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High 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 high-heels.

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 and knees.

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.

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