While it isn’t news that women often sacrifice comfort for fashion, science is beginning to tally the cost of doing so. I’ve written before about the painful consequences women suffer from wearing high heels. Now, several studies show that short-term pain is but a prelude in terms of long-term damage. Just last month, for example, a study led by Professor Marco Narici, from Manchester Metropolitan University in the U.K., showed that wearing high heels really does a number on the wearer’s tendons.

According to Professor Narici, when women wear two-inch or higher heels frequently, they shorten the fibers in their calf muscles by an average of 13 percent. This exerts pressure on the Achilles tendon, making it thicker and stiffer. The result is often calf pain and difficulty stretching the foot up and down, which can make it more difficult to walk on flat surfaces and to run. And although I can hear chiropractors, massage therapists, and other body workers saying, “I told you so,” it is worth at least passing notice that scientific research has finally confirmed the findings of non-traditional practitioners.

Indeed, another recent study conducted by researchers at Iowa State Universitydemonstrated that high heel wearers face increased risk of joint degeneration and the eventual development of osteoarthritis due to the extra pressure exerted on the knees. Led by Dr. Danielle Barkema, the researchers looked at the impact on women between the ages of 18 and 40 of wearing flats, two-inch heels, and 3.5-inch heels. They used sensors and cameras to measure the forces and shock waves in the legs of the women as they walked in the three types of shoes.

The research showed that wearing heels changed the women’s posture and caused their ankles to tilt inward, destabilizing their ankle joints. In addition, there was a significant increase in the loading on the inner knee — a type of pressure known as ‘medial loading’ that increases the risk of joint degeneration and osteoarthritis.

Interestingly, the leaders of both studies stopped short of recommending that women stop wearing high heels. (They must be fans of ZZ Top’s Legs.) Professor Narici advised women to limit the amount of time spent in stilettos and add a regimen of stretching exercises. Looked at from a certain perspective, that’s the equivalent of advising women to periodically stab themselves but keep a good supply of bandaids around. In a similar spirit, Dr. Barkema said that her study didn’t mean that every woman who wore high heels would develop arthritis in her knees. Still, she did allow that high heels are “just not very good for the body.”

Rheumatologist Naija Shakoor of Rush University Medical Center in Chicago, who is investigating what makes for the perfect shoe, echoes the sentiments of Narici and Barkema. “It’s just common sense that high heels are bad for women. I would save them for social occasions and going out. For every day, light, flexible and flat is the way to go,” she said in an article on the DiscoveryNews website.

Perhaps these researchers are just being practical, given the conviction with which women wear high heels. WebMDcites a survey conducted by the American Podiatric Medical Associationthat showed “some 42% of women admitted they’d wear a shoe they liked even if it gave them discomfort; 73% admitted already having a shoe-related foot issue.” But then again, how many potato chip fans refuse to indulge even though they know the negative impact on health? In any event, the article makes clear that “many women refuse to give up their high heels.”

Still, many women in their 40s and 50s admit that it is harder for them to wear heels now then it was when they were in their 20s and 30s. That correlates directly to anatomical changes in the legs and feet of women as they age. For example, loss of fat on the bottom of the foot commonly occurs with aging. This means less protection on the bony ends of the feet, which then grind into the sole of the shoe from all the weight that bears down when a woman slips into her stilettos. The result can be foot pain and increased risk of stress fractures and osteoarthritis. Plus, if a woman has bunions, corns, or calluses, high heels can make them worse.

So if you can’t feel your womanly best without significant time strapped into your Manolos, WebMD lists five tips for protecting your feet in high heels. First, get heels that fit correctly, so your foot doesn’t slide forward to create more pressure and pain on the toes. Second, use cushioned silicone inserts to replace the lost fat on the bottom of your foot. Third, increase stability by wearing a thicker heel and vary heel heights to reduce Achilles’ problems. Fourth, wear a heel with a more gradual slope to the “flatbed” part of the shoe. It will place less stress on the arch. And fifth, to relieve pressure on corns and calluses, wear open-toed shoes.

On the other hand, if you’re inclined to see stilettos as a modern-day version of Chinese foot-binding (and the parallels can’t be ignored, considering the disabilities caused by heels), just say “no” and wear something that allows your feet and legs to do what they were designed to do.

:hc