Angela Manning lost her left leg to diabetic vascular disease. But it didn't stop her from wearing chunky, colorful, attention-grabbing high heels.
"I just ordered five pairs... and they are gorgeous," the former corrections officer said. "I love my heels."
But Manning, 52, wears heels only when sitting in her wheelchair because she isn't sure she could balance in one on her prosthetic. Plus, the prosthetics on the market now aren't made to fit the sky-high heels she favors.
A group of engineering students at Johns Hopkins University might have a solution for women such as Manning, who have lost legs or feet and miss the joy of fashionable footwear. They have developed a prosthetic foot with an ankle that can adjust to accommodate many different heel heights.
"Women with prosthetics are now limited to what shoes they can wear," said Joey Tilson, a member of the team of five students who developed the device for their senior project. "This allows them to wear almost any type of shoe they decide."
Their design, dubbed "Prominence," is not the first high-heeled prosthetic. But the current choices are limited and the Hopkins model might be the most versatile and advanced to date.
Amputees now can get custom-made prostheses for high heels. There are a few off-the-shelf models on the market, but none of them can adjust for heels beyond 2 inches, lower than many women want.
The Hopkins students tested their model on a pair of 5.5-inch gold strappy heels, and say it has the potential to support even taller shoes.
Forgoing heels might seem like a small inconvenience compared to the more drastic life changes amputees endure. But therapists and prosthetists say it is a common concern among female amputees. Still, many insurance companies won't cover prosthetics that accommodate heels because they are not seen as a necessity.
Kim Cardosa, a physical therapist at University of Maryland Rehabilitation & Orthopaedic Institute, frequently hears from women who have lost limbs to diabetes or vascular diseases and other ailments. High heels were once an integral part of their outfits for church or dinner with friends and family. Others would like to wear nice heeled shoes with their business suits.
"They want to try to get back to as normal a life as possible and sometimes they get a little upset that their footwear is limited," Cardosa said.
Anne Mekalian's favorite shoe style is anything with a heel. But she is a double amputee, and her prosthetics don't allow her to wear footwear higher than a quarter inch.
Mekalian, 70, lost both her legs and arms in 2011 to complications from strep throat and double pneumonia. She misses the days when she could dress up in fancy heels.
"I once wore them every day, all day," she said, disheartened. "I don't like practical-looking shoes. I don't like tennis shoes. They are for running and tennis."
There is a growing demand for more options as amputees become more open about their conditions, those in the field say. Some prosthetic feet now are built with slits in the toe so people can wear sandals.
"People aren't trying to hide their prosthetics like they once did," said Rebekah Spielman, global marketing manager for prosthetics manufacturer College Park Industries in Michigan. "There is a sense of community, being proud of who you are and showing off your mettle."
College Park Industries makes one of what they said are three models of heeled prosthetics on the market.
Some men buy the prosthetic to wear with cowboy boots or other shoes with heels.
Spielman said developing and testing a heel and taking it to market can take years. A high-heeled prosthetic needs to be robust, but flexible and comfortable, she said.
"It has to be finely engineered and hold up to so much impact as well," she said.
Despite improvements in prosthetics design, the Hopkins students found that most are built for men's feet, and the options for women are few — even though nearly half of all amputation procedures in 2013 were performed on women, according to the Virginia-based Amputation Coalition.
The students made the prosthetic with advice from professionals from the Walter Reed National Military Medical Center in Bethesda.
They wanted to provide more options for amputees, particularly soldiers who lose limbs in combat. As more woman serve in combat, they said, the need for better-fitting prosthetics is growing.
"We just want to make quality of life better for veterans," said Hopkins student Luke Brown.
More than 1,800 female veterans with amputations have received care and services from the Veterans Administration since 2000.
Dave Laufer, director of orthotic and prosthetic services at Walter Reed, said enhancing mobility for wounded soldiers is a top priority.
"Basically, our prosthetics department is constantly looking to improve the function of all prosthetics in order to improve the quality of life for those service members, veterans and their families with amputations," he said.
Of course, veterans aren't the only people who will benefit from these efforts.
Alexandra Capellini, a rising senior studying public health and pre-medicine at Hopkins, lost her leg to bone cancer in 2003. She remembers seeing girls in high heels in high school and feeling like she missed out on that rite of passage.
She tried the prosthetic her fellow students developed while wearing a flat shoe. She wasn't sure if her prosthetic, which has a computerized knee, would respond to the heel, but she hopes to be able to try it one day.
"I was completely ecstatic when the team first approached me about the initial design process," she said. "I think it is an exciting time in prosthetics, and that we may soon be able to offer a woman a night on the town with her friends in high heels."
The Hopkins students now plan to assess whether the prosthetic has commercial appeal and would qualify for a patent.
The Amputee Coalition, which serves more than two million people with limb loss and more than 28 million people at risk for amputation, gets frequent inquiries about high-heeled prosthetics.
A representative said there are some options, but not everyone will be able to wear heels like they did before their amputations. It depends on their injuries.
"Just because someone wants to wear five-inch heels doesn't mean one can or should based on their medical condition," said Dan Ignaszewski, the coalition's director of government relations and marketing. "It might be difficult for them to be mobile in a heel. You have to look at things like balance and if the person can walk comfortably. All that is best determined working with a medical team."
Before Mekalian lost her legs, she was a third-grade teacher at Cathedral of Mary Our Queen Catholic School in Homeland. She always wore heels.
"I always felt more dressed up when I wore heels," she said.
She describes the shoes she wears now as utilitarian. She would love more options.
For now, she settles for fancy flats with sparkles and colors. But it's not the same.
"My choices are really limited," she said. "It's quite a bummer."