Years ago a reporter asked me if I’d be willing to do an interview alongside the high heel shoe designer, Manolo Blahnik. According to the reporter, Manolo Blahnik agreed to do the interview as long as I would accept a pair of his shoes. I wouldn’t, and the interview never happened. Oh well. Later I found that the typical women’s “casual” or “comfort” shoe is even worse than Manolo Blahnik’s.
My expertise in footwear all started back in 1998 when I published what became a landmark research article demonstrating a link between stiletto high-heeled shoes and knee arthritis. Specifically, I showed that stiletto’s significantly increase the loads on the knee joint relevant to the development and progression of knee osteoarthritis (the most common form of arthritis).
Knee osteoarthritis, or cartilage breakdown, is a major health problem. We all get it to some degree as we get older but we women get it twice as often and more severely. It’s so prevalent that it causes more disability with respect to mobility than any other singular disease in the elderly. I often describe it as a silent epidemic.
I believe one of the main reasons women get knee osteoarthritis more than men is because of differences in footwear. But I don’t think it’s the classic stiletto heel that’s the problem. Why? Because even though they increase the loads on the knees, they are so uncomfortable in the foot that it’s hard to wear them for any extended period of time. The much bigger problem is the traditional women’s dress, “comfort,” or “casual” shoe, with a modestly elevated heel that feels comfortable enough that you wear it much of the day, every day.
It’s this “casual” or “comfort” shoe, that you think because it’s more comfortable than a high heeled shoe, that it must be good for your knees. But it’s really not. My research team and others have shown that wide-based heels and moderately heeled shoes, like what’s in a “sensible” women’s dress shoe or “comfort” women’s shoe, e.g., a Dansko, abnormally increase the loads on the knees to nearly the same extent as a Manolo Blahnik. Those abnormally increased loads occur with each and every step and even just while standing.
In fact, ANY heel elevation abnormally increases the loads on the knee. We’ve shown that even the small heel of a traditional athletic shoe abnormally increases loads on the knee.
Which is why the very best shoe you can wear is one that is absolutely flat, with no heel elevation whatsoever.
Back to high heels and specifically those 2”, 3” and 4” stilettoes. Are they bad? Yes of course they are. But as long as you find them so uncomfortable that you never ever wear them, well then, they’re really not THAT bad.
1. Kerrigan DC, Todd MK, Riley PO. Knee osteoarthritis and high-heeled shoes. The Lancet 1998;351:1399-1402.
2. Kerrigan DC, Lelas JL, Karvosky ME. Women’s shoes and knee osteoarthritis. The Lancet 2001;357:1097-1098.
3. Kerrigan DC, Lelas JL, Bryant M, Boxer J, Della Croce U, Riley PO. Moderate heeled shoes and knee joint torques relevant to the development and progression of knee osteoarthritis. Archives of Physical Medicine and Rehabilitation 2005;86:871-875.
4. Kerrigan DC, Franz JR, Keenan GS, Dicharry J, Della Croce U, Wilder RP. The effect of running shoes on lower extremity joint torques. PM&R 2009;1:1058-1063.