How to wear High Heels?

“I am not giving up my high Heels. Period”.

If that’s something that relates to you, then carry on reading.

Designer shoe-companies promote high heels as a way of enhancing the length of women’s legs and improving their figure. On average, 72% of women wear heels at some point in their lives. Studies show that women have approximately four times as many foot problems as men, heels being one of the biggest factors contributing to this startling statistic.

Your feet are the base of your body’s movement and posture, and the type of shoes you wear can affect your entire alignment. Wearing heels shifts your weight toward the balls of the feet, so your knees and hips go forward and your back must hyperextend backward for you to maintain balance.

Problems that can be aggravated with wearing high heels constantly include:

  • Hallux Valgus (bunion):

The bunion is a medial prominence of bone at the base of your big toe joint. It is caused by inward movement of the 1st Metatarsal (forefoot bone) and outward shift of the actual toe. Although the high heels cannot be blamed as the only cause for developing a bunion, it certainly can be one of the main reasons of aggravating it. The common pointed end of the fancy stilettos squish the toes together and gradually increase the big toe deviation. It also increases the rubbing against the bunion and can cause this area to inflame.

  • Metatarsalgia (forefoot pain):

The high heels push your weight forward. More weight is pushed to the ball of the foot. Hard skin start to develop in this area as a sign of overloading. The overloaded joints can inflame and irritate the nerves in-between the forefoot bones causing a “Neuroma”. This cause burning pain that shoots down the toes.

  • Lesser toe deformities:

The constant position of elevation of the lesser toes in high heeled shoes causes the intrinsic muscles of the foot to become weak. These are the muscles that bend the toe at the top joint and straighten the toes at the middle joints. The result is a disadvantage of these muscles and the longer muscles coming to the toes from your leg taking over. These muscles do the exact opposite. They extend the toes at the top joint and bend the toes at the middle joints. That’s the position of clawing. The more you spend in high heels the more this position become fixed.

  • Tight Calf Muscles:

In high heels the heel moves upward causing your calf muscles to shorten. If the heels are worn for extended periods gradually the calf muscles tighten. In turn this increases the overloading of your forefoot, midfoot and ankle joint.

  • Achilles Tendonopathy (pain and inflammation of the Achilles tendon):

The tight calf muscles build significantly more tension in the Achilles tendon which can predispose the tendon to inflammation. The inflamed tendon deposit haphazard fibers that are weaker and cause the tendon to swell and become painful.

  • Ankle Instability:

The position of the foot pointing downward is an unstable position of the ankle joint. As such your muscles work harder to stabilise your ankle. These muscles can inflame causing pain. If they get tired it becomes easier for you to go over your ankle.

  • Posterior Impingement:

The foot pointing downward position pushes the heel bone towards the back of the leg bone. An excess bone in this area is sometimes a normal variant in some people. This position can cause this bone to be trapped causing pain in certain positions or during certain movements.

“Ok. I still love my heels and I want to wear them !!”

Fair enough, you have possibly invested a small fortune on those heels. So, if you must wear heels, here are some simple advice that might help you:

  • Alternate:

Change the height of the heel you wear from day to day. Wearing heels of the same height every day consistently contracts the Achilles tendon. By regularly switching between heels and flats, you allow the tendon to stretch.

  • Limit the time in heels:

Cap the time you’re walking in heels to three hours at a time. This can be done by wearing flat shoes until your important meeting or when you are driving.

  • Lower your heels:

Wear lower heels or wedges if possible. This means less load on the ball of the foot and less tightness developing in your calf muscles.

  • Wider toe box:

A narrower shoe can become far more unfordable after a shorter period because of excessive side-to-side pressure on the nerves of the forefeet.

  • More stable heels:

Choose a slightly thicker heel as this will spread the load more evenly providing some stability and reducing the chance of falls.

  • Stretch:

Putting some regular calf muscle stretching in your routine is a great idea. It will allow you to wear flat shoes like trainers for exercising. If the calf muscles are very tight some females struggle to go in the flat shoes. Both active and passive, static and dynamic stretching is useful.

  • Not for the long walks:

Avoid the heels when you expect a lot of walking or a lot of standing in ques. If you are travelling for example it is a bad idea to have those when you could be running between terminals to catch your connection flight.

  • Not when you have a problem:

If you have any active foot problem, like forefoot pain, a corn at the ball of the foot, pain in your Achilles, a recent inversion injury to your ankle, it is best to avoid aggravating things by wearing heels.

If you are buying new shoes, these are some tips to allow you to pick a better fitting and more comfortable shoe:

  • Try new shoes on at the end of the day. Feet normally swell and are at their largest size at that point of the day. This will allow you to avoid shoes that are on the tight side.
  • Have your feet measured if possible. As you get older, the size and width of your feet can change.
  • Always try the new shoes while standing and walking. This will give a much better idea on how well the shoes are fitting. Also, minor inconveniences like rubbing at the back of the heel can be discovered.
  • Press on the end of the shoe and move your toes to make sure you have enough space for your toes. You need a half-inch of space between your longest toe and the end of the shoe.
  • Wear the same type of socks you intend on wearing regularly to try on shoes.
  • Your normal size might not be the most comfortable for you with all different models and makes of shoes. So always relay on trying the shoe to be sure it is comfortable.


Hisham Shalaby









How to decide about surgery?

How to decide about your Foot and Ankle Surgery?


Let’s face it. Nobody wants to have surgery. Patients & doctors should always leave surgery as a last resort after all the conservative measures have been exhausted. Yet even when the patient feels they had enough of the conservative treatment and they are still experiencing problems, the decision to go for surgery is not easy.

So here are some things to think about if you are unable to make your mind:

  1. How big is the problem?

The bigger the impact, the foot and ankle problem is having, on your daily activity, the more justifiable it is to proceed with surgery.  You should think about the things, this problem, are preventing you from doing and evaluate their importance to you. This is very variable from one patient to another and depend on many factors like age, general level of activity and general health. Doing your favourite sports could be the main thing for one patient while short walks might be the thing for others.

  1. Have you really exhausted conservative treatment?

There are simple measures that can make foot and ankle problems better. Not all of them are convenient, but when weighed against surgery they would possibly make a lot of sense. Wearing comfortable stable shoes is always a starter. Resorting to less impact-exercise, like cycling and swimming could make a difference. Sometimes simply using a walking stick. It is easy for doctors to ask patients to lose weight. Obviously, it is difficult for someone to exercise to lose weight when they are in a lot of pain. However, there are always other measures that could help weight loss and invariably these improve foot and ankle symptoms even to a small extent.

  1. How big is the procedure?

Many operations are small interventions that could leave a big impact on your symptoms. A good example is excising a symptomatic large Morton Neuroma. Such operations are easier to decide about as the recovery period is generally short and the long-lasting relief is certainly worth it. For a bigger procedure like a complex fusion of joints in the hind foot the case is different. The recovery will take much longer both in plaster and to rehabilitate after. Bigger procedures could still be justifiable if you pain is more significant and if you have exhausted the conservative treatment.

  1. Is your foot or ankle problem your limiting factor?

You need to ask yourself “What is preventing me from doing the things I want to do?”. If the answer is something else apart from your foot and ankle problem, then maybe you need to address that thing first before you consider surgery. A good example is a patient with advanced ankle arthritis who is offered an ankle replacement. Ask yourself what is preventing you from walking? Is it the ankle or is it shortness of breath or chest pain for example? If it is the ankle then surgery could make you walk better and improve your general health, whereas it would not change much if the latter is the case.

  1. Are you prepared for surgery?

If surgery is the way forward, it pays a lot to be prepared. Being prepared makes the decision easier. This could be in the form of moving a bedroom downstairs or asking a neighbour or relative to help or sorting out the kids and the dog. If you get those aspects in order you have more peace to focus on your problem and will make you far less stressed after your surgery.


Although the decision to have surgery is a big one, and although each procedure carry certain risks, often if surgery is done for the right reason and it go to plan the impact on your symptoms is great. Patients go for surgery to improve their quality of life, being to go back to sport, to be able to work, to enjoy their life with their kids or to walk their dog again. Whatever your reason for considering surgery, thinking about it rationally using the points highlighted above hopefully will help you to make the right decision.

Hisham Shalaby

Running, How much should I do?

The joy and beauty of running

Studies have shown that exercise in moderation can reduce your risk of heart disease, high blood pressure, diabetes, Alzheimer’s, dementia, obesity, and premature aging. Regular workouts can also promote muscular health, skeletal health, and boost your mood. In many ways, exercise may be the most important component of a healthy lifestyle.

Running is a great way to get into shape. It has a proven effect of lifting your mood and is an incredibly effective way of making you healthier.


Why more people are running now?

There is no doubt that more people are taking running as their preferred method of exercising now that ever. Not only does it take you out of the confinement of the gym, but It is also a great way of making more friends, exploring new places, listening to your favourite music, breathing some fresh air and keeping a good shape.

Scientifically, running can raise your levels of good cholesterol, increase your lung function, boost your immune system and lower your risk of developing blood clots. Some studies show that running can help to lower your risk of breast cancer. It can also help reduce the risk of having a stroke. It is one of the best forms of exercise for losing or maintaining a consistent weight. Running can also provide a noticeable boost to your confidence and self-esteem. By setting and achieving goals, you can help give yourself a greater sense of empowerment that will leave you feeling much happier. It also helps to reduce your chances of developing tension headaches and depression.


Should we just run more then?

Having mentioned all these benefits of running it is important to point out that like many things in life, too much is not necessarily too good. Unfortunately, people are different and we are not all capable of running to the same extent or with the same intensity.


What is a good running style?

There is a general assumption that everybody already pretty much knows how to run. Running however is a complex mechanical process when thinking about the multiple joints, muscles and tendons involved.

In general, it is broadly agreed that a good running style should involve a mid-foot strike; ground contact should be as near to under centre of mass as possible; runners should have a slight forward lean in their stride–from the ground, not from the hip; your arms shouldn’t cross the centre of your body. But the reality is that people are different and even professional runners have different running styles. You need to be comfortable in the way you run and experiencing no significant pain.


How can I run in a safer way?

To be able to enjoy running for longer you must look after your body. Here are some precautions that can help you to run in a safer way:

  • Your running should be pain free. You can feel tired or exerted after running but you should not be in pain during running. Pain usually arise from tendons that inflamed or bone that is too stressed and about to break. If you push through pain barriers the likelihood is that you will tear a tendon, or cause it to inflame significantly, or you could sustain a stress fracture. If your running becomes painful you need to slow down and look closer at the cause of the pain, at your running shoes, at your running style or your pace.
  • You should increase the distance or speed of your running very gradual. The classic example I see in the clinic is the very occasional runner who gets too excited and decides to run a marathon. They build their running up over a short period and that’s when they get injured. The best is to increase your running by no more that 10% every other day.
  • You should always give a chance to your tendons and muscles to recover before hammering them again and in general that means running no more than every other day.
  • You running shoes need to be very comfortable, very supportive and very well padded. Good running shoes are very important. In general, different running shoes have different heel to toe inclination. If you are serious runner you will know that too high inclination could increase your risk of ankle injuries and too low inclination could put too much tension on your Achilles tendon. You must strike the right balance in between.
  • Never to ignore pain from your Achilles tendon. Your calf muscles must not be tight to allow you enough flexibility to pull your foot up during running. Running with tight calf muscles has a lot of down sides including building a lot of tension in your Achilles tendon that can cause it to inflame or even rupture. Stretching is an important part of preparing for your running.
  • You must know your limitations. If you are 40 and you had a previous ankle fracture and surgery you should not assume that you can or should run like a 20-year-old who never had any previous injuries. A fracture can cause a process of wear and tear to start in the ankle and the high impact from running can only make this process progress faster. Although a lot of patients who sustain an ankle fracture might still have a very healthy joint, if you do have arthritis it might be better for you to consider other forms of exercises than running.
  • You must keep stretching. To reduce injuries, you’ve probably got to stretch for more than five minutes in total, doing a few different stretches. Dynamic stretching is different than static stretching. In simple words, static stretching tells the body’s muscles to calm, whereas dynamic stretching excites your body’s systems and gets the body prepared for further movement. That’s why you can do the static stretching at any time but it is better to do the dynamic stretching just before the start of your running.The static stretches however can be used in preparing muscles for eccentric activities in which the muscle lengthens as it is stressed (like hiking downhill).


Being addicted to running

Numerous studies showed that moderate exercise was good, but excessive exercise could be damaging.

The term “positive addiction” has been used to describe those runners who simply cannot stop running. Those who run excessive distances and soldier through pain and keep going even when they know they are injured. The word “positive” here is used to differentiate it from “negative” addictions like smoking and alcohol dependence. The difference is that positive addictions usually are praised by surrounding people and in many ways, is not regarded as such a bad thing for you.

The reality however is over doing the running can cause a lot of injuries like Achilles tendonitis, plantar fasciitis, metatarsalgia, stress fractures and arthritis. Professional athletes are a completely different group of people, as due to many factors they can sacrifice health for the sake of performance to achieve certain targets. But most runners are not professional athletes and to be able to enjoy running for longer and to avoid injuries it is very useful to have a good balance between exercise and rest and to have a healthy running style.


Hopefully by following some of the points mentioned here we can all enjoy running for longer.

Hisham Shalaby