The high heel is one of history's most appealing footwear concepts. Sexy, smart, professional, and sometimes addictive … the high heel appears to have many positive qualities. However, wearing high heels, which are defined as pumps with heels that are 2 or more inches in length, can come at a price when they are worn too high, too often. High heels have been deemed biomechanically unsound because they can contribute to issues with posture and safety, such as knee and back problems, injuries from falling, shortened calf muscles, and a gait that is unnatural.

All the information in the world, unfortunately, won't necessarily persuade your patient to put her Jimmy Choo collection up for sale on eBay. But with rest, chiropractic care, and orthotics designed just for ladies' footwear, you can ensure that your patient puts her best foot forward.

Teetering on Stilts

According to Gerard Clum, DC, president of Life Chiropractic College-West, Hayward, Calif, high heels have been a long-standing concern for chiropractors with regard to their patients. As a spokesperson for The Foundation for Chiropractic Progress, Clum has been hot on the heels of this subject, with the goal of educating the public about the benefits of chiropractic and the risks of overusing high-heeled shoes.

The 5th Avenue Collection from Foot Levelers is available in a wide variety of lengths to fit most dress shoes.

The Foundation for Chiropractic Progress' most recent campaign cautions women that overuse of high-heeled shoes poses health risks, and recommends women wear shoes with heels no higher than 2 inches.

"We have seen for decades the damage and the problems that people have. High heels are one of those things that seem to come and go in fashion circles, and they seem to be in season now. As a result, we are seeing more problems," says Clum, who points out that fashion has its price.

And what a price to pay, with the abnormal weight-bearing and stressful posture that high heels induce, which strains the neck and low back, as well as the foot, ankle, and knee. Depending on the person, some women experience the effects of high heels within minutes of slipping them on. For others, the damage is done by wearing high heels for hours on end.

"It depends not on how much time you wear them, but how much time daily that they are worn. If a girl wears high heels 1 to 2 hours a day, the damage will be lesser. When worn for hours on end, bunions can form and other changes can occur in the arch and the whole tarsal system. With prolonged high heel use, it does affect the shortening of the Achilles tendon, as the foot is not used to being on the ground," Clum says.

Sitting or Standing?

Whether sitting pretty in high heels, or standing at attention, the patient is probably doing better by sitting. However, even with a minimal amount of weight, and when the foot is in the elevated position that high heels induce, there is strain put upon the arch and the ankle joint. Although sitting may not have the ramifications of standing in high heels, it is a long way from what is normal and healthy for the foot.

So, what is a chiropractor to do if a patient loves her high heels and refuses to give them up?

Dressing Up Orthotics

Orthotics are taking a fashionable twist to accommodate the needs of high-heeled patients. Manufacturers such as Foot Levelers Inc, The Orthotic Group and Powerstep offer special orthotics designed just for dress shoes, to make looking good easier on the feet.

DressFlex and FashionFlex from The Orthotic Group address the growing need for women’s dress shoe orthotics.

The 5th Avenue Collection of Spinal Pelvic Stabilizers from Foot Levelers Inc is designed to help women maintain a healthy posture when wearing dress shoes. Available in several lengths to fit most any dress shoe, the 5th Avenue Collection provides a fast break-in period and allows women to feel better on their feet, even after a day of wearing high heels.

DressFlex and FashionFlex orthotics from The Orthotic Group can help patients feel more comfortable in their shoes. DressFlex is designed for patients who need mild to moderate biomechanical control in their slip-on or narrow-cut dress shoes. FashionFlex is more suited for women who require support in their narrow high-heel pump shoes or dance shoes. Both DressFlex and FashionFlex can be precisely fitted using The Orthotic Group's Gaitscan biomechanical diagnostic tool.

SlimTech from Powerstep provides a 3¼4-length starter support, as well as a slim, thin shape that allows it to fit into many casual, slip-on, and dress shoes. The SlimTech also offers a four-component design that includes prescription-like arch support, heel cradle and platform, double-layer cushion casing, and a Sanitiz etc antibacterial top sheet to ensure patient comfort.

Clum notes, however, that although a dress orthotic won't overcome the effects of high heels that are 2 inches or higher, they can make things a bit better and more comfortable. He also notes that the effectiveness of any given orthotic also depends on how "bare" the dress shoe is.

"The variability and design of high heels … it is much more variable in terms of whether the orthotic will fit, based upon the design of the heel. With a closed shoe, as with a normal walking shoe, that is not as much of a problem. With a high-heeled strappy or open shoe, the ability of the shoe to hold the orthotic is limited," Clum says.

High Heels and Chiropractic

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In addition to counseling patients about high heels and prescribing custom dress orthotics, doctors of chiropractic can create custom treatment plans to help keep patients' feet in shape. Looking at where the patient feels strain … in the neck, low back, or hip … helps determine where the body is accommodating changes in biomechanics, as well as where symptoms of wearing high heels will present themselves. Clum notes that chiropractic involvement is directed toward early intervention for mild cases, particularly with regard to the secondary effect high heels have on the spine.

However, surgery may be necessary to correct conditions such as bunions or hammertoes caused by long-term high heel use. This information alone just might be what helps your patient choose to lose their high-heeled shoes.