Hollywood stars and supermodels make walking in high heels look easy. They float along gracefully looking tall and elegant. But high heels can actually make any flat-footed woman look like royalty if she knows how to walk in them. It's a learned skill and that's why woman worldwide attend courses to find out how to do it right.

"What looks elegant is also healthy," said Edeltraud Breitenberger, a high heel trainer in Munich. She works with women who wish to "emphasize their femininity, feel comfortable walking in high heels and want to avoid hurting themselves."

How to choose your heels

We're not talking about the colour or pattern of the shoe here. Take a good look at the structure of your heels.

On women's shoes, the base of the high heel should curve gently downwards from the sole so that it is directly under the middle of the heel. If the heel is too far back, it's almost impossible to walk with a rolling motion, and it is bad for posture.

By definition any heel more than 10 centimetres is a high heel. Shoes with 14-centimetre heels or higher are considered a fetish. That's why all shoes on sale in regular shoe stores stop at 13.5-centimetres heels, said Breitenberger, who warns women against heels higher than 10 centimetres.

"You don't need height to be elegant," said the expert. "In my opinion no woman should walk on heels more than 10 centimetres on a sustained basis."

One rule of thumb is that the smaller the woman's foot, the smaller the heel should be.

Training your toes

The course begins with a foot massage and toe training.

"The big toe is the boss of the high heels," said Breitenberger, who is also an adviser to tango dancers. If the toe is strong, it holds the weight.

Breitenberger advises women who are already good at walking in high heels not to wear them daily. It's better to alternate wearing different shoes.

Orthopedic doctors warn against regularly wearing shoes with more than a 3-centimetre heel.

How often should you wear high heels?

"A woman who regularly wears high heels – more than three times in a week for the entire day – will have problems," says Renee Andrea Fuhrmann, head doctor at a podiatry clinic in Germany. Heels that high and higher change the way a woman walks, she adds.

Ten per cent of Fuhrmann's patients come to her with problems resulting from years of walking in high heels. Many complain about splayed feet, bunions or hammer toes. High heels only make these deformities worse in feet that already are predisposed to them.

High heels can also cause problems in a woman's calves, knees and back. The knee stays slightly bent when a woman walks in high heels and the pressure on the knee cap increases. The wear and tear can even require treatment from a specialist.

"Wearing high heels over a long period of time can lead to back pain," said Fuhrmann.

Can you still walk in flats?

The Achilles tendon and the calf muscles get shorter when a woman wears high heels over a long period and this causes something called Cinderella syndrome, in which it hurts to walk in shoes that don't have high heels.

"I have many patients who say they can no longer walk in a flat shoe," said Fuhrmann. Therefore, exercises to stretch the Achilles tendon and calf are very important.

A typical patient in the clinic is a 40- to 50-year-old woman who has worn high heels for years. They usually don't want to stop wearing them. There could be fewer cases in the future because younger women are being more sensible about the footwear they select. Fuhrmann said the tendency is towards more comfortable shoes.

However, the trade industry association that represents shoemakers and leather workers in Germany says the trend is actually the opposite.

"The high heel trend is currently very pronounced among young women," said Claudia Schultz, a spokeswoman for the association. "They again have the desire to dress femininely."

How often do you wear heels? Do they hurt your foot? If not, share your stiletto secrets with us.

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