High Heel Foot Problems

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... When I was in my late 20s one podiatrist diagnosed me as having equinus feet and wanted to prescribe orthotics which I could not afford at the time. I did get a pair a few years later, and have had orthotics prescribed several times since then. ...

M.O. - 5 Dec 2004

Maggie,

It depends on the amount of shortening. If the shortening is less than one inch, orthotics with heel lifts (up to an extra one-half inch of thickness) may be prescribed.

J.J. - January 30, 2005

Hello. I “googled” and discovered your website. I think I may be a victim of this shortening. I haven’t been able to walk right for several days. I have severe calf soreness in both legs. It feels like I “maxed out” at the gym but only my calves. I didn’t work out though. At all. One day I simply couldn’t stand. Every pair of shoes I have worn for the past four or so years (or even longer) has been heeled. At least 2 inches or more 3 and a half is my max and those boots are not worn often.

It has actually been 5 days of pain. The only thing I can do to help the pain is put on my heels. I have walked flatfoot for 8 hours doing chores and no amount of stretching or warming them up made a difference. It would be nice if you had any information I can use. Does this sound like the shortening you described? I would like some help.

M.C. - 29 Dec 2004

Dear Marcy,

<< Does this sound like the shortening you described? >>

I can NOT diagnose your disease, illness or problems. Please see your podiatrist to get a proper diagnosis and remedy. A podiatrist can test you for "ankle equinus".

Regards,
J.J. - January 30, 2005

JJ:

Read your site with interest on the subject of lengthening. Your comments seem to indicate that this procedure is extremely risky. My limited research indicates the same. Do you have any new information in this regard?Specifically, have any new procedures been developed that make a full recovery (with dorsiflexion and near full strength) more probable?

In the alternative, are you aware of any non-surgical procedures that can deal with a long-existant problem? Thanks.

R.B. - 20 Jan 2005

The result of any surgery is always unknown. It is always possible to get a result that is worse than what is anticipated or hoped for. The result of any surgical operation usually depends on the particular case, how well the surgeon did his job and post-recovery efforts.

The only non-surgical procedures are relatively new and include the "Manual Manipulation Technique" and Rolfing. The "Manual Manipulation Technique" was first reported in October 2000. Rolfing was first reported to me by a Certified Rolfer, who got the heels of a lady with "congenital ankle equinus" to touch the ground for the first time, in Florida in July 2004. Both methods seem to be better alternatives to surgery and *might* help cases that have existed for many years.

J.J. - January 30, 2005

Hi I just found your site and was very relived to find out I was not the only person stuck in high heels most of what is written seems to apply to me, I am fit and have no trouble in 3-4 inch heels but as soon as I try to walk in flat shoes trouble starts. 15 mins walking in flat shoes leaves me unable to walk for about three days!! However unlike most cases described on this site I think my problem started when I was a child as I always walked on my tip toes which has carried on up until the present day (im now 22) if I am barefooted. Luckily the pain in my ankles is not very bad at all but my calves are extremely painful.

I desperately want to correct the problem but my doctor say's that as im not in pain if I wear heels he fails to see the problem and offers little help. So please could you tell me
1) if you believe that my problem could be calf shortening even though the problem started when i was a child.
2) how can i make a start in correcting the problem?

Thanks
H.J. - 28 Apr 2005

Dear Holly,

1. Based on what you wrote "my problem started when I was a child as I always walked on my tip toes which has carried on up until the present day (im now 22) if I am barefooted.", you probably have "congenital ankle equinus" (or was born with short Achilles tendons and/or calf muscles) and always walked on tip toes since you first started walking. It is unlikely that you developed the problem later on.
   
   However, it might be possible for a child, who can already walk, to develop a very bad habit of tip-toeing around all of the time. Perhaps, to mimic a cat -or- to walk silently and not be heard?
   
   Also, note that it is easier to correct "congenital ankle equinus" while the person is still a child, traditionally by calf stretching exercises or surgery. That is because the tendons are still in their growing phase.
   
   
2. Beware that in your case, you can't have it both ways. If you choose to come back down to flats, then you really need to stay in flats and avoid heels (of any height) for the remainder of your life.
   
   I have already answered your second question in my book and this PROBLEMS web page. I will try to briefly review and summarize because I know that there are other women like you. Last year, I saw another young woman tip-toeing around.
   
   Until Achilles tendon lengthening surgery was perfected, people with ankle equinus either tip-toed around or wore heels (as high as needed) for life. This has happened to thousands of people (using the most conservative and lowest estimate). So, if you stay in heels for the remainder of your life, you will not be the first person to do so.
   
   One of the traditional remedies recommended by doctors is "heel lifts" (also referred to as "heel raises"). If the amount of heel height needed is less than one inch, the type of heel lift used is usually an "orthotic" worn inside the shoes. If the amount of heel height needed is one inch or more, then heel lift means "external heels" or shoes with heels as high as needed so that there is no pain.
   
   Visit these medical web sites:
   
   KLM Laboratories, Inc. , where podiatrist Keith Gurnick, D.P.M. (Doctor of Podiatric Medicine) mentions using "heel lifts" specifically for "ankle equinus", which is permanently shortened Achilles tendons and/or calf muscles.
   
   and The American College of FOOT ANKLE ORTHOPEDICS MEDICINE (ACFAOM) - HTML or The American College of FOOT ANKLE ORTHOPEDICS MEDICINE (ACFAOM) - PDF NOTE: This web page is in Adobe PDF format. You will need Adobe Acrobat to read this document. If you do not have Adobe Acrobat, you can download a FREE Read-Only Version of it at www.adobe.com   In this document, see page 17 (of 36) where it mentions "The spectrum of treatments for equinus includes heel lifts, shoe modifications, foot orthoses, braces, physical therapy, surgery and similar treatments."
   
   Again, visit these web sites so that you know that there is truth to what I say. Also, note that "braces" were mentioned. Ankle braces help protect the ankles from injury. This is why I previously mentioned that it is probably better for those with permanently shortened Achilles tendons to wear boots with tight ankles and shoes with ankle straps. These styles of footwear basically do the same job that ankle braces would do with high heel footwear by supporting and protecting the ankles from injury.
   
   Furthermore, when one has permanently shortened Achilles tendons and/or calf muscles for more than a year or two (especially over 10 years), there are other ligaments throughout the lower body (including the lower back, hips, knees and feet) that can be affected (i.e., they can change in shape). Each and every one of these other ligaments can become weakened, whacked out and prone to problems, after coming back down to flats.
   
   For example, the person may sometimes feel Earth tremors (or the floor/ground moving), when (instead) her hips and/or knees are slightly (but noticeably) shaking or trembling. In this case, the trembling limbs would not be due to Parkinson's disease.
   
   You wrote that you have been walking on tip toes since you was a child. If "child" means 12 years old or younger and you are now 22 years old, then it means that you have been like this for over 10 years. If that is the case, then what I just wrote above applies to you.
   
   I know that you are only 22 years old, but your age should have nothing to do with your decision. A female body only grows until 21 years of age and is over 90% grown by 17 years of age.
   
   Note that I previously mentioned that there are only two groups of women, street walking prostitutes and BDSM submissives practicing heavy activities, who are prone to becoming stuck in high heels (2.75 inches or higher) at a young age. I did not mention young women with congenital ankle equinus because they usually become stuck wearing low to medium heels (that are 1.0 to 2.5 inches in height).
   
   In regards to heel height, the degree of shortening (whether its for 1 inch or 7 inch heels) should have nothing to do with the decision either. However, it might be easier to commit oneself to wearing low and medium heels for life rather than high heels for life.
   
   As always, I prefer not to make any recommendations. All I can say is that if I had ankle equinus for over a year, I would stay in heels (as high as needed so that there is no pain) with no regrets.
   
   Also, be sure to read the Las Vegas Sun newspaper article (linked to on my NEWS web page). It mentions that the woman podiatrist Jodi Politz, D.P.M. keeps her patients in heels.
   
   Obviously, giving up flats also means giving up doing things that can only be done while wearing flats. However, there are some "pros" for wearing heels. I documented all of the significant advantages and disadvantages in my book. For example, you can learn tango dancing, in which women normally wear 3 or 3.5 inch high heels, and get all of the exercise and fun that you will ever need.
   
   Note that almost every living person has some things that they can not do. If you have no trouble in 3-4 inch heels, you should be grateful and thank God for the ability to do. There are many people who wish they could walk in 3-4 inch heels, but are unable to do so.
   
   However, if you decide to continue wearing heels and give up wearing flats, there are (of course) dangers as well. You really need to be careful whenever wearing heels to avoid accidents, injuries and other foot problems. This was a point that I tried to stress in my book and includes wearing only properly-fitted footwear, in terms of length, width and toe box.
   

   ---

   Of course, it is your body and your choice to come back down to flats. I would understand and respect your decision to do so and wish you the best of luck. The main choices are:
   
   
   • Calf Muscle Stretching Exercises (also referred to as "Heel Cord Stretching" and "Gastro-Soleal Stretching")
     
     Some health professionals do not distinguish between the varying degrees of shortened Achilles tendons and/or calf muscles (probably, due to ignorance) and recommend calf muscles stretching exercises. However, beware that Calf muscle stretching exercises work for Stage 1 - Temporary Shortening only.
     
     Beware of the danger of over-stretching and tearing (or rupturing) one of the Achilles tendons (either fully or partially), while doing calf muscle stretching exercises. Partial tears can be in the form of tiny micro-tears that do not prevent a person from walking, but can hurt and sting badly at times.
     
     This can happen and probably, happens to many people every year. Then, they go back to their podiatrist and are diagnosed with "Achilles tendonitis" (or inflammation of the Achilles tendon), which is the number one foot problem. Furthermore, they end up going to their podiatrist on a regular monthly (or biweekly or weekly) basis, paying a substantial monetary fee each time.
     
     So, if you decide to do these exercises, then it probably wise to do so under the careful supervision of a good physical therapist.
     
     
   • Manual Manipulation
     
     You can ask a podiatrist to try the relatively new technique called "Manual Manipulation" to come back down to flats. (Note that I do not know what the long term results of this treatment has been.)
     
     
   • Rolfing
     
     You can visit a Certified Rolfer to try Rolfing to come back down to flats. (Consult with Laura Barnes of Village Rolfer in Florida. I have never been able to get any follow-up information regarding her patient, who had congenital ankle equinus. However, this treatment is most interesting. Laura was able to do the same the job that surgery does WITHOUT LEAVING ANY SCARS and the shape of the Achilles tendon in each leg probably looks better than ones that are cut up. Moreover, the cost and time needed for treatment and recovery would probably be less as well.)
     
     
   • Achilles Tendon Lengthening Surgery
     
     You can ask a Board-Certified and reputable foot and ankle surgeon to perform Achilles tendon lengthening surgery to come back down to flats. (This procedure is the most drastic and risky one.)
     
     

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This page was last edited on December 17, 2005.
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