With No Choice in Footwear, Models Deal with Podiatric Problems as a Part of the Job

Models walk the runway at the Diane Von Furstenberg fashion show during MBFW Fall 2015 at Spring Studios on February 15, 2015 in NYC. FashionStock.com / Shutterstock.com

Australian model Abbey Lee Kershaw started confidently down the runway during Rodarte’s Spring/Summer 2009 show, but as she made her way back up, her ankles began to tremble. Before making it backstage, the model collapsed in an accident that left her with torn knee ligaments requiring several surgeries that forced her out for the remainder of the season. The reason for Kershaw’s fall was the high heels she was assigned to wear for the show.

According to the American Osteopathic Association, one in 10 women wear high heels at least three days a week and a third have fallen while wearing them. While torn ligaments are an extreme example, there are several damaging effects that can be caused by wearing heels.

Season after season, models are forced to wear the inhumane footwear in order to participate in fashion shows. After the incident at the Rodarte show, Kershaw refused to walk in an Alexander McQueen show after seeing the footwear. She later said to Australia’s “Today Tonight” that, “Hopefully [heel height] is going to come back down soon because health and safety regulations have got to come into play at some point.”

Off the runway, women still sport heels to work, to go out and to attend special events. In either scenario, high heels are putting women at risk for dangerous foot and ankle issues, but oftentimes they don’t register the gravity.

Japanese model Chiharu Okunugi admits that she once fell on the runway because of her shoes, but she says she didn’t sustain any injuries. “If the shoes are difficult to walk in, of course there is the opportunity to slip or fall, but as I say, practice makes perfect. I do check out the shoes at the fittings so I’m prepared,” she says via email.

Like many models, Chiharu participates in several fashion weeks a year, requiring her to wear an assortment of shoe styles. “During fashion weeks I have to wear all types of shoes, sometimes flats, sometimes very high heels, but it’s always fun.”

But Dr. Ben Cullen from the San Diego Podiatry Group says there are a lot of different problems that can come from high heels, ”but the main problems stem from the narrow toebox and high heel height,” he says. “What can happen is you can get deformities on your foot, such as bunions and hammertoes from squeezing the toes in there. You could also get pinched nerves on the ball of your foot called neuromas. You can also get corns or calluses from rubbing of the toes.”

In a 2014  study done by the American Podiatric Medical Association (APMA), 71 percent of heel-wearers reported that their shoes hurt their feet.

The first woman to be documented wearing a style similar to the heeled footwear we see today was Queen Elizabeth I in 1595. Some historians attribute the high heel’s origins to 15th century male equestrian riding footwear from Persia.

The style of shoe was designed to help men balance while shooting a bow from the back of a horse, and was not intended for everyday wear.

Other historians feel the modern high heel evolved from the chopines, an early 16th century platform that was popular with Venetian women. The height and shape of the shoe required wearers to be accompanied by someone to help them balance.

Both origins suggest the impracticality of the footwear, which has come to signify glamour and sexuality in today’s society.  In a 2009 poll taken by the American Podiatric Medical Association, 82 percent of the 503 women surveyed wear the heeled style for fashion or style, while 54 percent wear them to look sexier and more attractive.

In a piece by Camile Paglia, she compares the mutilating effects of high heels to that of the Victorian corset. As she explains, the heeled style has been eroticized since the early 19th century.

“The high heel creates the illusion of a lengthened leg by shortening the calf muscle, arching the foot, and crushing the toes, forcing breasts and buttocks out in a classic hominid posture of sexual invitation.”

The high heel, especially popular styles like the thin stiletto, is another example of the unattainable and often dangerous beauty standards that are expected of women.

Like the case with Kershaw, high heels have the potential to weaken the ankles.  As Dr. Cullen says, “Heels can cause ankle sprains or potentially even ankle fractures from having the foot be in an unstable position and being the predisposition for rolling or twisting the ankle. I had a patient a week ago who broke her ankle and actually had to have surgery for it.”

The risk for injury is increased with the height of the heel. Dr. Cullen suggests that two inches should be the maximum.

Model Chiharu Okunugi walks the runway at the Diane Von Furstenberg fashion show during MBFW Fall 2015 at Spring Studios on February 15, 2015 in NYC. FashionStock.com / Shutterstock.com

The heel’s height can worsen the problem, she says. “It puts your foot at an abnormal position and puts a lot of pressure on the ball of your foot. It also tightens the Achilles tendon on the back of your leg, that can also put more pressure on the ball of your foot and can cause heel pain as well.”

Unfortunately, models have no control when it comes to footwear choices during a show. Besides the heel height, the shoes are often provided only in a size 40, forcing them to cram their toes into shoes that are too small, or stuff them with anything they can find so that their foot doesn’t slip out.

Before the Prada presentation in 2008, models were having anxiety attacks and crying backstage before walking down the runway in the extremely high heels. Many of them toppled over as their ankles gave out midway through the show.

In 2011, because of her high-profile status, supermodel Gisele Bündchen refused to wear high heels during the Balenciaga fashion show, requesting that designer Nicolas Ghesquiere design her a pair of flats.

“The idea was to have this crazy casting with Gisele [Bündchen] and Amber Valletta and Carolyn [Murphy], and they said no for high heels. They were not used to walking with heels anymore. Gisele was worried,” Ghesquiere said to Women’s Wear Daily.

Dr. Cullen says that wearing heels in moderation will lessen the potential for serious issues down the line. “Moderation is everything. If it is something you wear to social functions and you’re not in heels all day everyday, then that is okay. If you have shoes you can switch out of when you first start noticing symptoms then it is probably not going to hurt you too bad.”

A recent study by Stanford University’s biomotion team found that the angle of the leg caused by high heels could put significant stress on the knees that could lead to arthritis and potentially a knee replacement.

A recent story in the Daily Mail, shared the experience of 67-year-old Angela Kelly, who was a daily high heel wearer since her teens. Kelly has undergone surgery twice for serious knee injuries sustained from wearing heels.

“The chronic issues really do occur after a period of years and years of wearing heels. People in their late teens or early 20s, anyone wearing heels for a long time, your feet will hurt,” says Dr. Cullen. “If you get out of them, then you will recover and you will be okay as long as you don’t do it for years.”

“But, people I see who have the chronic issues are more in their late 30s or potentially late 40s, when they start coming in and have the deformities. Then it gets a little more tricky to fix.”

Dr. Cullen says he hasn’t experienced any patients with knee arthritis, but it is a possibility. “I think that is more of a stretch to say knee arthritis is caused by heels. Of course if you are in four or five-inch heels all of the time on a daily basis, I could see how it could throw your alignment out of whack.”

Even with the risks associated with high heels, the trendy footwear doesn’t look like it is going away anytime soon. Just last season, designers sent models out in teetering stilettos causing them to tumble on the runway.

Although Chiharu is forced to wear uncomfortable footwear for several weeks throughout the year, she does say she likes to wear heels during the day and in her freetime. The APMA study also reported that 38 percent of women said they’d wear the heels anyway if they liked them.

Dr. Cullen has advice for other women who will continue to wear heels despite the dangers. “One thing that can really help is getting a pad that goes in the shoe.  You want to put that behind the ball of your foot. I see a lot of people coming in and they have it right under the ball of the foot, but you really want it behind it because that can take a lot of pressure off of the foot when you are wearing those types of heels.”

“You can also get inserts that go inside the heels that can hold the foot in a better position and take some of the stress off and allow you to wear them longer without having those damaging affects.”