Angela spent many years wearing high heel shoes . Four years ago, a shopping trip was torture for Angela Kelly, 67. Though still a super-fit events organiser, the former over-50s All England badminton mixed doubles champion was reduced to hobbling at a snail's pace, hanging onto her trolley for support. It may sound as though Angela was struggling with a debilitating disease or catastrophic accident. In fact, she was suffering from the painful legacy of a lifetime wearing high heels. Her story is a cautionary tale for those of us who blithely slip our feet into shoes several inches high on a daily basis. 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. At 5ft 3in, Angela had always loved the extra height afforded by her favourite heels. 'I wore vertiginous stilettos and towering platforms every day of my teens and 20s,' she says. 'And after that, a 3 in heel or more, whenever I wanted to look smart.' Even the first twinge of arthritis, which began in her right knee in her early 30s, couldn't persuade her to kick her heel habit - instead, she gritted her teeth and controlled the pain with anti- inflammatories, until it suddenly worsened four years ago. She had almost no cartilage left in her knee and needed to have a titanium knee replacement . 'I was struggling to get out of bed or in and out of the car,' she says. 'I sometimes had to use crutches to get about and would have to lean heavily on a trolley to get around the supermarket. 'All my lovely high-heeled shoes had to be banished and I started living in trainers. 'My husband Rob and my friends were all very sweet, telling me I looked great in my frumpy, flat shoes and encouraging me to get my knee sorted out - but I felt really down about it. 'If I walked any distance or tried to play badminton, my knee would swell horribly and I'd have to apply ice packs to control the pain. 'Tests showed that I had almost no cartilage left in my knee and it became obvious that I needed to have a titanium knee replacement, which involved major surgery and a lengthy recovery period.' Luckily, Angela's knee surgery at the Royal Bolton Hospital in 2011 was a success. After following the advice of her doctor and physiotherapist to swear off heels altogether, to avoid damaging her new, artificial knee, she is fitter than ever. She has lost 1½ st, is playing badminton several times a week and goes to the gym regularly. 'I miss my heels and envy friends who can still wear them,' she says. The average woman spends £136.52 on five new pairs of shoes a year . The knee op wasn't her only surgery. 'I had to have a bunion surgically removed from my left foot last year, too, which was caused - or certainly worsened - by years of wearing tight, pointy stilettos. 'I probably would have paid more attention to the fit of my shoes, rather than how fashionable they looked, if I'd known they would force me to go under the knife twice.' Vanity is the obvious reason why Angela is far from the only woman willing to suffer for fashion - there's no question that legs look longer and more elegant in beautiful heels. 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. Retired teacher Susan Owens, 61, has also suffered life-changing knee problems from wearing heels since she was a teenager. 'My husband and I go on a lot of cruises, and recently took up ballroom dancing, which call for lots of dressing up and wearing high-heels for hours on end,' she says. But unbearable knee pain that began in 2010, when she was 55, threatened to curtail her leisure activities altogether. Susan Owens has also suffered life-changing knee problems from wearing heels . 'At first, I just put the pain down to ageing and tried to soldier on, but as time went on, over-the-counter painkillers stopped working and the niggling, arthritic pains were keeping me awake at night,' she says. 'Six months after they started, I went to see my doctor and was given steroid injections in my knee. They really helped in the short term, but I still found I couldn't wear heels when we went out or on holiday - it was just too painful. 'I was still teaching young children at the time, but I struggled to kneel down beside them in the classroom. I couldn't drive and as I stopped being so active, I started to pile on weight and suddenly felt old, despondent and frumpy.' Susan had to undergo arthroscopies - keyhole surgery to remove damaged cartilage - on both knees before a right knee replacement by orthopaedic surgeon Shivanand Geeranavar at BMI Edgbaston Hospital improved things. 'Within six weeks of having my knee replaced I was driving again and went on holiday to Italy. 'Within nine weeks, I could ride my bike and go back to ballroom dancing. I still wear heels occasionally - mainly when I'm dancing - but the heels are lower than they used to be.' 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. Tim Allardyce says wearing high heels regularly can also be at the root of a raft of excruciatingly painful back, hip and even neck problems. 'Standing and walking on the balls of your feet throws the skeleton out of its usual, healthy alignment, which means muscles and joints throughout the body have to compensate to maintain its centre of gravity and keep the body upright,' he says. Despite being otherwise fit and healthy, former BBC television sports presenter Sally Jones, 60, blames her fondness for heels for the excruciatingly painful lower back problems that plagued her 40s and 50s. At times, the pain was so bad she was unable to drive and was forced to use a stick. 'High heels have always been considered part of a female TV presenter's uniform,' she says. 'Not that I complained - high shoes have always be my preferred choice of footwear when I've got to look smart. The shame is that I can't really wear them any more.' Though her back problems had been triggered by squash and tennis injuries in her 30s, Sally was advised by an orthopaedic consultant and osteopath that her penchant for heels was exacerbating her problems. 'I was told to stick to flats or shoes with a very low heel and to spend as much time barefoot as possible to help correct my posture, which had been thrown out of alignment by wearing heels day in and day out,' she says. Standing and walking on the balls of your feet throws the skeleton out of its usual, healthy alignment . 'I was also given exercises to follow to strengthen my abdominals and back muscles, and help correct the poor postural habits I had developed, which were putting strain on my lower back. 'For the past 15 years, I've had to stick to flat footwear and keep up the exercises to keep my back pain at bay. 'I still take heels with me to slip on for TV appearances, but the twinges in my back start if I have to stand in them for more than an hour.' For high-heel lovers not yet suffering painful problems, podiatrist Michael Ratcliffe advises picking shoes carefully. 'If you are after height, wear a comfy platform or a shoe with a heavy block heel -which will give you support - rather than a flimsy stiletto with a thin sole,' he says. And Tim Allardyce says: 'Take a break. If you're wearing a pair of heels over 2 in high, limit the time spent wearing them to two hours maximum. 'After two hours, sit down, take the heels off and walk around barefoot if possible for 30 minutes to allow time for your feet and knees to recover.' Interestingly, consultant knee surgeon Marcus Green, at the BMI Priory Hospital in Birmingham, has even more hope for those who can't bear to part with their favourite 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. 'Yes, there is a definite link to issues such as Angela's bunions and Sally's postural problems. 'But when it comes to knees, keeping your weight down and exercising regularly to keep the supportive muscles around the knees fit and strong are, in my opinion, by far the most important steps you can take to prevent or slow down arthritis in the knees.'
Angela Kelly suffered the painful legacy of a lifetime wearing high heels.
She had arthritis in her early 30s but wouldn't kick her heel habit.
Four years ago, at 63, she had have a titanium knee replacement.