Heels Take a Toll on Women's Knees
by Jennifer Wider, MD
(Washington DC, 5/13/04): High-heel shoes seem to be wreaking havoc on the
joints of women everywhere. Osteoarthritis is the most common type of arthritis
and is seen more often in women than in men. The type of shoe one chooses to
wear may be part of the reason.
Several studies conducted by D. Casey Kerrigan, professor and chair of the
Department of Physical Medicine and Rehabilitation at the University of Virginia
School of Medicine in Charlottesville, Va., support the claim that wearing high-heel
shoes increases the risk of osteoarthritis for women. "We showed that high-heels
over two inches increased forces in the region where women typically get osteoarthritis,"
Kerrigan said. "Animal and human surgical data support that these increased
forces (torques) lead to joint degeneration." The studies examined several different
types of shoes including stilettos, wide heels and men's shoes. Wide heels may
feel more stable, but the forces place the same pressure on the knee joint and
are just as dangerous, according to the study results. Kerrigan explained that
the shoes worn by most men do not affect the rotatory forces that increase pressure
on the knee joint. Therefore, men do not have the same risk as women who wear
Osteoarthritis is a degenerative joint disease that affects the cartilage,
the section of joint that cushions the end of the bone. When the cartilage wears
away, the bones tend to rub against each other. This can result in the loss
of motion of the joint, swelling and severe pain. If a person has the condition
for long enough, their joints can lose their normal shape and bone spurs can
grow at the ends of the joint. The disease most commonly affects the hands and
weight-bearing joints including knees, hips, ankles and feet.
Men are more likely than women to suffer from osteoarthritis in most joints
before the age of 45. After that age, the numbers dramatically shift and women
are much more likely to suffer from the disease, especially in the hands, feet
It's not just the shoes. Men and women have biological differences that contribute
to their unequal risk of osteoarthritis. On average, men have a larger volume
of knee cartilage than women. Because osteoarthritis results when the cartilage
gets worn away, men are more protected than women when it comes to the knee.
In addition, the carpometacarpal joint that connects the thumb to the wrist
in women tends to have more curvature. This makes the joint much more vulnerable
to osteoarthritis in women than men.
Women disproportionately experience osteoarthritis around or after menopause,
which may suggest that hormones may play a role. There is some evidence that
elevated levels of estrogen are contained in the cartilage of osteoarthritic
patients. Further studies are needed to figure out the exact role hormones play
in the etiology of the disease.
The problem is not going away. More than 20 million Americans suffer from osteoarthritis
and the numbers are rising. The disease is more common in middle-aged and older
people. By the year 2030, the National Institute of Arthritis and Musculoskeletal
and Skin Diseases estimates that roughly 70 million people will be over the
age of 65 and be at risk for the disease.
Women need to be aware of their risk for osteoarthritis. Changing the shoe
a person wears may help lower their risk. "Do not wear shoes with a heel over
half an inch," Kerrigan warned. Some studies suggest that women are not referred
to orthopedic surgeons for joint replacement as frequently as men. Given their
risk, it's important for women to discuss warning signs and treatment options
for osteoarthritis with their doctors.
The Society for Women's Health Research has launched a public education program,
"Living Well With Arthritis," to educate women about the symptoms and management
of osteoarthritis. The campaign is headlined by actress, dancer and arthritis
sufferer Debbie Allen, who will appear in a television public service announcement
encouraging women to seek appropriate treatment and not let arthritis slow them
down. For more information, click here www.womenshealthresearch.org.
The Society for Women's
Health Research is the nation's only not-for-profit organization
whose sole mission is to improve the health of women through research. Founded
in 1990, the Society brought to national attention the need for the appropriate
inclusion of women in major medical research studies and the resulting need
for more information about conditions affecting women. The Society advocates
increased funding for research on women's health, encourages the study of sex
differences that may affect the prevention, diagnosis and treatment of disease,
and promotes the inclusion of women in medical research studies. Dr. Donnica
Moore has been a member of the Society since 1990 and is a past member of its
Board of Directors.
Created: 5/13/2004  - Donnica Moore, M.D.