Simple steps to healthy feet

Posted on 25 January 2016

High heels, flat soles, pointy toes… Those new shoes look great on you, but are they also damaging your feet? A Mediclinic podiatrist separates the facts from the fiction.

Fiction: tight shoes cause bunions
A bunion is a swelling on the first joint of the big toe – and not only is it painful but it can also lead to further problems, like arthritis and deformation (a bad bunion could push your second toe out of place). The exact cause of bunions is unclear: most scientists agree that they’re genetic, while some point to other conditions like arthritis. Ill-fitting shoes aren’t a direct cause… but they definitely don’t help, says Dr Warren Visser, a podiatrist at Mediclinic Vergelegen in Somerset West. ‘Wearing tight shoes won’t really be a causing factor, but – especially if the shoe is tight at the front – that’s going to advance the growth of the bunion a lot quicker,’ he says. ‘If you’re wearing a shoe that’s very tight, then that is going to exacerbate the condition in an earlier stage. So instead of being at Stage 1, it could be at Stage 4 within a shorter period of time.’

‘It’s all about education,’ adds Dr Garyn Cohen, a podiatrist at Mediclinic Morningside in Gauteng. ‘We educate our patients a lot about footwear because bunions are largely hereditary. What makes up bunions is about 70% genetic, so there’s nothing we can do about that. Another 15% is biomechanics, which occur in the forefoot when the foot tends to roll in or overpronate’ – more on that later – ‘and then you get pressure at that bunion joint. What makes the other 15% is ill-fitting footwear.’

Fact: tight shoes are bad news
Just because they’re not a direct cause of bunions, doesn’t mean ill-fitting shoes are good for you. In fact, the wrong shoes could cause damage that starts at your feet, and ends elsewhere in your body. ‘High heels can shorten your calf muscles, which can eventually lead to backache,’ warns Dr Visser, adding that, wearing the right shoes can help prevent problems like plantar fasciitis (which causes heel pain).

Despite all that, Dr Cohen says that Mediclinic’s podiatrists still get some patients who are not interested in changing their shoes. ‘There’s nothing much we can do for them,’ Dr Cohen shrugs. ‘They want the magic quick fix, which we tell them is impossible. The only “quick fix” is the surgery route, which should be a last resort, even though it is successful. We can put an orthotic device into the shoe, which is made specifically to offload the stress where the bunion forms. The problem there is, it takes up a bit of space. If you put an insert into a shoe that’s already very tight, the insert is going to sit in the patient’s cupboard and they’re going to be very unhappy.’

Can’t the doctors just insist that their patients throw out those two-sizes-too-small foot-crushers? ‘We can try,’ says Dr Cohen. ‘I’ve been in practice since 1996, and I realised after about 15 years that you’ll get patients who’ll listen to you, and you’ll get patients who you can talk to until you’re blue in the face. Those are the shoes they’re going to wear, and unless their feet are literally falling off, they’ll walk around all day and then cry at night when they’re in pain.’

Fiction: high heels are just the absolute worst
Wait a minute. High-heeled shoes look great, and many women look great wearing them. And whether we’re talking stilettos, scarpins, kitten heels or pumps, high heels can – in some cases – actually be good for you. ‘Yes,’ admits Dr Visser, ‘as podiatrists we do generally try to get ladies out of high heels. But sometimes, if you do have short calf muscles, then you do need a raised heel… as long as it’s not excessively high.’ Might be best to stick to the kitten heels then.

Published in Orthopaedics

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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