Most women are well aware that wearing high heels for any length of time can result in sore feet, pinched toes and tight calf muscles. But a worrying new study by researchers in the U.S. suggests high heels can also put dangerous pressure on knee joints, wearing away cartilage - the body's built-in shock absorber - and increasing the risk of osteoarthritis. Some women need invasive knee replacement surgery.
In the study carried out by Stanford University's biomotion team, the knees of healthy women were scanned as they walked at normal pace in flat shoes, 1½ in heels and 3½ in heels.
They found that in high heels, women's knees are held in such an awkward, bent position that their joints looked and performed like aged or damaged joints - increasing the risk of osteoarthritis.
Physiotherapist and osteopath Tim Allardyce isn't surprised: patients with postural problems caused or exacerbated by heels are common at his Croydon clinic.
'Because of the odd angle at which the feet are held in high-heeled shoes, it increases the downward pressure on the knees by 25 per cent, placing significant stress on the kneecaps, even when you're standing still,' he says.
In a recent survey of 1,200 women, 93 per cent said they felt sexier and more feminine when they wore heels, 88 per cent said they considered themselves more stylish and 77 per cent said their heels made them feel slimmer.
With statistics like those, it's no surprise that many women seem to take a dangerously 'no pain, no gain' approach to their footwear, however dire the warnings.
Of course, arthritis and bunions are not the only problems that can be caused by high heels - squeezing feet into too-tight points can lead to misshapen hammer toes, and regular wearers of 3 in heels may suffer from tendonitis, where the Achilles tendon shrinks and tightens painfully.
Interestingly, consultant knee surgeon Marcus Green, at the BMI Primary Hospital in Birmingham, has even more hope for those who can't bear to part with their favorite footwear - he is not convinced the link between high heels and arthritis in the knees has been proved.
'There's no doubt that high heels change the forces on the knee joint, but none of the long-term studies I've seen suggest they go on to cause serious knee problems,' he says.