The Perils of High Heels — Ankle Instability and Injury
Patients come to our specialists about ankle instability, noticeable in the inability to wear high heels. It can be sudden, or it can be something they’ve always had. DeLoor Podiatry is in New York, the hub of fashion, corporate and high-achievers; women are equally enamored by flats and high heels. But ankle instability is a problem in walking, running, climbing stairs, dancing; it’s not just about high heels!
In our previous article about weak ankles due to cartilage damage, we’ve mentioned ligament damage. Cartilage and ligament each play a part in your ankle’s function.
If cartilage is like a cushion between the bones of the joints, ligament is like the duct tape that connects the bones to each other. When this “duct tape” is unable to do its job due to injury and damage, the joint becomes unstable in its movements.
Your ligaments’ function
Ligaments are bands of tissue that hold bones together. They’re extremely tough, made of collagen. You have ligaments that connect your leg bones (the tibia and fibula) to your foot bone (the talus). And you have ligaments on the sides of your foot, the lateral ankle ligaments.
The tibiofibular ligaments allow you to move your foot up and down: dorsiflexion and plantarflexion, respectively. This is the movement of walking and climbing. The lateral ligaments support your foot when you move it left and right, which are movements only needed during dancing and pushing yourself on your office chair.
The most injured ligaments are the ones located in the ankles. When you twist your ankle, you sprain the front and middle bands of your lateral ligament.
Like cartilage, ligaments have a poor blood suppy. Torn and damaged ligaments take a long time to heal by themselves. DeLoor Podiatry provides arthroscopy procedures and foot and ankle surgery to speed up the healing process.
What happens when you wear high heels
“When you wear high heels, you force your feet into an unnatural, unstable position. This backfires in a lot of ways.”
Your ankles move up and down when you walk. This is made possible by your tibiofibular ligaments.
When you wear high heels, however, your feet are in a permanent plantarflexion. So the tibiofibular ligaments are in a permanent stretch downward while the achilles tendon is pinched.
In high heels, you strap your ankles in a permanent extension. You can no longer move your ankle in its up and down flexions. Every step lands on the balls of your feet. The arch of your feet, trapped in a flex, no longer supports your body weight.
Wearing high heels strains your tibiofibular ligament, your metatarsals (the balls of your feet), your legs, your knees, and your back.
Dr. Loor says, “High heels, are really damaging to a women’s ankles and the rest of her body. When you wear high heels, you force your feet into an unnatural, unstable position. This backfires in a lot of ways.”
Dr. Loor adds, “High heels put your bones, muscles and joints out of alignment. You put yourself at a higher risk of injury, and meanwhile, you’re already damaging your body. To avoid negative effects, you really shouldn’t wear more than 2-inch heels, and when you do wear high heels, keep it under 2 hours! Some of our patients say they’re already hurting in as little as 10 minutes!”
The negative effects of high heels:
- The ankle muscle has to contract to keep you standing and walking; once the ankle and lower leg muscles get used to this, the ankle muscles no longer contract and begin to weaken, leading to ankle instability.
- Leads to ligament and nerve damage in the ankles, which leads to leg and back pain due to the muscles losing their efficiency and strength.
- Can lead to neuroma due to pinched toes.
- Shortened calves: shortened muscles at the back of the leg and lengthened muscles at the front, leading to discomfort when wearing flats
- Osteoarthritis due to strain on the bones and joints.
- Negatively altered body posture and gait, similar to the gait of those with knee arthritis. Every step delivers the impact and weight load to the metatarsals and the knees.
- Leg and ankle muscle fatigue.
- Exacerbates other foot problems like plantar fasciitis, bunions, hammer toes and ingrown toenails
- Lower back pain, neck pain and shoulder pain. The muscles in the foot are connected to your calf muscles, which are connected to your hamstrings, which are connected to your pelvis and lower back. When you walk on the balls of your feet, your center of gravity is shifted forward– you compensate by arching your back, stiffening your shoulders… Your whole body is forced in an unnatural form, leading to pain.
- Ligament damage when you twist your ankle while in heels. Ouch.
Symptoms of a torn ligament
Ligaments stretch and may even tear during injury. After a bad sprain, you would have difficulty walking. Joint instability is a serious problem that needs specialist care. Unless your ligaments are given the time and care they need to heal, your joint may move more than it should, which leads to cartilage damage, and eventual bone damage.
Dr. Jose Loor says, “Over time, an injured ligament would weaken and lose its efficiency. Your muscles and bones would then compensate to stabilize your joint. This leads to spasm and pain, and then into bone overgrowth and the resulting arthritis. You know arthritis is a whole new level of pain and disability by itself.”
First degree sprain: You’ve stretched your ligaments and there’s little to no tearing. You have mild pain and inflammation in your ankle. No bruising, no loss of ankle function.
Recovery time: 4 – 6 weeks
Second degree sprain: You probably felt the tear or snap that happened to your ankle. You might lose ankle function. Inflammation is bad, and a bruise appears 3-4 days after the injury. Walking is very difficult or almost impossible. Recovery time: 4 – 8 weeks
Third degree sprain: You’ve torn your ligaments. Your joint may have been dislocated– it might have slipped out and then back in place. Your ankle would look deformed. The inflammation is very severe and your joint “doesn’t seem to work” in keeping your foot where it should be. Walking is impossible. You might need surgery to recover.
Recovery time: 6 – 12 weeks
Radiofrequency Ablation in New York
DeLoor Podiatry specialists would assess your ligament damage with imaging technologies– X-ray, CT scan and MRI–and offer the best treatment. Stem cells and platelet-rich plasma (PRP) injections can coax ligaments and cartilage into healing. Arthroscopic radiofrequency ablation is another technique.
Arthroscopic radiofrequency ablation (RFA) uses radio waves to create heat to heal or reconstruct the collagen in a damaged ligament. This speeds up the healing process.
You are a candidate for radiofrequency ablation if:
- Your ligament is badly stretched, but not torn
- Your ligament was torn (ruptured) but it had healed badly
Radiofrequency is a much safer and cheaper option to lasers, the former technique used to “fix” damaged ligaments. Your arthroscopic radiofrequency ablation at DeLoor Podiatry would be an outpatient procedure, and completed in minutes.
Arthroscopy is called a “keyhole” surgery because it only uses small incisions. These become the entry and exit points for the arthroscopic instruments, which is also an imaging procedure used in fine-tuning the radiofrequency ablation to heat, shorten and strengthen the collagen in your ligaments.
You would regain full range of movement in 2 weeks, and you can even go back to marching in high heels after 12 weeks.
BUT it’s recommended that you don’t. Dr. Jose Loor says, “After RFA and during the 3-month recovery period, you should be careful to avoid injury. The collagen in your ligament wouldn’t be mature yet, and you shouldn’t stretch it and completely undo the good your procedure had done.”
Some tips for wearing high heels
Always do stretching and strengthening exercises to keep your joints healthy and to make sure your calf muscles don’t get shortened and stretched.
- Place a one-inch thick book on the floor.
- Rest the balls of your foot on the book, with your heel on the floor.
- Bend at the waist and reach for your toes. Hold for a bit, feel the nice stretch to your calf muscles and hamstrings.
- Do the same to your other foot.
- Gradually increase the thickness of the book(s) you use by inch every week.
Buy heels in the afternoon when your feet are at their biggest. Avoid pointy-toed heels that will only add to your overall discomfort by pinching your toes. You’d also avoid bunions.
Look for good insoles so your feet wouldn’t slide down.
The steepness of the heel matters more than the height. Look for platform shoes that actually reduce the steepness between your heel and the balls of your feet.
Wear high heels to work, but not to walk. Bring another pair of shoes to walk around in.
Take off your heels and plant your feet flat on the floor as much as possible.