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Footwear and public health: “My shoes are killing me!”

High heeled shoes, once worn exclusively by rich men and women (thus the term “well-heeled”) are now the topic of public health warnings.

High heeled shoes, once worn exclusively by rich men and women (thus the term "well-heeled") are now the topic of public health warnings.  The Centers for Disease Control and Prevention, lists high heels as a falling hazard on its "Prom Health and Safety" tip sheet. The American Osteopathic Association links high heels to a range of ailments and says constant wear can lead to chronic pain. Information about high heels and health appears on popular news websites like the Huffington Post and on medical information websites like WebMD.

If you've ever worn tight fitting, hard-to-walk-in shoes, you might have uttered the phrase "my shoes are killing me."  And certainly there's always a chance for a fatal fall while navigating slippery steps in stilettos.  Shoes worn in the workplace are, by contrast, considered protective equipment, along with hard hats, gloves and protective eyewear.

Shoes can be deadly.  Recall the 2001 incident when a terrorist boarded a plane with explosives hidden in his shoes that he intended to detonate during a transatlantic flight.  That's why we take off our shoes and get them scanned at the airport. (Thankfully, the 2009 "underwear bomber" incident did not lead to full strip searches in airport lines). During the Victorian era, arsenic dyes used in shoes (as well as clothing and household items) exposed shoemakers and shoe wearers, along with dressmakers, and just about anyone purchasing fashionable items made with green arsenic dye, to a deadly chemical.

This episode in fashion history is explained in a new exhibit, "Fashion Victims" at the Bata Shoe Museum in Toronto, and in the book The Arsenic Century: How Victorian Britain Was Poisoned at Home, Work, and Play by medical historian James C. Whorton.  (A related exhibit, "Killer Heels: The Art of the High-Heeled Shoe" is on view at the Brooklyn Museum.)

The Bata exhibit also reveals that shoes could be killers of the young boys who worked on the streets as bootblacks. The shoe polishes they used contained nitrobenzene.  It gave a nice shine, but exposed the boys (and the shoe wearers) to dangerous chemical fumes that could cause fatigue, weakness, dizziness, depressed respiration, coma, and death.  Nitrobenzene is still manufactured and used (even in some shoe polishes) but exposure is infrequent.  The real life experiences of children trying to earn a living shining shoes were a far cry from the famous fictional account in Horatio Alger's classic 1868 novel Ragged Dick: Or, Street Life in New York with the Boot Blacks.

Today shoe manufacturing is a global industry with China producing the most footwear followed by India, Brazil, Vietnam, and Indonesia.  Shoe workers continue to face occupational hazards on the job from both machinery and chemicals in their poorly regulated factories.  And, while children no longer earn a living and support family members by shining shoes in the United States, child labor in overseas shoe factories remains a problem.  Shoes and public health hazards are an old story and an ongoing one.

Read more about The Public's Health.