On Stem Cell Advances
With islet cell transplantation research quickly on the rise to help regenerate the disordered islet cells of the pancreas, we have seen much promise in stem cell research. Ideally, the in vitro generation of insulin-producing cells from stem or progenitor cells presents a promising approach to overcome the scarcity of donor pancreases for cell replacement therapy in people with diabetes.10

In an ongoing study, researchers at the Diabetes Research Institute are assessing the effects of biohybrid devices, also known as “scaffolds,” to house and protect the transplanted insulin producing cells.11 These “scaffolds” are designed to mimic the pancreatic environment and are being tested in different areas of the body that include the abdominal pouch, muscle tissue or subcutaneously. Furthermore, the “scaffolds” are also being tested to deliver favorable agents that may help promote the growth and viability of the transplanted islet cells.

Current studies are very optimistic in showing that these “scaffolds” co-transplanted with mesenchymal stem cell regenerative islet cells can help accelerate angiogenesis, which prolongs the longevity and functionality of islet cell regeneration.12

Encouraging Patient Adherence: What Recent Studies Reveal
Patient adherence is one of the many challenges in the treatment and management of diabetes. For years, physicians have been researching new methods in tracking patient adherence to glucose monitoring and management, and to pressure mitigation devices.

In an article published in the Annals of Family Medicine, researchers looked at the participation levels of patients with type 2 diabetes in their primary care check-up visits.13 Several offices sent questionnaires to these patients regarding their treatment goals and plans at the initial visit as well as follow-up visits. Researchers found that the more patients participated in their treatment decisions and management, the better they adhered to the prescribed medications and treatment. This resulted in better control of their diabetes.

Another study compared the efficacy of a reciprocal peer support program with that of nurse care management in 244 men with diabetes in two Veterans Affairs healthcare facilities.14 Researchers matched patients in the reciprocal peer support group with another age-matched peer patient and were encouraged to talk via telephone and participate in optional group sessions. Patients in the nurse care management group attended a 1.5-hour educational session and were assigned to a nurse care manager.

After six months, the mean hemoglobin A1C level for patients in the peer support program decreased from 8.02% to 7.73% while it increased from 7.93% to 8.22% in the nurse care management group.14 This was statistically significant.

Both studies support the notion that some patient empowerment in their treatment decisions and management may translate into better long-term outcomes.

In Conclusion
Diabetes is estimated to impose more than $174 billion dollars per year on United States healthcare. This astounding financial toll is expected to continue to rise as more and more people are diagnosed with this debilitating disease.2 In addition to being aware of the plethora of current research, patient education and preventative care are important strategies to emphasize. It is through innovative research, teamwork and preventative strategies that we continue to gain successful outcomes and improvement in the prevention and management of diabetes and its complications.

VOLUME: 24 PUBLICATION DATE: Jan 01 2011
Author(s):David A. Farnen, BS, and Stephanie C. Wu, DPM, MSc

Current Insights on Conservative Care for Heel Pain

Heel pain in children is commonly caused by calcaneal apophysitis or Sever’s disease. This is a traction apophysitis at the calcaneus due to the pull of the Achilles tendon insertion and the origin of the plantar fascia. Typically, the child is involved in a youth sport or activity, such as soccer, baseball, track or basketball, which involves a lot of running and jumping.

Usually, the condition will resolve on its own over time but it is helpful to treat symptoms in the active child using many of the aforementioned treatments such as taping, proper shoe recommendations, ice, stretching (not during acute episodes), etc. I like to apply a low Dye strapping with a closed basket weave on the heel. This has worked very well in allowing children to participate in their activity relatively pain free.

Institute a stretching exercise program for the Achilles tendon and plantar fascia when the child is not in a pain cycle. Addressing footgear is also critical in allowing the child to return to activity and reduce symptoms.

During the exam, the child with calcaneal apophysitis will have a positive squeeze test with medial and lateral compression over the heel with localized tenderness. The activity level is based on response to treatment and minimizing pain with activity.

Keys to Ensuring a Good Fit with Athletic Shoes
• Measure both feet standing on a Brannock device.
• Have patients try on shoes in the afternoon or evening due to swelling.
• Have patients wear similar weight socks or orthotics for activity.
• Have patients try on shoes a half size larger to compare fit.
• Do the basic three shoe tests to evaluate quality.
• Tell patients there should be at least one finger width from the end of the longest toe to the end of the shoe.
• Have patients wear new shoes indoors first to make sure they are comfortable.
• The shoe should not require a break-in period.
• Educate patients on knowing when to replace shoes and the differences among shoe brands.

Treating heel pain can be a real challenge. It is very important to get a detailed history from the patient as to the etiology of the heel pain. The vast majority of heel pain results from overuse. When acute injuries become chronic, one should identify and address biomechanical causes. Evaluating the patient’s training, shoe gear and any previous treatment is essential to a successful treatment plan.

Commonly, the diagnosis points to plantar fasciitis. However, remember there are many causes of heel pain and your differential diagnosis could include a calcaneal stress fracture, nerve entrapment/neuritis, calcaneal apophysitis, calcaneal bone cyst, Reiter’s syndrome or a possible tumor. A good history and exam will help pinpoint a diagnosis and direct a subsequent treatment plan.
Heel pain in the athlete is commonly caused by an increase in the intensity and frequency of activity. Often the athlete is adding running to the workout routine and for cross-training workouts. A good history will include the following key points: sudden or gradual onset of pain, localized or diffuse pain, pain intensity (scale of 1-10), duration of pain and what relieves the pain. The patient history also includes any prior history of problems, any previous treatment, any changes in training intensity and frequency, and any changes in athletic footwear.
The problem with using the pain scale is getting the patient to understand the relative number as most patients will say it is a 10. It is sometimes difficult to determine if the pain is mechanical or neurological in nature. Commonly, the pain is insidious in nature and there is no incidence of trauma.

Medical Attention Or Been Hospitalized Because Of Wearing Trendy Shoes

LONDON, 2010 -- One in 10 women in Britain admit they've received medical attention or been hospitalized because of wearing trendy shoes, a survey indicates.

The survey of 3,000 women in Britain who wear high heels was conducted by Hotter Shoes, a British shoe manufacturer.

Nearly half of women say they have twisted their ankle because of their footwear and two-thirds admit wearing shoes that have caused them injury. The most frequently reported injuries caused by shoes were broken ankles, twisted knees, infected blisters, bunions and torn tendons.

"As a comfort shoe maker we were amazed to discover the pain and discomfort that women were prepared to endure for a pair of killer heels or an ill-fitting impulse sale bargain," Lisa McCarten of Hotter Comfort Concept Shoes says in a statement. "Nothing can ruin a day more than sore and tired feet, every person in our design and technical team works hard to ensure that our shoes are stylish and comfortable."