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Neal M. Blitz, D.P.M., F.A.C.F.A.S. Headshot

The High Heel Foot Fracture: A Real Injury

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Breaking your foot from falling in high heels is a real possibility. You could also need surgery to have the bones repaired. As heel heights increase, so do foot injuries associated with them. The higher the heel and skinnier the stiletto, the more likely one is for a fall -- especially on uneven terrain.

The midfoot arch is particularly susceptible to injury when wearing high heels. Remember, the foot is not designed to function in this position, so when one trips or falls in high heels there can be excessive force placed on the midfoot, causing it to break or dislocate.

Below is an example of a dislocated midfoot. The highlighted area illustrates the malalignment. Surgery involves realigning the anatomy and using surgical screws to maintain the position.

2012-06-24-HighHeelFootFractureDrBlitz.jpg

As a reconstructive foot surgeon, I can tell you that midfoot injuries come with a lot of problems.

What I call the high heel foot fracture, medical professionals (and lawyers) know as a Lisfranc's fracture or dislocation, named after the arch joints that are involved. The Lisfranc's joint is a complex interlocking articulation of nine bones with strong ligamentous attachment.

The problem with the high heel foot fracture is two-fold. Patients may not appreciate the severity of the injury (so they neglect to seek out medical care), and the injury can go undetected by health care professionals.

Sometimes the injury is very obvious, other times is quite subtle. Fractures can be prominent or not noticeable when the injury is predominantly ligamentous. Treatment can involve casting or surgery depending on the severity and stability of midfoot.

One would think that they would know if they had a bad injury, but often people just shrug off their discomfort as a bad sprain. Of course swelling and bruising suggests a real problem. Some people may hear or feel a popping sensation in the foot when they had a misstep. Pain may be instant or delayed. Patients have also reported only minimal trauma but wake up with a very painful foot -- more pain than typical "high heel hangover" pain.

X-rays can diagnose the high heel foot fracture, but they are not always accurate. A CAT scan may uncover small serious fractures. Surgeons often recommend surgery when the injury is unstable to stabilize the midfoot. A variety of techniques exist involving wires, plates, screws and/or fixators. The prognosis is mixed, as there is a high incidence of post-traumatic arthritis.

I want to point out that these injuries can occur in any shoe gear combined with a misstep. High heels just make you more prone to misstep and falling. And, just because you injure your foot in heels doesn't mean that you will need surgery or have life-long problems. The purpose of this blog is to inform you that these injuries can and do happen. Obviously they are not very frequent considering just how many people wear heels, but they are frequent enough for me to write this blog and tell you about it.

Should you injure yourself; however, be sure to find a specialist who can properly identify any subtle injury. If you insist on wearing heels, just watch your step!

Have you had a high heel foot injury? If so, tell us about it.

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To learn more about Dr. Blitz, please visit www.nealblitz.com.

For more by Neal M. Blitz, D.P.M., F.A.C.F.A.S., click here.

For more on foot health, click here.

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