Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

A Woman and Her Shoes

Sexuality and pain courtesy of Bruno Frisoni and Walter Steiger.

There are those who believe shoes carry more symbolism than any other piece of clothing a woman wears: It is through shoes that a woman defines herself. The shoe is able to shape the image presented to the world, while simultaneously shaping the woman, destroying her joints, and perhaps contributing to psychosis.

Fashion shoes may be the newest sexually transmitted disease, a public health threat preferentially targeting women, contracted not from an episode of unsafe sex or a public toilet seat, but rather from the perfumed displays of Bloomingdales or the Windex-etched resin shelves of DSW.

Podiatrists generally believe that heels over two inches can be dangerous. Risk factors for chronic foot and ankle pain include being overweight, or having high or flat arches. These conditions are common enough in the general population, and can result in tendon and muscle strains, hammertoes, bunions and stress fractures. But add high heels to the mix and the wearer is asking for additional conditions such as tendinitis, ankle sprains, and torn ligaments and tendons.

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A study published in 2009 in “Arthritis and Rheumatism” found that older women who said they usually wore athletic shoes were 67% less likely to have pain in the hindfoot compared to women who wore other types of shoes. This study also showed that most women have worn footwear with poor biomechanical support, such as high heels. In contrast, only 2% of men reported wearing such poor shoes; it is not surprising that men showed no relation between shoe type and foot pain. At least, it was found that most people changed their shoe wearing habits when they experienced foot pain; modifiable behavior is still in the repertoire of humankind.

Other research has shown that the foot may also play an accomodative role in pathology elsewhere in the body, as there is a correlation between back, hip, and knee pain and the foot. For example, high heels throw the body out of alignment: Feet are forced up at an unnatural angle, the body is pushed forward, and the balls of the feet are supporting most of the body weight. In turn, the knees tense up, as more stress is put on them in order to keep the high-heeled individual upright. Over time, accelerated cartilage damage to the knees is inevitable.

While the orthopedic conditions related to the wearing of high heels may seem to many intuitive, the relation of heels to psychiatric disorders involves a little thinking—and I daresay, imagination.

A few years ago, in the journal “Medical Hypotheses,” a Swedish scientist claimed that heeled footwear led to the occurrence of the first cases of schizophrenia. His hypothesis was based on historical conclusions that the oldest depiction of heeled footwear is found in Mesopotamia, where supposedly also were the first institutions dedicated to mental disorders. In the words of Dr. Flensmark: “During walking, synchronized stimuli from mechanoreceptors in the lower extremities increase activity in cerebellothalamo-cortico-cerebellar loops through their action on NMDA receptors. Using heeled shoes leads to weaker stimulation of the loops. Reduced cortical activity changes dopaminergic function, which involves basal gangliathalamo-cortical-nigro-basal ganglia loops.”

In other words, high heels cause an unnatural stiffening up of the calves, upsetting the dopamine homeostasis, and thus predisposing to psychosis. Considering this theory, however, one of my colleagues wondered aloud as to whether Dr. Flensmark wears high heels.

To show manufacturers of high-heel shoes that all sides are considered, there may be a sexual benefit to such shoes, apart from the obvious emphasizing of the lower extremity muscles so pleasing to many men. Chronic pelvic pain can have a devastating impact on a women’s sexuality, and can be related to tension of the muscles of the pelvic floor; the relaxation of the involved muscles as a result of the biomechanics of wearing high heels could have beneficial effects.

The wearing of high heels also appears to tilt the pelvis posteriorly, move the promontory superiorly and posteriorly, and allow for the tip of the coccyx to move anteriorly. According to a magnetic resonance imaging study of sexual positions published a decade ago in the “Journal of Sex and Marital Therapy,” this is the configuration of the female anatomy during intercourse in the missionary position.

So, a toast to the high heel shoes in our lives. They have been accused of driving men crazy, and women psychotic. They may ease pelvic pain and enhance sexuality, and possibly cause disability due to musculoskeletal injuries.

Limping has never been so sexy.  A new pair of Van's has never been so appealing.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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