Wednesday, December 28, 2011
High heels, knee torque and obesity: The real deal
Research from Oxford University researchers under the direction of Oxford University public-health studies professor Ray Fitzpatrick was published in the Journal of Epidemiology and Community Health in the latter part of 2003. The findings supported there was no evidence of risk that glamour-gal footwear harmed feminine knees. The reverse may be true, but conditions apply.
"A consistent finding in the analysis was a reduced risk of osteoarthritis in association with regular high-heel usage," says the report, published this week. The researchers noted, "It is very unlikely that prolonged wearing of high-heeled shoes represents a risk factor."
This conclusion treads heavily on conventional medical wisdom of the last 250 years or so, which has blamed high heels for sore backs, corns, sprained ankles, abnormal gait, ingrown toenails, shortened calf muscles and hammertoe. Historically this is a misogynistic viewpoint which has enjoyed its greatest vogue at times when women enter the workforce.
The Yale University School of Medicine Foot and Ankle Service recommend half-inch heels, while the podiatric association calls high heels "biomechanically and orthopedically unsound."
Studies have shown 2/3rds of women wear shoes smaller in volume than their anatomical foot. Women with tighter fits tend to suffer from friction, which accounts for the callous and bunions, but not in every case.
The foot police continue to promulgate the doom and despondency myth with relatively little evidence to support it, but well meant none the less. Orthopods and podiatrists tend to see a small skewed population and obviously conditions apply. Over the last five years or so there have been several similar but small studies, all of which have come to different conclusions.
The Harvard Medical School studies measured “knee torque" of high-heel wearers. Surprisingly enough the torque was about 22% and they linked it to the cause of knee arthritis. Researchers later extended the study to include sensible heels and found the torque on the knee measured 25%. Shocked and stunned they dismissed the evil high heel theory and clung instead to cause and effect. This was immediately refuted by the British Arthritic Society who was keen to reassure heels heights were only contributory in those people prone to osteoarthritis.
Another study from Medical College of Georgia found that older women lost their balance 12 percent of the time when they wore high heels. Similar works have been conducted in Australia by Stephen Lord and Hylton Menz over in Sydney and there may be more credibility here than an association with arthritis. A new trend reported relates to toe amputation as a fashion accessory. Whilst this is not new the frequency would appear to support a new phenomenon and orthopedists and surgical podiatrists have been asked to undertake elective cosmetic surgery in such numbers as to cause bioethical dilemmas.
"High heels have an allure that men may appreciate, but cannot fully understand."
As Marilyn Monroe said “I don’t know what man invented them but all women should be grateful.”
There was an even more pronounced link between regular dancing in three-inch heels and a reduced risk of knee problems. The researchers described this finding as "surprising", but said that they would not expect a larger-scale study to overturn their findings.
"Our data suggest that future research in relation to risk and prevention might usefully focus on the age at which people first undergo excessive weight gain and whether or not this gain is sustained." Certainly, becoming overweight before the age of 40 was strongly linked - with a 36-fold increase in risk - with arthritis of the knee. Researchers noted: "Most of the women had been exposed to high-heeled shoes over the years. Nevertheless, a consistent finding was a reduced risk of osteoarthritis of the knee."
Don't fret about shoes — worry about weight, they counseled. Obesity at any age is "the single most preventable risk factor," said Oxford's Mr. Fitzpatrick, who said those who were overweight by 40 pounds had 36 times the risk of developing arthritis in the knee.