New research from the US suggests that wearing shoes such as high heels, pumps and sandals was strongly linked in women's later life with heel and ankle pain. The researchers found nearly 64 per cent of older women who reported hind-foot pain regularly wore such shoes at some point in their lives whereas no link was found between foot pain and the types of shoes men wore.

The study was the work of lead author Alyssa B. Dufour from the Institute for Aging Research of Hebrew SeniorLife in Boston, Massachusetts, and colleagues, and is published in the October issue of the journal Arthritis Care & Research.

Dufour, a graduate student in the Institute's Musculoskeletal Research Program, told the press that:

"We found an increased risk of hind-foot pain among women who wore shoes, such as high-heels or pumps, that lack support and sound structure."

The study is the first to look in detail at types of footwear use and foot pain. Other studies have looked at high heels but not at different types of shoes at the same time.

Foot pain is a common complaint among adult Americans, and foot and toe symptoms count among the top 20 reasons that older people aged from 65 to 74 visit their doctor in the US.

However, we know very little about the causes of foot pain among older adults, although we know women are more likely to report it than men, we don't know if this is because of lifestyle choices like shoe wear, or a higher prevalence of underlying disease or deformity.

For the study, Dufour and colleagues analyzed data from more than 3,300 men and women in the the Framingham Study. The participants were given a selection of 11 different styles of shoe and asked to pick the one that most closely resembled the type they currently wore regularly and had regularly worn during five different age periods in the past.

The participants were also asked if they felt pain, aching or stiffness in either foot on most days.

The shoe styles were classed as "poor" (eg high heels, pumps, sandals and slippers), "average" (hard or rubber soled shoes and work boots) and "good" (athletic and casual sneakers).

The results showed:
  • More than 60 per cent of women reported wearing "poor" shoes in the past.

  • Only 2 per cent of men reported wearing "poor" shoes in the past.

  • 13 per cent of women reported wearing "poor" shoes currently.

  • Nearly 30 per cent of women and 20 per cent of men reported experiencing generalized foot pain (this is line with previous studies).

  • There was a significant link between between women reporting hind-foot pain and previous wearing of styles that included high heels and pumps.

  • After adjusting for age and weight, compared with women who reported wearing "average" shoes, those who reported wearing "good" shoes in the past were 67 per cent less likely to report hind-foot pain.

  • In men there was no link between foot pain, at any location, and shoewear.

  • However, the lack of a significant link for men could be due to the fact less than 2 per cent of them reported wearing bad shoes (such a low percentage makes it difficult for the statistics to detect a relationship).
Dufour and colleagues concluded that:

"Even after taking age and weight into account, past shoewear use in women remained associated with hindfoot pain."

"Future studies should address specific support and structural features of shoewear," they added.

Dufour said:

"Young women should make careful choices regarding their shoe types in order to potentially avoid hind-foot pain later in life."

Each time our heel hits the ground when we walk, a significant biomechanical shock enters the foot, and is absorbed mostly in the heel and ankle.

"Good" shoes like sneakers, trainers, and other athletic footwear often have soles and other design features that absorb this shock and protect the foot.

Poor fitting shoes cause many problems, not just pain, some of which can be disabling. More than 43 million Americans have foot problems, many of them serious enough to need medical attention.

Follow this guide to make sure you choose shoes that fit you properly, said Dufour:
  • Choose comfort over style.
  • Judge size by how they fit your feet rather than the number on the box as sizes vary by brand.
  • You feet get bigger as you age, so measure them regularly.
  • Fit shoes to your longest foot (most of us have one foot bigger than the other).
  • Avoid high heels and shoes that taper or end in a point at the toes.
  • Try on shoes at the end of the day when your feet are at their largest.
  • Put both shoes on and walk around to make sure they are comfortable.
  • Make sure you can wiggle your toes inside the shoes when you try them on.
  • Bear in mind this simple rule: your shoes should conform to the shape of your feet, and not the other way around.
"Foot pain: Is current or past shoewear a factor?"
Alyssa B. Dufour, Kerry E. Broe, Uyen-Sa D. T. Nguyen, David R. Gagnon, Howard J. Hillstrom, Anne H. Walker, Erin Kivell, Marian T. Hannan
Arthritis Care & Research, Volume 61, Issue 10, Date: 15 October 2009, Pages: 1352-1358
DOI: 10.1002/art.24733

Additional sources: Institute for Aging Research.

Written by: Catharine Paddock, PhD