Author: William A. Rossi, DPM Published: Podiatry Management, February 2001
Note: This is an original summary, not the full article. The complete text and all figures remain copyright of Podiatry Management.
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Summary
This installment focuses on the single most visible difference between a shod and an unshod foot — the elevated heel — and argues it is a source of trouble that runs far up the body.
Rossi insists there is no such thing as a “sensible” heel: any elevation, even one inch, immediately alters the foot’s natural mechanics.
Standing barefoot, the body’s weight line meets the floor at 90 degrees, with weight shared roughly evenly between heel and forefoot. The moment a heel is added, that perpendicular is broken, and the body column makes a cascade of joint adjustments to stay upright — ankle, knee, hip, pelvis, spine, shoulders, neck. He cites the pelvic angle tilting from about 30 degrees flat to 45 degrees on a two-inch heel, and points to a Harvard (Lancet, 1998) finding that walking in two-inch heels increased pressure in the center of the knee joint by 23%, a possible contributor to knee osteoarthritis.
• Shortened Achilles tendon and plantar fascia. Heel elevation draws heel and ball closer, shortening the fascia and making it more vulnerable to strain — a plausible link to plantar fasciitis. He uses the dominance of barefoot-raised East African marathoners (full-length, un-shortened tendons) as an illustration of how much propulsive power the heeled shoe “steals.”
• The sustentaculum tali. He highlights this small shelf of the calcaneus, set at 180 degrees in humans (versus angled in apes), as one of the most important and overlooked supports of the long arch — and one that an elevated heel and crooked last can disturb.
• Lost weightbearing at the fifth ray. Lifting the shank off the ground removes the base of the fifth ray and the cuboid from their normal support role, shifting that load onto the heel and metatarsal heads.
• Reduced tread. The combination of heel, raised shank, toe spring and concave bottom shrinks ground contact dramatically, concentrating wear on a tiny area.
He is sharply critical of the “sensible shoe” and “sensible heel” as myths — less foot-negative than fashion shoes, but never a positive — and warns that orthotics often target the foot when the shoe is the real culprit. His governing principle: a shoe should be a non-intrusive, near-replica covering of the foot. “The less a shoe does TO a foot, the better FOR the foot.” He concludes that until the foot/shoe relationship becomes central to podiatric training, the profession will remain, in his words, unfinished.