high heel pain
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Researchers investigated whether hyaluronic acid injections into the feet of women with high heel pain would reduce the discomfort associated with high heels.

For many people, wearing high-heeled shoes can be painful, but for some, the pain can persist and remain over a period of time. Typically, people experience pain centered over the ball of the foot where the bones of the toes (the phalanges) meet the bones of the front part of the foot (the metatarsal bones). The term for this type of pain is metatarsalgia. There are many causes of metatarsalgia, with high heel pain being one of them. High heel pain can be caused by the regular wearing of high-heeled shoes because the heels put extra pressure on the ball of the foot, and deteriorate the natural cushiony fat pad that normally sits there.

Medical advice to treat and prevent high heel pain is to stop wearing high-heeled shoes. However, this route of treatment is not acceptable to some people and so researchers have made efforts to find other treatments. Previously, silicone injections have been placed in the ball of the foot of 1,500 patients with high heel pain to act as a cushion with favorable results. However, silicone implants do not have FDA approval for this particular use because they cannot be easily removed in the case of an adverse event.

Hyaluronic Acid vs. Silicone Injections

Researchers from a French company that makes hyaluronic acid that can be used for the purpose of filling up spaces under the skin, such as lip enhancement procedures, designed a study to see if this same product would be useful as a cushion in people with high heel pain. In contrast to silicone, hyaluronic acid is a natural product of the body and as such can be naturally degraded by the body. The particular type of hyaluronic acid used by the researchers, in the study reported here, is not FDA approved but they report that a similar FDA-approved product is available from their company.

As reported in Dermatologic Surgery, results are available from this treatment from 14 women who reportedly had high heel pain for an average of nine years. All of the women were injected with a combination of hyaluronic acid and a short-acting local anesthetic to prevent any pain associated with the injection. The women then reported on their levels of pain on a scale of 0-10 over a period of six months.

Hyaluronic Acid Injections Decreased High Heel Pain

The researchers found that after six months, approximately one-third of patients reported no high heel pain. The women that were still experiencing pain were able to wear the heels for a longer period than before the injections because it took longer for the pain to set in than before, and longer than before for the pain to become intolerable. There were no adverse reactions to the injections in any of the women. Only minimal pain was experienced during the injection in half the women, and the other half reported no pain at all.

Study Limitations

There are some limitations in interpreting the results of this study. Firstly, it is not clear that the women had metatarsalgia from high heel pain or from other causes. If it were from other causes, this type of treatment may not be effective, making the results look worse than they really should. Secondly, it is also not clear if the women were continuing to wear high heel shoes with the same frequency as before the treatment. If it were less than that would also affect the results, making the results look better than they really should.

Most importantly, however, there were no women treated with a placebo – that is, an injection that has no treatment effect whatsoever. Such placebo treatments are incorporated into clinical trials so researchers can understand if there are any situations where a subject may report that they are feeling better just because of the psychological effect of believing to have received a treatment.

In conclusion, the women in the study reported that an injection of hyaluronic acid in the ball of the foot provided long-lasting relief from high heel pain, without any adverse effects. This exciting study presents a new non-surgical option for those with high heel pain.

Written by Nicola Cribb, VetMB DVSc Dip.ACVS

Reference: Foumenteze J, Simpson H, Kerrouche N. Hyaluronic Acid Filler Injections Under the Metatarsal Heads Provide a Significant and Long-Lasting Improvement in Metatarsalgia From Wearing High-Heeled Shoes. Dermatol Surg 2018;Publish Ahead of Print:1.

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