Her Highness ... Kate Middleton favours fashionably high heels.

Her Highness ... Kate Middleton favours fashionably high heels.

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," says Edeltraud Breitenberger, a high heel trainer in Munich. She works with women who wish to "emphasise their femininity, feel comfortable walking in high heels and want to avoid hurting themselves".

Breitenberger also teaches men - transvestites who have never worn high heels before, for example - but also men who want to look more elegant when they walk. She promises to teach them how to walk like Richard Gere.

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 and that's more than high enough, said Breitenberger, who warns women against heels higher than 10 centimetres.

"You don't need height to be elegant," says 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.

Participants have to start learning about high heels at their feet. The course begins with a foot massage and toe training.

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

Carmina is one of Breitenberger's students. The 32-year-old said she enrolled in the course in order to learn how to walk in high heels without hurting herself.

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 three-centimetre heel.

Heels that high and higher change the way a woman walks, said Renee Andrea Fuhrmann, head doctor at a podiatry clinic in Bad Neustadt, Germany. This has been proved in studies that analyse walking and muscle action. "A women who regularly wears high heels - more than three times in a week for the entire day - will have problems."

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. The back muscles are also strained.

"Wearing high heels over a long period of time can lead to back pain," says Fuhrmann. 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," says 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 as heels are the predominant footwear trend for women.

"The high heel trend is currently very pronounced," says Claudia Schultz, a spokeswoman for Germany's shoe manufacturers.

"They again have the desire to dress femininely," she says.

DPA