If you don’t use it, you lose it! Is this a phrase you have heard in the past? In podiatry, we find that this most often will refer to range of motion or flexibility within the foot. In particular, the Achilles tendon is often the culprit.
Our foot structure is determined based on our genetics. Yes, you will inherit certain characteristics from your parents. However, it may not be in the way you expect. If your mom has bunions, you may well develop bunions, but this is not a directly inherited trait. Rather, the foot structure that leads to the development of bunions is inherited and over time your foot may develop bunions due to imbalances in the joints as well as joint laxity (or looseness) over time.
A large contributor to the way your foot functions is the Achilles tendon. This tendon attaches your calf to the back of your heel. It is the strongest tendon in the body and if it isn’t functioning optimally can cause a great many problems. Most often, the issue stems from a tight achilles tendon. This is a condition we refer to as equinus – the word is derived from the word for horse. Horses function on their tiptoes essentially.
When you have a tight achilles tendon, it places more strain on the heel which can lead to insertional achilles tendonitis. This condition is painful most often with activity but also causes pain in the mornings or after resting due to it being tight and then suddenly having to ‘stretch’ back out to a functional length. Pain after rest is something we refer to as post-static dyskinesia.
But what is it that makes the achilles tendon tight? There are actually many answers to this question. There are some neurological conditions that lead to this. However, most often it is due to the activities we perform and the shoes we wear every day. In particular, exercises performed on our tiptoes, running and elliptical and cycling without regard for proper stretching before and after allow the tendon to get tighter and tighter.
Back to our first point, if you don’t use it you lose it. If you do not utilize the full length of the achilles tendon, it will get shorter over time. We have had many patients come into our office for pain in the back or bottom of the heel. While this is a common problem we see, it is far more difficult to improve or resolve in patients who tell us that they wore high heels or boots every day for work - over the period of years.
Some patients come in saying that they wore high heeled shoes for years because of work and that when ballet flats became popular, they took to heart all they had heard from others about high heels being bad for their feet. That being said, very flat shoes carry their own risks as well. Especially when someone transitions from having had their heel 1.5-3 inches off the ground on a daily basis to having their foot completely flat on the ground, their achilles tendon is not prepared for this strain.
In treating achilles tendonitis, stretching is a key component for your care. Stretching increases the pliability of the tendon. In more severe cases, physical therapy is often utilized. This allows a trained professional to ensure the stretching is performed correctly and these professionals also perform a few other modalities to loosen up the tendon. Deep tissue massage helps to loosen things up. There are also two primary forms of tissue treatments that utilize tools that are run along the calf and achilles tendon under pressure to relieve adhesions that restrict tendon motion. These techniques are called Graston and ASTYM. While they differ in how they are performed, the goal of each is the same – to loosen you up!
So where does this prescription for Kitten Heels come into play? Let’s start by looking at all the possible shoes you may wear within any given week. Some may be a more athletic style which have a small heel to them due to the cushioning and padding. Some of your shoes may be ballet flats with essentially no heel height and minimal cushion or padding. Some may be heels of various heights – whether boots or pumps. There are a few keys when selecting shoes to wear.
First is to make sure that you are wearing an appropriate shoe for the expected activity. Athletic shoes may be appropriate for extended walking, running and strength training to ensure you have adequate support. Ballet flats and high heels are not indicated for extended walking as they will place more pressure to the forefoot. If you work at a job where you sit most of the time, other than walking to meetings, heels may be OK.
The second key in footwear is to wear shoes of variable heel heights from one day to the next. We realize that you may need to wear dressier shoes or high heels for some of your work. However, wearing a 4” heel every day, all day, 5 days a week for a few years will cause a lot of problems down the road. If you are already in this camp and thinking you need to get out of heels (or maybe a podiatrist has told you that you should!) – going from 4” to 0 will cause pain in the heel. A better solution is to gradually reduce the heel height as you initiate a stretching program. Reducing heel height by 1/2” per month is much less likely to incur pain in the tendon.
So, there you have it – kitten heels are a transitional type of shoe to wear if you have an active, painful achilles tendonitis. We don’t want to be in these shoes permanently, as stated earlier. However, wearing these types of shoes while you work on improving flexibility can be key in reducing future pain and problems in the achilles tendon.