Are High Heels Bad For You?

John Bradley, PT

I cannot tell you how many times I get this question: “Are high heels bad for you?”

As you might imagine, the question is often asked as the woman is standing right in front of me, obviously sporting a pair of high heeled shoes she just purchased and is delighted to have and wear.

Not being too quick to judge, I glance down and see a pair of shoes shaped like a hunting spear in the front with a heel no thicker than a number two pencil at least 3 inches long. I try to not look alarmed as I attempt to create an answer that is accurate and polite at the same time.

Sorry, but I do not have a good poker face.

high heels physical therapy

High Heels and Its Effect on You

The simple answer to the question she posed is high heeled shoes like the ones described above are not good for the feet, legs, or back. Biomechanically, these shoes create several problems.

First, the angle of the shoe pushes the body forward, causing more weight-bearing pressure on the ball of the foot and toes. These areas are not designed to hold a lot of bodyweight for long periods. Think about standing on a steep slope backward. You will be immediately aware of the pressure on your toes.

Secondly, since the body is angled forward, there will be compensation in the lower back to arch rearward to keep vertical. So, if you are on the slope in the example just given, you end up bending backward slightly to avoid tipping over.

Thirdly, the forward slope of the shoe often forces the foot into the narrowest part of the shoe. This will squeeze the toes together tightly and can lead to nerve and joint irritation. Just imagine having your fingers tightly bound with a bandage. It would be hard to move them as you wanted to. The toes must be able to move freely with walking to allow the foot to function properly.

High heels and Adaptive Shortening

Perhaps the most significant problem associated with high heeled shoes is what is called “adaptive shortening”. This refers to a phenomenon where the prolonged wearing of these shoes will lead to tightening and shortening of the Achilles tendon at the rear of the lower leg and ankle.

This tendon must be flexible to allow the ankle to go through a normal range of motion which is necessary for proper walking form. Normal walking dictates that the heel strikes the ground first. If the Achilles tendon is tight, the foot tends to strike the ground flatter, and this puts pressure on the middle and front of the foot-areas not intended to accept the initial shock of bearing weight.

Now, what percentage of people who ask me this question will actually change their shoe buying habits after I give them the answer? Now that is a good question. I do not expect everyone will stop wearing high heeled shoes.

heel exercises

Achilles Tendon Exercises

But, I want to teach people that if you do choose to wear these shoes, there are some things you can do to minimize the negative effects:

1. Stretch the Achilles tendon!
This is very simple. Just place an old book or piece of wood about 2-3 inches thick on the floor. Put the ball of one foot over the edge of the block. Keeping the knee of that leg straight, gently lean forward until you feel a stretch in the calf. Hold this for 30 seconds. Do this 3x for each leg.

2. Pick items on the floor using your feet
Get a handful of small objects like nuts, bolts, or marbles and place them on the floor in front of where you are seated. With bare feet, attempt to pick the objects up one at a time with your toes. Try to make thirty “pickups” with each foot. This will strengthen the muscles in the arch of the foot and increase your foot’s shock-absorbing ability.

3. Get a regular foot and leg massage from a licensed massage therapist.
We have described the stresses to the foot and leg from wearing high heeled shoes. A massage will go a long way to relaxing tension in those muscles and flushing the area with much-needed blood circulation.

Do you like how I ended my advice with “get a massage”? Now that is what I call “diplomacy” in light of one the most difficult questions I get!

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