American Osteopathic Association

Advancing the distinctive philosophy and practice of osteopathic medicine

The Real Harm in High Heels

High heelsYour killer heels are killing much more than you think. One in 10 women wear high heels at least three days a week and a third have fallen while wearing them. Statistics show that high heels are one of the biggest factors leading to foot problems in women, with up to a third suffering permanent problems as a result of prolonged wear. Natalie A. Nevins, DO, an osteopathic physician from Hollywood, Calif. who specializes in family medicine, osteopathic manipulative medicine, and neuromusculoskeletal medicine, explains the common medical problems associated with prolonged high heel wear and provides tips to avoid them.

High Heels: The Higher the Better?

Those perfect pumps can create the perfect storm for permanent health problems. If you frequently wear high heels, you are setting yourself up for long-term issues. "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," says Dr. Nevins. "High heels have also been linked to overworked or injured leg muscles, osteoarthritis of the knee, plantar fasciitis and low back pain," she adds.

According to Dr. Nevins, when you wear high heels - shoes with a heel two inches or higher - your foot slides forward in your shoe, forcing the toes into the unnatural shape of the shoe and redistributing your weight incorrectly. The increased weight on your toes causes your body to tilt forward, and to compensate, you lean backwards and overarch your back, creating a posture that can strain your knees, hips, and lower back. "The change to the position of your spine puts pressure on nerves in the back and can cause sciatica, a condition where nerves become trapped, triggering pain and numbness as far down as the feet," Dr. Nevins adds.

High Heels and Chronic Pain

Over time, wearing high heels can shorten the muscles in your calves and in your back, leading to pain and muscle spasms. "Any time you wear shoes that restrict the natural shape of your foot, you’re at risk for experiencing pain," Dr. Nevins points out. According to Dr. Nevins, many women who wear high heels often suffer a shortening of the Achilles tendon because once the heel is pointed upwards, it tightens up. Stretching it again or switching to flats can be very painful; it can even lead to plantar fasciitis. "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," adds Dr. Nevins.

Do You Have to Give Up Your Heels?

No, but to avoid the problems that develop over time, Dr. Nevins recommends the following routines:

  1. Choose sensible heels. Select shoes with low heels - an inch and a half or less - and a wide heel base; a slightly thicker heel will spread the load more evenly. Narrow, stiletto-type heels provide little support and three inch or higher heels may shorten the Achilles tendon. 

  2. Wear soft insoles to reduce the impact on your knees.

  3. Make sure your shoes are the right size so the foot doesn't slide forward, putting even more pressure on the toes. Pick a shoe with a wide enough toe box to allow you to wiggle your toes.

  4. Wear heels on days that require limited walking or standing.

  5. Alternate your shoe choice throughout the day or from one day to the next. Don't wear your high heels all day; and wear more comfortable shoes, such as athletic or walking shoes for commuting to and from work. Wearing shoes that allow your body to move naturally during walking will allow your feet, legs, hips and back to stretch.

  6. Stretch. Take time every day to stretch your calf muscles and feet. Dr. Nevins recommends standing on the edge of a step with your shoes off. With your weight on the balls of your feet and your heels extending off the edge, drop your heels down to stretch. You can also put a pencil on the floor and try to pick it up with your toes.

The Final Word on Foot Health

Don't let your sense of style cripple your ability to stand or step pain-free. "Your feet are, quite literally, your base of support. If your feet aren’t happy, nothing above them will be," says Dr. Nevins. "Take a closer look at your shoe selection and take small steps now to prevent big foot problems later."

 

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