But many still experience discomfort
By Emily Delzell
Most women who want to return to wearing high heels after hallux valgus surgery do so, but may sacrifice comfort for style, according to research from the University of Manchester in the UK. Clinicians in the US say many of the study’s findings—although not all—are consistent with their experience.
The orthopedic surgeon investigators identified 65 women who’d undergone corrective hallux valgus surgery between 2011 and 2013 and grouped them into two age-based cohorts. Participants completed a footwear-specific outcomes questionnaire a mean of 18.5 months after surgery (range 6.9-35.9 months). The researchers defined comfortable footwear as normal-fitting, nonprescription shoes with a heel less than 3 cm high and a wide toe box; heels were defined as tight-fitting shoes 3 cm or higher with a narrow toe box.
Almost two thirds (31) of the 50 patients who said they wanted to go back to wearing heels after surgery did so, and 24 of these women said their postoperative use equaled or exceeded the frequency of their preoperative wear. There were no differences between pre- and postoperative heel heights.
However, 58.5% of study participants reported difficulty with heel wear, and 13.9% said they had significant restriction, and couldn’t wear anything without pain but custom orthopedic shoes or slippers. Most women (86%) were able to return to comfortable shoes after surgery with minimal or no discomfort; 27.7% said their footwear choice was unrestricted, meaning they could wear both comfortable shoes and heels with minimal discomfort. The 23 women older than 65 years were twice as likely to report significant restriction as those in the younger cohort; compared by operative type, patients who had the most extensive procedures had the highest rates of restriction. The findings were published in June by the World Journal of Methodology.
Two independent experts who reviewed the study for LER: Foot Health were surprised at both the high number of women in the study who wanted to return to heels after surgery and the number who were actually able to get back into the footwear.
“I’ve seen an increased awareness among my patients of the problems tight, pointy-toed heels can cause, and my patients with hallux valgus are usually willing to take my footwear suggestions, which are definitely on the conservative side,” said Megan Leahy, DPM, a podiatrist at the Illinois Bone & Joint Institute in Chicago. This concern for foot health is especially noticeable among her younger patients, many of whom want to preserve their foot function so they can be active, she said.
Her observations echo data from the study showing the younger cohort was less likely than the older group to report preoperative high-heel use (66.7% vs 78.3%). Few women (21.1%) who weren’t wearing heels before the surgery adopted them postprocedure.
Althea Powell-Chandler, CPed, LPed, OST, owner of Powell Shoes in Vero Beach, FL, also sees fewer heel-wearers among her patients, though she noted her tropical location may influence shoe selection.
“Most seniors here usually wear comfortable athletic shoes or open-toed sandals, and they’re especially likely to stick with sandals after they’ve had bunion surgery—they want something open that they can adjust,” Powell-Chandler said. “I was surprised that so many in this study went back into heels, though I’ve noticed that people who want to be in heels aren’t changing their minds.”
The study authors touched on this phenomenon, writing, “…we suggest our finding may misrepresent genuine functional limitation,” ie, that women with a history of heel wear will accept some degree of foot pain to get back into their stilettos.
Leahy has seen this dynamic among her patients.
“If, for example, they have a job they feel really requires power heels—attorneys are one profession who often sees heels as part of their uniform—it seems that they will fight through foot pain. Some think foot pain is normal, making them much more likely to go back to that type of shoe,” she said.
Helping patients understand what kind of shoes they can expect to wear after bunion surgery should be a priority for practitioners, concluded both the authors and Leahy, who noted, “I emphasize that it takes a very long time to get into a regular shoe and that you may not ever get into a heel; women should not do this surgery to get into a heel.”
Longtime heel wearers may go back to their footwear relatively quickly, however. In addition to having higher rates of preoperative heel wear than their younger counterparts, older women also returned to heel wear sooner (mean, 16.4 weeks vs 24.1 weeks).
Both Leahy and Powell-Chandler said patients often underestimate the time it takes to heal from bunion surgery—up to a year for residual swelling and pain to resolve—and caution patients that returning to heels can increase the risk of bunion recurrence.
“Tight, narrow toe boxes and high heels can speed up progression,” Leahy said. “If you jump right back into high heels after surgery the deforming forces will be there again, and there’s chance of faster recurrence.”
Robinson C, Bhosale A, Pillai A. Footwear modification following hallux valgus surgery: The all-or-none phenomenon. World J Methodol 2016;6(2):171-180.