Are high heels bad for your body? Old wives' tale or truth?

Are high heels bad for you? I thought that we could take the barefoot vs shoes debate a step further this week and look at what high heels do to your body. :) My mother is a firm believer that high heels are to blame for all sorts of foot trouble (and she is usually right about most things), but is there any research evidence to back this up?

It turns out that mom may actually be right. Since anything that influences the feet usually also causes a reaction higher up in the body, I’ve searched the available literature to answer the following:

• Are high heels bad for your feet?

• Are high heels bad for your knees?

• Are high heels bad for your back?

• All is not lost, a heel can sometimes be useful.

Are high heels bad for your feet?

The first and most obvious change that happens in the body when you wear high heels is that your weight is shifted from your heel onto your forefoot and research has shown that the higher the heel, the more pressure it puts on the ball of your foot (metatarsal bones).

It is this increase in pressure on the forefoot that can cause the balls of your feet to ache after a night out. Stomp et. al made 3 healthy women walk 7km in flat shoes and then in high heels on two consecutive days and MRI scanned their feet after each session.

The scans showed swelling not only under the balls of their feet, but also over the top of the metatarsal bones after walking in high heels. So, if you are struggling with pain in your forefoot or metatarsal bones, also known as metatarsalgia, you may want to ditch the high heels.

Incidentally, I find that making a switch from wearing normal hard soled (flat) shoes to wearing trainers a very effective treatment for forefoot pain or metatarsalgia. Especially for my patients who have a long walk during their commute to work.

Barnish et al. did a review of the literature to see if they could find any evidence that high heels causes lasting problems for your feet. Interestingly they did not find any evidence that wearing high heels causes osteoarthritis in the foot, but it does seem to cause your big toe to push out over time.

Halux valgus deformity is the academic name for when the big toe decides to wander over to the second toe. This is more commonly known as a bunion.  Bunions can be extremely painful and problematic and also cause the other toes to lift up and deform.

Hallux Valgus or Bunion deformaty of the big toe. Photo credit: Angela Simon https://commons.wikimedia.org

Are high heels bad for your knees?

It is obvious that high heels change the position of your feet, but what a lot of people don’t realise is that it causes the whole body to alter its posture. Kerrigan et al. were interested to see how the forces around the knee change when you put high heels on your feet.

What they found correlates well with what I see in practice. They found that high heels increased the force across the patellofemoral joint (kneecap) and also produced a greater compressive force on the medial compartment of the knee (average 23% greater forces) compared to walking barefoot. The patients that I see in practice who suffer with patellofemoral pain (pain over the front of the knee) often report walking in high heels as a major aggravating factor.

This study does, however, not prove that high heels causes knee osteoarthritis. The only study that I could find that specifically investigated this issue did not find a relationship between wearing high heels and developing knee osteoarthritis, but the researchers stated that this may have been due to people with knee pain being forced to give up high heels at a young age due to pain.

Are high heels bad for your back?

Physios and other healthcare professionals often state that high heels can cause back pain, but I have not been able to find any research to back this up. I think the reason for this is that back pain can have many different causes, but also that the flexibility of the entire lower limb will determine what happens at the back when you wear high heels. There is also a massive lack of research in this area and we may get the answer to this in a few years from now.

For now, we will have to make do with what I (and others) observe in my clinic. You generally end up with an increased curve in your lower back when you put high heels on your feet. This increased curve or lordosis will be bigger in someone who generally has a big lumbar lordosis, an anterior tilted pelvis or very tight quadriceps muscles.

If you back pain is predominantly caused by facet joint irritations, you may find this position very painful since it will cause extra pressure on the facet joints. However, if your back pain is predominantly caused by a structure towards the front of the spine, you may find that wearing high heels provide relief since it will offload that part of the spine. Do any of this cause long term damage? The verdict is still out on that one.

All is not lost - a heel can sometimes be useful.

No, I haven't lost my mind. Granted, I am not talking about stilettos. Wearing a medium heel can be very useful in the early treatment of calf strains and Achilles tendinosis. The heel will offload the calf muscle and Achilles tendon by putting them in a slightly shortened position. This can give the damaged tissue a chance to calm down and will protect it during the acute stages of healing.

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ReasearchGate.

References

1. Kerrigan, D. C., Todd, M. K., & Riley, P. O. (1998). Knee osteoarthritis and high-heeled shoes. The Lancet, 351(9113), 1399-1401.

2. McWilliams, D. F., Muthuri, S., Muir, K. R., Maciewicz, R. A., Zhang, W., & Doherty, M. (2014). Self-reported adult footwear and the risks of lower limb osteoarthritis: the GOAL case control study. [journal article]. BMC Musculoskeletal Disorders, 15(1), 1-7.

3. Rossi, W. A. (2001). Footwear: The primary cause of foot disorders. Part, 2, 129-138.

4. Russell, B. S. The effect of high-heeled shoes on lumbar lordosis: a narrative review and discussion of the disconnect between Internet content and peer-reviewed literature. Journal of Chiropractic Medicine, 9(4), 166-173.

5. Speksnijder, C. M., vd Munckhof, R. J. H., Moonen, S. A. F. C. M., & Walenkamp, G. H. I. M. (2005). The higher the heel the higher the forefoot-pressure in ten healthy women. The Foot, 15(1), 17-21.

6. Stomp, W., Krabben, A., van der Helm-van Mil, A., & Reijnierse, M. Effects of wearing high heels on the forefoot: an MRI evaluation: Scand J Rheumatol. 2014;43(1):80-1. doi: 10.3109/03009742.2013.847117. Epub 2013 Dec 3.