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By DAVID P. NEWMAN, D.P.T., Correspondent

Published: September 6, 2007

My wife loves shoes. Watching her shop is analogous to a big game hunter stalking prey along the Serengeti. She tirelessly tracks the infamous Manolo Blahnik waiting for the perfect time to buy, but strikes quickly for the cagey Cole Haan on sale.

On occasions when I've grudgingly volunteered to join her, she always hits me with the question "Do you think these are cute?" My response is always a thoughtful, "Yes, yes they are." However, silently I'm snickering, "Oh boy, are those going to hurt!"

The love affair with shoe wear perseveres despite all the nuisances — namely blisters, calluses, bunions and corns. Stylish shoes seem to be a necessity when going out on the town, even if you come home carrying them in your hands. What you may not realize is that those "cute" shoes may be hazardous to your knees.

Researchers have linked improper shoe wear to knee osteoarthritis, a painful condition in which the cartilage covering the bones in your knee wears down. Bone spurs and cysts begin to develop, limiting knee motion and your ability to climb stairs and stand up from low surfaces. Walking for long periods becomes difficult. Patients frequently complain of pain along the inside of the knee, which tends to worsen over time.

If this degeneration continues to the point of bone-on-bone contact, the patient may need a total-knee replacement.

High-heeled shoes may be one of the culprits. Heels, even as short as 11/2inches, can increase knee-joint stress and potentially increase your chances of developing osteoarthritis or worsening existing arthritis.

Surprisingly, wide-based high heels are just as bad as narrow-heeled shoes. Both increase the amount of pressure built up along the area of the knee joint that is typically prone to arthritis. If injury prevention outweighs your desire for great looking shoes, there are better options.

Running shoes, walking shoes or flats more effectively reduce the strain on your knees than walking with high heels or barefoot. Unfortunately, it may be difficult to coordinate a comfortable pair of running shoes and a skirt.

Shoe inserts with a small wedge along the outside of the heel (lateral wedges) significantly reduce harmful stresses on the knee joint. They can be custom-made for your foot, or you can purchase off-the-shelf inserts that fit into many shoes. You don't have to buy the full-length insert; a three-quarter length will do and is more likely to fit into narrow shoes.

More shoe companies are offering products that may reduce knee-joint stress. Such shoes are made with higher arches or have futuristic designs with rounded soles — known as rocker or double-rocker shoes. Research is still ongoing to determine if these designs actually prevent or slow the progression of knee osteoarthritis.

Until shoe designers and researchers invent the ergonomically-correct high heel, your best bet is to stick with what we know.

High heels are not the best choice if you suffer from knee arthritis. Although they may not be fashionable, alternative shoes and shoe inserts offer more knee-friendly options. Looking good shouldn't mean that you have to sacrifice your health.

Dr. Newman is an assistant clinical professor and coordinator of the Physical Therapy Center at USF Health.

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