Here’s to Your Health
June 2, 2007
At the new Orthopedic Hospital at the University of Utah, Dr. Charles Saltzman, professor and chairman of the Department of Orthopedics, spoke about the history of feet and their love affair with high heels through the centuries. The doctor attended Brown University and the University of North Carolina School of Medicine. He did a foot and ankle fellowship at the Mayo Clinic in Scottsdale, Ariz. He is also the principal investigator on two major NIH studies. He is the current secretary for the American Orthopaedic Foot and Ankle Society, and has served the society as program chair and research council chairman.
Saltzman began with the history of shoes and the individuals in history who wore them. You will be surprised to learn that men wore high heels for centuries, including 2000 BC to 400 BC, and later in the Medieval and Renaissance periods. During those centuries women wore flat shoes of fabric and leather while the men dressed in high heels. In the Battle of Sempach in 1396, when the Swiss defeated Duke Leopold III, depictions of the battle showed the warriors wearing high heels. Could this have been the reason for the defeat? In later battles, the combatants removed their high heels. During the 1530s, Catherine d’ Medici, wore a high-heel shoe that was called a "chopine." A chopine is a type of women’s platform shoe that was popular in the 15th and 16th centuries. Chopines were originally used as a clog or over shoe to protect the shoes and dress from mud and street soil. They soon became an article of fashion and were made increasingly taller; some extant examples are over 20 inches (50 cm) high. Preserved chopines are typically made of wood, or sometimes metal (Wikipedia). All of the aristocracy followed the trend and copied Catherine’s style.
Saltzman showed pictures of the chopine and later the recent Japanese fad of wearing high-heel edboots the can be from six to 12 inches high.
During the days of the British aristocracy under Kings Charles, James and William (1740-1775), paintings from that era reflect their high-heeled shoes (three- to five-inches high). It is of note that the lowly individuals in the kingdom could not afford high heels. They were lucky to own any shoes at all.
For 5,000 years, the Chinese bound young women’s feet so they would be "beautiful" because of their small feet. They wore small (four-inch long) shoes and they couldn’t walk. But this made them eligible for families to arrange a marriage-match to a wealthy man. As a result, their feet became terribly deformed and unhealthy. Of course, poor women mostly went barefoot.
In contemporary times, Salvatore Ferragamo came from Italy to the United States, and brought shoes that he designed for the female Hollywood Stars. The glamorous stars wore the shoes and American women copied them. During the past few years the stiletto heel is back in all of the fashion magazines and women are buying them by the gross.
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Currently, more women than men require foot surgeries. Some of the disorders that Saltzman says are predominant surgeries in his practice are on: hammer toes, neuromas, bunions (these surgeries are only successful 80 percent of the time) and corns. He also treats knee pain, sprains, disfiguration of the ankle, and even back pain. These conditions are associated with women wearing shoes that are too tight and too high in the heels. Wide high heels are no better than narrow stiletto heels either.
The doctor showed some "disgusting" slides of how our feet can become disfigured by wearing these types of shoes mentioned above. The shoes can press on the ball of the foot causing nerve damage and pain. Arthritis is also common especially when women wear high heels. He thinks flat shoes are best, but finds it difficult to convince women that this is good for them.
Of note, he says that one should never shop for shoes before noon because our feet become wider and longer as the day goes on. This will help to get the proper fit. All shoes may vary in size slightly because all manufacturers may not be consistent in sizing. It is important to try them on for comfort, not for size. Because of this, he recommends not buying from a catalogue. His mantra is flat shoes are best. Even flip-flops are better for you than high heels. It was interesting to hear that Saltzman knew Taryn Rose when she was a student of podiatry. You may have heard of her now very popular and expensive shoe firm.
He says that podiatrists may not be able to deal with complications regarding the feet because theirs is a separate pathway to study than orthopedic surgeons. Orthopedic medical studies are more rigorous, have residency training requirements (three to four years), require board certification, have training in treating diabetes and cardiology, and in performing surgery on removing diseased bones from the foot when necessary. This specialty has high standards and selects only the best and the brightest in the field.
As finale to this part of the discussion, the doctor showed a slide of his daughter with six of her friends all dressed in high heels and pretty dresses. He says he has no control over the latest teenage fad. But he worries about the disfigurement that will eventually occur in terms of bunions, calluses, and the possibility of required foot surgeries.
The discussion about flat feet revealed that they could keep you out of the army. After World War II and during the Vietnam War, flat feet were ignored. In the Israeli Army, flat-footed men had fewer fractures than those who were not. Saltzman also notes that flat-footed football players are statistically better players.
In the question-and-answer session following his talk, Saltzman said that infants don’t need shoes — barefoot is good. Having well-fitting running and walking shoes is important. He says we should go to a sports store where clerks are trained in fitting a person and know which shoes are best for various activities.
So there you have it. High heels are bad, having well-fitted, flat shoes are best. But, like Dr. Saltzman’s daughter and her friends, most women will wear high heels at some time in their lives, and the orthopedic specialists will be there to repair the injuries.