The Spine Health Institute reports that 72% of women in the United States wear high-heeled shoes at some time during their normal routines. Over the years, several studies have pinpointed both short- and long-term damage these women may be doing not only to their feet, but also to their bodies.

When you factor in that escorts are much more prone to don a set of spikes, the concern increases even more about the effects of those "killer" heels.

There are several aspects of your life, career and health that are influenced by your heel-wearing habits. Even though many clients expect an escort to show up in stilettos, it doesn't mean that you have to risk your health in order to please a client. Consider these issues and tips when you are picking out your next pair of escorting pumps:

1. Your image is certainly impacted by your high heels. While the fashion industry depicts the epitome of fashion as a woman who dons 5-inch Manolo Blahniks, it's pretty obvious that the way a woman carries herself says as much about her style and image as the type of shoes she is wearing does. And, while a great pair of heels can give you the confidence and sex appeal you need to appeal to your clients, your shoes can also take away from that poise just as easily if you're not comfortable or skilled in them. When your shoes cause your feet to hurt, it's impossible to walk without wincing or exhibiting your discomfort. Additionally, any escort who can't walk with skill or ease in her stilettos is doing a disservice to herself by detracting from her sexiness. Shoes that cause you to limp, walk with an uneven gait or wobble don't make you look sexy; instead, they cause you to look inexperienced and as though you're playing dress up with someone else's wardrobe. Additionally, ensure that your heels are appropriate for the encounter you have planned with your client. Very high, platform heels are often considered "stripper heels" and fail to make you appear classy and sophisticated. Also, depending on the time of day and location of your encounter, some heels are less appropriate than others. If you're going to a ballgame or meeting up in the afternoon, your sparkliest strappy heels are probably best left at home. Make sure that you are promoting the image you desire when you squeeze into those heels.
2. Wearing high heels can make you the target of an attack. While assailants may not be looking specifically for a woman who is wearing high heels, they definitely identify you as an easier target than a woman who is wearing flatter-soled shoes. When you're traveling to an outcall, it's probably pretty common for you to walk through a parking garage or down a street in your heels. When an attacker picks you out of the crowd, he may do so knowing that it's going to be harder for you to run, since you've got heels on. Also, it's more difficult for you to keep your balance when struck or grabbed, when you're teetering in your stilettos. Detective Mark Brooks of the Newark, New Jersey, police department instructs a women's self defense class and he says, "Wearing heels won't make you a target, but they aid in an attacker's choice of picking you from others. He sees your heels as a weakness." However, many women argue this point by suggesting that they can use their heels as weapons against any attacker.
3. Heel-wearing escorts are more prone to trips and falls, increasing their chances of injuries. The Spine Health Institute reports that due to balance issues, spine misalignment and shortening of the Achilles' tendon (from extended high-heel wearing), women who wear high heels are much more likely to trip or fall in incidents that cause injuries. Because your foot is already placed at an unnatural angle in your shoe, experts from the Institute indicate that foot fractures and severe sprains are often the result of a simple misstep. Additionally, slippery surfaces, uneven walkways and steps become even more dangerous locations to walk, when your balance and posture are negatively affected by wearing high heels. Wearing heels is deemed such a risk that even the Occupational Safety and Health Administration has considered implementing high-heel restrictions in some workplaces where safety is a concern. While it's doubtful that you'll experience a serious fall while wearing heels in your client's hotel room, it is a concern when you escort all over town and wear your shoes for long periods of time.
4. Wearing high heels does not create a healthy posture. While many clients think that the way an escort stands in her heels is sexy, the way your spine aligns in them is not promoting your long-term health. Dr. Ava Shamban, a board-certified podiatrist and author, told Shape Magazine in April 2012, "The bottom half of your body leans forward so the top half must lean back—this disrupts the normal ‘S' curve of your back, flattening your lower spine and displacing your mid-back and neck. It is very difficult to maintain good posture in this position—not only is it detrimental to the health of your spine, ‘stooped over' is not a sexy look!" When you stand like this for extended periods of time, you are exerting unnecessary wear and tear on your spine that may cause you significant problems later. Additionally, due to your posture and alignment being off due to common problems associated with escorting (it's impossible to maintain perfect posture while giving a client oral sex), you should pay attention to protecting your back as much as you can the rest of the time.
5. High heels can cause damage to your feet and toes. According to Dr. Natalie Nevins, Do, an osteopathic physician from Hollywood, CA "Extended wear of high heels and continually bending your toes into an unnatural position can cause a range of ailments, from ingrown toenails to irreversible damage to leg tendons. Additionally, cramming your toes into a narrow toe box can cause nerve damage and bunions."She told the American Osteopathic Association, "High heels have also been linked to overworked or injured leg muscles, osteoarthritis of the knee, plantar fasciitis and low back pain." While you may think you're doing good things for your career by wearing sexy heels, you could be doing the opposite for yourself. In order to maintain a good client list and your abilities to satisfy your escorting requirements, you have to take care of yourself. Taking time off for bunion surgery or experiencing nerve damage will significantly reduce the success of your career as an escort.
6. Chronic pain (more than just a high heel hangover) can be a result of consistently wearing high heels. Over time, wearing heels can shorten the muscles in your calves and back, which can lead to pain and muscle spasms, said Dr. Nevins. She explained that women who wear high heels often suffer from shortening of the Achilles tendon, because once the heel is pointed upwards, it tightens up. "Any time you wear shoes that restrict the natural shape of your foot, you're at risk for experiencing pain," she points out. "Stretching your foot out, again, after wearing heels, can be very painful. Even if you're just switching to flats, it can hurt a lot." She further explains: "This tendon is designed to be flexible, so the foot can lie flat or point. With repetitive wear, you can develop unhealthy patterns that can persist even when you're not wearing high heels." Many escorts think that this issue only applies to women who have worn heels for several years, but damage has been observed in much younger high heel wearers. An Australian study published in The Journal of Applied Physiology in 2012 found that damage is detectable in women as young as 25 years old.
7. Wearing high heels can lead to plantar fasciitis. Dr. Morris Morin, DPM and director of podiatric medicine at the Hackensack University Medical Center, told WebMD, "As you age, you lose some of the fatty deposits that normally protect the ball of the foot — and some of it also slides forward toward the toes." He went on to explain that when women slip their feet into stilettos and step down, their weight is thrown on the very spot they have the least protection. "In extreme cases, you actually have the bony ends of the foot grating down into the sole of the shoe with almost no protection at all," he says. This causes severe pain, and it can also increase the risk of stress fractures and osteoarthritis in the feet. Morin mentioned that treatments are marketed by cosmetic surgical clinics that promise to repad the foot using injections of silicone or wrinkle-filling injections like Restalyne, but he advised against them. "These injectables aren't meant to withstand the pressure of body weight; they don't last and tend to move around from the weight," he stated. The American Orthopedic Foot and Ankle Society warns women against these types of procedures and risks associated them (infection, nerve injury and difficulty walking).
8. Escorts who habitually wear high heels may be at risk for sciatica. Sciatica, according to the Mayo Clinic, is "pain that radiates along the sciatic nerve — which branches from your lower back, through your hips and buttocks and down each leg." It most commonly occurs when a herniated disk or bone spur on the spine compresses part of the nerve. While the condition can be caused by a number of reasons, doctors indicate that your footwear can contribute to the problem. Escorts who wear high heels (at least two inches or higher) are at increased risk, because of the way their shoes shift their weight and shape their feet unnaturally. The increased weight on the toe area causes your body to tilt forward, and to compensate, you lean backward and overarch your back. Your shoes may create a posture that can strain your knees, hips and lower back, according to Nevins. "The change to the position of your spine puts pressures on nerves in the back and causes sciatica, trapping nerves and triggering numbness as far down as the feet," she said.
9. Spider veins may be a result of wearing high heels regularly. Women's Health Magazine reports that wearing heels forces your ankles to bend forward, in an unnatural manner. As your ankles bend this way, it can cause restricted circulation in your lower limbs and cause spider veins to appear. While most of the time, spider veins don't really pose serious health risks, they detract from the shapeliness of your legs. If you've worked hard to tone up your stems and take pride in wearing short shorts or miniskirts, the roadmap of veins on your legs will seriously infringe on your sex appeal. Most escorts take pride in their sexy legs, but it's pretty difficult to conceal spider veins once you get them. While spider veins are fairly common as women enter their 50s, escorts should attempt to avoid them as they work in their youth. While there is no way to determine that wearing high heels will cause you to develop spider veins, it's a possibility you should attempt to avoid, if possible.
10. Anatomical changes are common side effects of long-term high heel wear. Escorts who wear high heels daily over a number of years are subjecting themselves to the risk of changing how their feet, calves and spines function in their bodies. Extended wear puts undue stress on the back and knees as the weight of the body shifts forward, according to the Spine Health Institute. Calf muscles may shorten. Tendons in the foot and leg may thicken (reducing their elasticity). And, spondylolisthesis may occur. (Spondylolisthesis is the slippage of one vertebrae over another.) This is extremely common in the lumbar region of the spine, where the body's weight is usually concentrated. These changes can have several physical effects, including pain and difficulty walking. While the mentioned anatomical changes may be reversible (often with surgery), they can be expensive issues to deal with. Both due to health costs associated with them and the loss of work you will experience due to coping with them.
11. Wearing high heels can result in foraminal stenosis. The Spine Health Institute explains that foraminal stenosis is a spinal nerve condition that can occur when spinal abnormalities block or reduce space in one or more foramina. Shooting pains, numbness, tingling, muscle weakness, spasms and pain that radiates down to the buttocks and legs are possible effects of the condition. Escorts who develop this condition may require extensive medical care and chiropractic adjustments to remedy their situations. However, if they continue abusing their bodies with their commitment to wearing high heels, symptoms will likely return, requiring surgical repair.

While there are many health issues related to wearing your high heels, you can implement various measures to reduce the ill effects and still reap the benefits of a sexy pair of stilettos. Consider these tips:

1. Prep your legs for wearing high heels with exercise: Neal Blitz, DPM, told the Huffington Post that a workout plan involving three exercises will counteract the risks of wearing pumps. The first exercise is barefoot squats; they will target the foot by recruiting the small muscles of the toes to engage the ground. Focus should be on grabbing the floor with the toes on each rise, says Blitz. (Other benefits include at toned core and legs.) The second exercise is calf muscle stretches. This move will help stretch out the calf muscles and tendons that tighten up due to extended high-heel wear. The final exercise that an escort should incorporate to reduce high heel effects is single leg dead lifts. This exercise focuses on keeping the balance and spatial centers of the body active, along with strengthening the outer muscles (peroneals) of the lower legs to prevent ankle twisting.
2. Ensure proper fit when you buy a pair of shoes: When you go out looking for your next pair of sexy pumps to visit a client in, take some extra time to find a pair that fit, especially if you will be wearing them out of the bedroom. Attempt to find a pair that does not allow your foot to scoot to the front of the shoe, leaving a gap in the back at the ankle. Look for a snug fit that won't rub blisters.
3. Look for a thicker heel: Morin suggests that a thicker heel provides more stability. "A thicker heel will give you better balance and may help relieve some pressure by distributing the weight on your foot more evenly," he says. A wedge-heeled shoe or a pump with a bigger spike may be just what you're looking for. (And, wedges are a huge fashion trend this year!)
4. The slope of the heel is important: Morin insists that the "pitch" of the heels may provide relief from some pain normally associated with wearing high heels. Look for a shoe that doesn't have a straight drop down into the flatbed portion of the shoe. A more gradual slope is much gentler on your foot. It also is more comfortable for your arch and ball of the foot.
5. Alternate shoes: Even if your red pumps are your favorites, avoid wearing them every day. Change them up with a black or nude pair from time to time. Swapping out your shoes regularly allows your feet some transition and reduces the chances for permanent malformation.
6. Wear peep toes: A popular trend at the moment, peep-toed heels will actually relieve pressure on corns and calluses that may be causing you pain and discomfort. If peep toes aren't really your style, consider sandals for summer, as a way to reduce pressure.
7. Insert insoles: Dr. Morin suggests using a silicone metatarsal pad in your high heels to cushion the ball of the foot. "The look like a flattened gummy bear, but they do a super job of shock absorption," says Morin.

While it's probably not possible to get rid of your stilettos altogether when you work as an escort, it is possible to attempt to wear them more responsibly. When you know you will be walking long distances or standing for long periods of time, wear shoes with a lower heel. Or, wear comfortable shoes and bring your stilettos for when you actually come face to face with your client.

Even though your clients may favor your high heels, don't risk your long-term health for a few extra bucks now. There are always alternatives you can implement in the interest of preserving your own health and comfort.

Image: https://www.flickr.com/photos/dave77459/356189023