Are High Heels Really That Bad For Your Feet?

Posted 13 Mar '23

It comes as little surprise when during a visit to a podiatrist, a physio, or a doctor, you get told that you really shouldn’t be wearing high heels all day, and that they’re not doing your feet or body any good. And while for some cases of high heels it may feel obvious - like those small stilettos that have the thinnest heel which can easily make you lose balance, can the same really be said for all high heels? Here’s a look into the facts and research behind wearing high heels and the effect they’re having on your body.

High Heels Do Overload Your Forefoot

According to research on middle-aged women, wearing 3 inches (7 cm) heels increases your forefoot pressure by 76% compared to wearing flat shoes. A 2-inch heel (5 cm) heel increased the forefoot pressure by 57%, and even a 3 cm heel increased the forefoot pressure by 22%. Given that our feet are responsible for supporting our entire body weight over and over with every step - including on one foot for a time while the other is in the air taking another step - this increase can have significant and painful consequences. Other studies have shown that it’s not just the forefoot that bears the burden of high heels, but swelling presents over the top of the metatarsal bones at the midfoot after walking in heels, too. 

While ‘overloading’ may not seem like the worst thing in the world, especially if you can just take your heels off at the end of a long day and rest your feet and stretch your toes, the reason it’s a big concern for us as podiatrists is because ongoing overloading means a much higher injury risk, and in many cases, it feels like a ticking clock until something reaches breaking point and goes wrong.

High Heels Do Increase Your Injury Risk

Specifically, this repetitive overloading can lead to a range of injuries, with a handful of examples including:

• Metatarsalgia: by placing more pressure on the ball of the foot and the metatarsal bones, this can lead to inflammation and pain in the area, which is known as metatarsalgia.
  
• Capsulitis: repetitive overloading can cause the joint capsules at the ball of the foot to become damaged and inflamed, along with the surrounding tissues and ligaments. This produces pain and discomfort, and is known as capsulitis.
  
• Synovitis: the synovial membrane is a thin layer of tissue that lines the joints, providing lubrication and cushioning. Overloading from wearing high heels can cause the synovial membrane in the foot to become inflamed, leading to synovitis.
  
• Plantar fasciitis: the plantar fascia is a thick band of tissue that runs along the bottom of the foot, connecting the heel bone to the toes. Wearing high heels can cause the plantar fascia to become stretched and strained, leading to inflammation and pain in the heel and arch of the foot, which is known as plantar fasciitis.
  
• Morton’s neuroma: wearing high heels can cause the bones in the foot to become compressed, leading to irritation of the nerves between the toes. This can cause a thickening of the tissue around the nerves, which is known as a Morton's neuroma, which produces sensations including pain, numbness, tingling, burning, pins and needles, and more.
  
• Stress fractures: repetitive overloading can lead to small painful hairline cracks in the bones, often in the metatarsal bones in the midfoot. When this happens, it’s known as a stress fracture.
  

Aside from these overloading-related injuries, other injuries such as ankle sprains are a common occurrence with high heels. When several ankle sprains are sustained and not properly rehabilitated, this tends to lead to ongoing ankle instability issues too.

High Heels Do Increase Your Risk Of Ongoing Problems

Alongside the injuries we named above, high heels also increase your risk of other foot deformities and ongoing problems. These include:

• Bunions: bunions are the frustrating bony bumps that develop on the inside of the foot at the big toe joint, causing the big toe to deviate inwards and face the other toes. While high heels alone don’t cause bunions, the added pressure on the forefoot can aggravate a bunion and hasten its progression. The effects can be even further accelerated when the high heels have a pointed or narrow toe box, rubbing against the side of the big toe joint.
  
• Corns and calluses: corns and calluses develop in direct response to excess pressure on the foot, forming thickened skin layers in an attempt to protect the skin from the added pressure. Wider areas of thickening are known as callus, whereas pinpoint areas of pressure turn into corns, which can become very painful and uncomfortable. Even if you get your corns and callus removed by a podiatrist, they are likely to keep returning as you continue to wear high heels. 
  
• Shortened Achilles tendon: when you’re in high heels, your Achilles tendon remains in a shortened and contracted position, while your calf muscles must work harder due to the forward shift in body weight. This makes the tendon more tight, and can lead to permanent Achilles shortening making it more difficult (and painful) to extend the tendon when you’re in flats.
  
• Hammertoes and claw toes: the pressure on the forefoot can also cause the toes to grip the ground and maintain a bent or unnatural position, ultimately increasing your risk of hammer toe and claw toe deformities.

High Heels Do Have Negative Effects On Your Knees And Back

It’s not just your feet that are affected, either. When you wear high heels and your weight is shifted forwards, your knees and quads have to work harder to help you support your balance, increasing the stress on the knees. Research shows that wearing high heels increased the forces across the knees and resulted in greater compression on the inside of the knee joint - an 23% increase in forces on average compared to walking with bare feet. Other studies have found that wearing heels may even increase your risk of knee osteoarthritis due to the way the increased compressive forces alter the way the knee moves, which can lead to joint degeneration over time.

While the evidence on high heels and back pain isn’t as clear-cut, several studies have shown that high heels may increase the curvature of the lower back, leading to increased stress on the lumbar spine and increased risk of lower back pain. Additionally, the use of high heels may also, in some cases, lead to reduced muscle activity in the erector spinae muscles, which are important for maintaining good posture and protecting the spine from injury. Finally, a 2019 study published in the Journal of Physical Therapy Science found that wearing high heels can lead to decreased balance and increased sway of the spine, which can contribute to back pain and problems.

The Verdict: High Heels Aren’t Recommended

Based on the evidence, we definitely stick with the notion that you shouldn’t be wearing high heels for long periods, like at work. With that said, we understand that some events call for high heels, so in these cases:

• Wear comfortable shoes before and after the event in the car, switching into high heels only when you have to. Try not to exceed 3-4 hours in high heels where possible.
  
• Take moments when sitting at a table to remove your high heels, stretch your feet and toes, and give them a rest with your feet in flat contact with the floor.
  
• When selecting heels, choose a lower heel with a wider base of support.
  
• Buy that gel or felt cushioning padding for your forefoot. It won’t change the pressure at the forefoot, but it may help your bones and joints absorb that pressure better.
  
• If your heels have a closed-in forefoot, ensure it has plenty of space and doesn’t cram your toes.
  
• If you start experiencing notable pain during your heel wear, don’t be afraid to take them off. If your pain persists, is present the following day, or you think injury has occurred, book in with your podiatrist.

References

• https://pubmed.ncbi.nlm.nih.gov/16110238/
•  https://www.sciencedirect.com/science/article/pii/S0169814101000385
• https://www.researchgate.net/figure/Effects-of-heel-height-on-erector-spinae-muscle-activity-at-the-initial-contact-of-the_fig2_220019618

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