Valgus toe, metatarsalgia, Morton’s neuroma, and venous insufficiency: these are some of the problems linked to the shoes we wear. Dr. Elisa Casabianca, vascular surgeon in Humanitas and Dr. Leonardo Maradei, Head of Foot Surgery and mini-invasive surgery at Humanitas, spoke about this in an interview with Corriere della Sera.

The footplate is crossed by a dense network of veins that function as a sponge and are essential for venous return. The plantar compression exerted when we walk and the muscle pump given by the contraction of the calf muscles are the fundamental instruments that allow liquids not to stagnate in the extremities; in practice they behave like a heart, which does not act as a mechanical pump, but for “squeezing” the veins and lymphatic vessels. It’s good to safeguard these two mechanisms and the shoes we wear can make a great difference,” explains Dr. Casabianca.


High heels, venous insufficiency and varicose veins

A study published in the Journal of Vascular Surgery compared three types of footwear (with 3.5cm heels, 7cm heels and 7cm wedges) and scientifically evaluated the effects of this on plantar support and calf muscle pump in some young women while simulating a walk.

With 7 cm shoes, the function of the muscle pump was reduced. Researchers observed a decrease in venous return and that venous pressure was higher than normal. Its values were maintained at physiological levels with a heel of 3.5 centimeters: with these shoes the foot bed was adequate and the muscles could work correctly. In particular, the wedge has proved to be an enemy of correct circulation: with this type of footwear, in fact, despite a sense of greater stability compared to the stiff heel, the effect of plantar squeezing was reduced precisely because of the stiffness of the sole. Therefore, we can conclude that the continued use of high heels is a risk factor in developing venous insufficiency. Venous insufficiency is the main cause of varicose veins formation,” says Dr. Casabianca.


Appearance of hallux valgus

Research carried out by the American University of Alabama in 2015 revealed that more than 80% of high heel injuries in American women affected the feet or ankles. In this case, the toe is particularly at risk, as Dr. Maradei explains.

The constant use of high-heeled shoes can in fact promote the appearance of hallux valgus, one of the most frequent pathologies affecting the foot characterized by the deviation of the base of the toe and its tip towards the other fingers. Let us remember, however, that wearing these shoes is not the cause of valgus toe, but it is a result of different causes ranging from family history to traumas. In addition, it is the tip of the very narrow shoes that accelerate the course of hallux valgus”.


Metatarsalgia and Morton’s Neuroma

The forefoot is the area of the foot plant with metatarsalus and five-finger phalanxes: “Standing too long on the toes of the feet puts the metatarsus under stress and it is the cause of metatarsalgia, a condition characterized by pain that is also rather acute”, explains Dr. Maradei.

Wearing narrow shoes and heeled shoes may also promote the appearance of symptoms of Morton’s Neuroma, a cyst on an inflamed nerve of the foot. Shoes don’t cause neuroma, but they contribute to the appearance of symptoms,” says Dr. Maradei.


Is it better to avoid heels?

It is important to counteract being overweight and obesity, which have a negative effect on pressure, to engage in physical activity that solicits the calf muscles and “do not use shoes with heels for long periods of time, especially if you have to stand. Even if varicose veins will not develop, after a long day with these shoes, you could still experience swelling, heaviness, redness on the legs and feet, especially during summer,” says Dr. Casabianca.

Women and girls predisposed to the onset of varicose veins can develop this condition if they use high heels in a brave manner: to wear these shoes, for a long time, with the aggravating force of the standing position is a risky mix. If you really need to wear high heels, a very useful prevention tool is the elastic-compressive sock, whose compression level should be assessed by a specialist.


What about ballerinas?

It is better to choose shoes about 3-5cm high. Very low footwear, such as ballerinas or flats, affect compression, the function of pushing on the sole of the foot. The combination of medium heel and elastic socks also applies to those who have already developed varicose veins, explains Dr. Casabianca.

Shoes without any elevation from the ground, while not damaging the health of the foot, may put the back at risk. Several people complain about lower back pain after wearing these shoes for a long time. The recommendation is therefore to stop at 4cm of heel”, adds Dr. Maradei.