Shoe Myths

This week’s guest blog is written by Elizabeth Scarpelli, a physical therapist working in San Francisco, CA. Here she reflects on the history and dangers of high-heeled shoes.

Ok, I admit it. I’m always concerned about women’s health over fashion. I watch a glamorous girl’s wobbling ankles as she tries to strut on 4-7 inch stilettos and think, “Hey there goes a future patient!” I can’t help it. It’s what I do for a living. As a physical therapist, I observe peoples’ habit patterns, their gait patterns; their breathing patterns and when necessary, try to improve on them. My patients get educated on the health risks, the perils of excess in our culture, the quest for the smallest waist, the highest heel, the sexiest body. I counsel them and discuss the possibility that the risks are greater than the rewards. But it isn’t easy. Should they believe me or that Cosmo girl?

My great Aunt Martha had a penchant for stilettos. She had walked miles in them in her high fashion days of the early 60’s. She also had toes that pointed east and west by the time she was forty. By fifty she could only wear slippers as her feet were so deformed and caused so much pain. Many women like Aunt Martha think the road to success, be it romance or work, is directly related to height – no matter how tall they are. There is a belief that the romantic interlude, or the corporate ladder, is reached faster in a high heel. And the higher the heel the better. Foot pain, back pain, plantar fasciitis, Achilles tendon tears, bunions and corns be damned. The message has been heard. “You must shove your tootsies into that high heel, preferably pointed, and walk in them no matter what, because fashion matters.” Ignore that it is torture to walk in them. After all didn’t Cinderella nab the prince with a tiny glass slipper while her sisters only fit into Birkenstocks?

A little history is relevant. High-heeled shoes may have been part of ancient Egyptian culture as far back as 3500 BC. It is speculated that they may have been a means by which butchers waded above the slaughtered waste. But filth was part of the general landscape so the upper class sought ways to strut above it too. Shoes called Pattens were strapped on to other shoes (like roller skates were in the 1950’s), to keep them above the muck.

In the 1400’s the Chopine, a backless platform shoe, which could be made to staggering heights of up to 30 inches, was produced in Turkey. (My mother often said, “You have to suffer if you want to be beautiful,” as she combed through knots in my hair, but this was ridiculous!). Shuffling forward in these bizarre shoes required that you either used canes for balance or enlisted the assistance of servants to keep you vertical! Considering that the heel of the shoe was placed well forward of the heel of the woman, you were more inclined to land on your tush. Did I say women invented these things? No!

The European men of 1500’s and then the high court royalty (both men and women) dressed in heels. The absurd nature of the high Chopine shoe made for difficult maneuvering should you want to escape anyone. It became clear to the keen observer that women could not “escape the harem,” (Kunzie 2004).


The obscenity called Chinese foot binding started in the tenth century. This propaganda of bound feet resembling a “Golden lotus flower” was passed on to generation-upon generation of women. Women could demonstrate their wealth by being carried place to place in a palanquin. Walking was for the peasants. It was torture as a girl – children as young as four had their feet broken – with the heel and toes folded under and then tightly bound with a ten foot long bandage for two years. The goal was to shove the foot into a tiny high-heeled silk boot the “ideal being less then 3 inches long” (Seagrave, 1985). Some lost toes, some died of gangrene. Men got off on having their penis caressed between two mangled feet. Sick or what? Reality was that “Confucians barely tolerated females and by crippling their feet it was certain that they could not stray far from their well-guarded quarters, or run from beating”(Seagrave, 1985). Are we beginning to see a pattern here?

In the 1700’s women taped their feet to reduce their size, to improve on a more sculpted line and therefore appear more desirable. (To whom I ask)? Though the Puritans were just worried about sexual depravity they put in their two cents to rescue women from the sins of heels. They banned women from heels and if the law was violated the woman could be tried as a witch (Murstein 1974).

The fashion of high heels shifted away at the end of the 18th century but resumed in the 1860s. The Stiletto (“small dagger” with tapering blade in Italian) was invented by Dior and Vivier in the 1950s. Here the damage really begins for modern day women.

The stiletto got narrower, shoving the toes forward and the angle of the arch got very steep. There are platform stilettos that are up 8 inches high with the weight-bearing surface of the foot from the base of the toes forward sitting on a boxy platform. In stilettos you are basically standing on tiptoes for what can be a very long time. This is totally unnatural as well as painful. The fat pad under your forefoot has no time to restore its natural shape. Under normal circumstances it would compress and refill but in a high heel it has steady compression, which can lead to early breakdown of the fat pad, which cushions the metatarsals. Over time it can make you feel like you are walking on a bed of nails.

But it doesn’t stop there. The pitch of the shoe is very stressful on the ankle joints and the joint receptors are sending messages to your brain, “If you don’t do something you are going to fall forward.” Automatically women will fight falling forward by hyper-extending their knees or excessively bend their knees when standing still. This creates many problems all the way up the kinetic chain. In English, that means it affects the ankle, knee, hip, low back and neck. They all make positional changes in order to keep you vertical and the changes are stressful. The Achilles tendon becomes shortened and in some cases it may rupture. To walk in a high heel requires that you do not hit heel strike with a straight leg but rather with a bent knee. Very unnatural for the knee. The lumbar spine is in hyper-extension and excessively stresses the last lumbar vertebrae. And then again you can’t run.

So ladies, think about why you are wearing a four, five inch or higher heel. About what the long terms risks are of ruining your other joints as well as your feet. Think about who is selling you the fashion statements and how corrosive it can be to your health and comfort. Think about being unable to run safely when you may need to. Aunt Martha is watching you.

Elizabeth Scarpelli, PT, OCS, FAAOMPT
Scarpelli and Kakehashi Physical Therapy

Dangerous Elegance: A History of High-Heeled Shoes:

Seagrave, Sterling. The Soong Dynasty. Harper And Row Pub. 1985. Pgs 158-161

Kunzie, David. 2004. Fashion and Fetishism: Corsets, Tight-Lacing, and Other
Forms of Body-Sculpting
. Thrupp, UK: Sutton Publishing Limited.

Murstein, Bernard I. 1974. Love, Sex, and Marriage through the Ages. New
York, New York: Springer Publishing Company

The views expressed in guest blogs are not necessarily those of

or Jennifer Siebel Newsom