Dedication Simple Solutions Experience

Don't feel so guilty about those high heels, and other ramblings about arthritis in the foot, about orthotics and knees, and about orthotics which feel more like golf balls under the arch than something which is supposed to be comfortable

High heels do get a lot of bad press in the medical community. They've been accused of causing back problems, hip problems, knee problems, ankle, heel, arch and toe problems. I've had my share of patients disdain high heels for such reasons. So high heels are not good for these people. But these people aren't all people.

I've also had a fair number of patients who can't live comfortably in flats, and the only way they can get around is by wearing an elevated heel height. People say this often enough to me that I mustn't be the only doctor who hears patients sing praises of how comfortable higher heels feel. So why do some doctors give the patent advice to avoid high heels?

I don't know. I can say there are criteria I use to advise people on their ideal heel heights, too high and too low. The easiest criterion for me is my individual patient's experience. If someone is spending money to come see me and they say they feel better in high heels, why shouldn't I believe them? (Actually, there is a reason not to agree, occasionally.) I'm actually more inclined to believe a person feeling better in heels than one who says flats feel best! It's not just the "you can't make this stuff up" flavor of the statement.

There are ways to measure a person's ideal heel height, too high or too low. I've been doing this on nearly every new patient I've encountered (roughly 1,000/year for the 26 years since I keyed in to this concept, or roughly 26,000 patients times two feet, times multiple visits with several of them so let's say I've done my little technique about 150,000 times) since 1980. I feel therefore that I have a fair degree of accuracy and have seen a lot of trends and correlations, lots of successes, and my share of failures till I got it right. I've taught this for 26 years. See my resume. Any lecture having to do with mechanical advice, and that's most of them, has included this info. I'm not at all reticent to share it with other doctors, and I'm not reticent to share it with you. It will be heavily covered in my book into which I'm about 1/4 along (I have a contract and a deadline). The details are beyond the scope of this website, but take seconds to perform in my office.

I feel a little like a circus sideshow performer who can guess a person's height or weight when I do this, because I'm often accurate to a 1/4 inch tolerance. People usually say things like "How did you know, that is what I like best!?" or "That's what I used to wear but I was told to wear flats." Or, "That's what I used to wear and I was told to wear flats so I could fit the orthotics inside."

In this case I might counter, "How long have you been wearing the orthotics for?"
They might respond, "Five years."
I might counter, "How long have you had this pain for?"
They might say, "Five years."
I then might say, "Why did the doctor tell you to get orthotics?"
They might say, "Because I have flat feet," or, "Because the doctor said they'd prevent bunions (see other case histories on this website)."
Then I'd say, if I felt there were no contraindications to this advice, "Try weaning yourself out of the orthotics and back into your beloved 1-1/4" heels. If you have any problems, call me. The best way to do this is gradually, so your tissues can readapt to the changed pressures. If all goes well, call me in (for example) a month. Let me know if your pain goes away once you've gotten used to the heels again." It's often a favorable result a patient calls in with on their follow-up call. They are most grateful, and so am I. Sometimes this job is so simple and common sense, it feels like a racket.

I don't really feel like a circus person because I know the information will contribute to a person's long term health and well-being. This technique is extremely helpful for patients with midfoot arthritis. Often but not always do these patients require orthotics to further stabilize the arthritis, but the maxim is for the appropriate heel-height shoe. Again, I teach the technique to determine this. Some can stretch their calves to reduce the required heel height; some have blockages which prevent this.

The technique also lets me know if I can make orthotics to change a person's alignment in the shoes they must wear during the pain producing activity. For example, lets say an orthopedist sends me a runner who has knee alignment problems (patellofemoral pain syndrome). The orthopedist observes there is nothing per se wrong with the patient's knees, but his/her flat feet are drawing the knees into poor alignment. The patient has tried physical therapy and proper strengthening exercises, but the problem persists. When I examine the patient, I indeed find knees which when standing, measure abnormally-high Q-angles (the barometer I use to determine how normal or abnormal the knee alignment is). When I manipulate the patient's feet out of a flat position into a position the imaginary orthotics might hold them in, I see their Q-angles become normal.

Then I do my test for ideal heel height. If the test reflects a heel height representative of the slope a running shoe has for heel height, we're proceeding with orthotics barring any other contraindications. If the runner has a measurement which requires a high-heel I can't make orthotics yet. Orthotics for this patient would feel like golf balls under the patient's arch. The only "orthotics" this patient could tolerate at present would be flat, play-acting pancakes which are doing zilch to improve knee alignment. These patients have to stretch calves, or I have to come up with something else to cheat around this heel-height measurement. Eventually, if necessary, I may make orthotics for the patient if they can do exercises I give them to reduce their heel-height requirement.

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