High-heeled shoes have long served as a marker of class, occupation and status. In ancient Egypt, butchers walked in heels to avoid stepping in the blood of slaughtered animals.
Chinese concubines and Turkish odalisques wore high shoes to prevent them from escaping the harem.
And in Europe in the mid-15th to mid-17th centuries wealthy women wore a platform overshoe called a chopine to protect their footwear and clothing from the street filth. Chopines were so high (up to 30 inches), their wearers needed servants and canes to help them walk.
Women may no longer need servants and canes to help them walk in high heels, but the difficulties and dangers associated with this ancient practice have caused British unions to put their foot down â€“ and Australian unions and health professionals are backing their cause.
The British move was officially supported this month at a Unions NSW meeting, though a spokesman said no similar motion requiring employers to carry out risk assessments on footwear would be tabled.
Nevertheless, Unions NSW Secretary Mark Lennon says if high heels are an issue for working women, the union would take it up.
â€œThree-inch heels from Manolo Blahnik and Jimmy Choo may be the height of catwalk fashion, but any boss that forces women to wear them represents the height of workplace bullying and discrimination,â€ Lennon says.
â€œNo worker should be forced to wear any item of clothing that compromises their health.â€
Few people realise that foot and ankle pain and lower back pain â€“ both conditions to which high heels contribute significantly â€“ are the top causes of workplace injury in Australia, says President of the Australasian Podiatry Council, Brenden Brown.
While the direct relationship between risky footwear and workplace injury in Australia has not been studied closely, Brown believes it is an area of increasing importance.
â€œI donâ€™t think you can use the words â€˜safeâ€™ and â€˜high heelsâ€™ in the same sentence,â€ says Brown.
â€œI would suggest that itâ€™s only a matter of time until companies are going to pick up the phone and start talking about getting some studies done.â€
â€œI had a large electricity supplier contact me in the last six months asking about high heels in the workplace â€¦ because they are concerned about the amount of injuries theyâ€™re getting from their administration staff wearing high heels in the office.
â€œThey were implying to me â€¦ that their foot and ankle injuries are in fact higher in administration areas than in industrial areas.â€
The short and long-term dangers associated with wearing high heels are well documented.
Aside from the increased likelihood of acute injury from foot and ankle sprain, wearers are also at risk from the excessive pressure put on the lower back, hip flexors, hamstring and calf muscles, and the overuse of small muscles in the feet.
â€œWearing high heels for a significant amount of time can cause considerable trouble for those muscles and give you really enormous postural and stability problems in later life,â€ Brown says.
â€œIâ€™ve seen ankle sprains, stress fractures, avulsion fractures â€“ this is where the ligament, instead of tearing in fact tears a piece of the bone off â€“ and countless cases of lower back pain from wearing high heels.â€
Gordian Fulde, head of emergency at St Vincentâ€™s Hospital, says he often sees CBD â€œpower ladiesâ€ with injuries from high heels.
â€œWeâ€™ve noticed an increased number of ladies with broken ankles because the heel gets caught. Some of the fractures have been very nasty.
â€œThose ladies are going to really suffer for the fashion of high heels â€¦ for a long, long time.
â€œI think itâ€™s a womanâ€™s choice but, as a doctor, Iâ€™d love the size of the heels to go down.â€
Orthopaedic surgeon Martin Sullivan says little work has been done to address the health problem of high heels in Australia.
Sullivan cites a US study done in the â€™90s, which estimated the cost of bad footwear at $US1.5 billion in medical expenses and 15 million work days annually.
Lorraine Jones from the British Society of Chiropodists and Podiatrists this month told reporters that about 2 million days a year are lost through sickness as a result of lower limb disorders and millions of pounds are spent on foot operations.
â€œCertainly in Australia, if you look at the Medicare figures alone, itâ€™s a multimillion-dollar problem â€“ and thatâ€™s not including the time off work after surgery,â€ Sullivan says.
Patients who undergo surgery for footwear-related problems take about five weeks to recover.
â€œI think [the British motion] is a positive move. Thereâ€™s no question of the dangers that these shoes cause,â€ he adds.
Sullivan treats hundreds of women every year for problems caused by high heels, including bunions, which are caused by a deviated big toe; claw toes, where the toes become deformed from being forced into the same position; and neuroma, a condition in which the nerve in the forefoot becomes crushed from prolonged excessive pressure.
Corrective surgery can cost up to $5000.
Sullivan says that virtually all his patients with this condition are women.
â€œItâ€™s essentially a female problem,â€ he says.
â€œI could see up to six women a day who need corrective surgery for neuromas.â€
The medical profession might be united but workplaces are not.
While workplace laws oblige employers to provide safe workplaces, the task of making that a reality is far more difficult.
Employees who feel that the dress code enforced in their workplaces poses a risk to their safety have the right to question that code under the Occupational Health and Safety Act, said a spokesperson from Unions NSW.
But, as Brown points out, the issue of what to wear at work goes far beyond legal, and even health, concerns.
â€œI was talking to a patient of mine, a high-level airline executive,â€ says Brown.
â€œShe wouldnâ€™t dare turn up to a meeting â€¦ without wearing high heels because she would be shunned.
â€œIt just wouldnâ€™t be the done thing to turn up in flat shoes; she wouldnâ€™t be taken seriously.
â€œWomen shouldnâ€™t be made to wear [high-heeled shoes]. I couldnâ€™t agree more. But thereâ€™s an unwritten expectation that they will and I think thatâ€™s far more important than any written rule.â€