Wearing high heels may be fashionable and make you feel taller and sexier, but at what price? High-heeled shoes can cause a plethora of foot problems while impairing stability and increasing the risk of injury. Leg, back, and foot pain are among some of the more common complaints. Long-term use can even cause structural changes in the foot itself, leading to bunions, hammertoe, and other conditions that may require surgical correction.1
In addition to injury, high heels place excessive stress on the back and lower extremities that can profoundly affect posture, gait, and balance.2
A high heel places your foot in a plantarflexed (downward extended) position, thereby increasing the pressure on the forefoot. This forces you to adjust the rest of your body to compensate for the shift in balance.
As the lower body leans forward to maintain a center of balance, the upper body must lean back as a counterweight. As a result, the alignment of your body is thrown off, creating a stiff, unnatural posture rather than a relaxed, neutral one.
The effect on your posture is amplified the higher the heels get. Even among experienced wearers, extra-high stilettos will force the body to lower the center of gravity at the hips, causing an unnatural curvature in the lower back.
Normal strides involve the rolling of the foot from the heel to the ball, pushing off with the toes. When walking in high heels, the plantarflexed position of the foot prevents you from pushing off the ground efficiently.
This unnatural change in foot position causes the hip flexor muscles to work harder to propel the body forward. Your knees will also need to stay more flexed, causing your knee muscles to work harder than normal.
Again, the higher your heels are, the worse this gets. If wearing extra-high stilettos, women will often have a lumbered, giraffe-like gait, particularly if their backs, knees, and calves don't the strength to compensate for the imbalance.
Walking in high heel shoes can be like walking on a balance beam. It takes a lot of balance and precision to navigate differing surfaces, elevations, and inclines. If moving quickly, you would need to place even greater weight on the balls of your feet to keep steady. By essentially walking on your tiptoes, you risk damage to the underlying bones and connective tissues.3
Stilettos are especially challenging since the stick-like heels give you little support or stability. They inherently force your foot and ankle into supinated (outward splaying) position, increasing the risk of falls and twisted ankles.4
According to research from the University of Alabama, no less 123,355 high-heel-related injuries were treated in emergency rooms in the United States from 2002 to 2012, primarily sprains and strains of the foot or ankle.
The normal C-curve shape of the back is meant to act as a shock absorber, reducing the weight-bearing stress on the vertebrae and pelvis. High heels cause the lumbar spine of the low back to flatten while forcing the thoracic spine of the mid-back into a hyper-curved position.
To compensate for this (particularly if you've worn your heels all day and are getting tired), you will need to lean forward to release some of the pressure on your back. Poor alignment will invariably lead to the overuse of the back muscles and increase the risk of chronic back pain.5
The hip flexor muscles are located on the upper front of your thighs. Wearing heels forces them into a persistent flexed position. While you may thinking of this as "exercising" your hip flexors and associated calf muscles, the chronic use of these muscles can cause them to shorten and contract.
Contraction of the hip flexors can lead to the progressive flattening of the lumbar spine and the development of both low back and hip pain.5
Knee osteoarthritis ("wear-and-tear arthritis") is much more common in women than men.6 Much of that blame can be placed squarely on the use of high heels. High heels increase the distance from the floor to the knee, causing excessive knee torque (force of rotation) and compression.
In high heels, the persistent flexed position of the knee will cause the tibia (shin bone) to turn inward, in part for balance. This altered position causes the compression of the medial (inner) knee, a common site of osteoarthritis.
If you already have osteoarthritis, you would be best served to avoid wearing high heels or risk the acceleration of joint damage and malformation.
High heels limit the motion and power of the ankle joint. When wearing high heels, the calf muscles (gastrocnemius and soleus muscles) are shortened dues to the excessive height, causing them to lose power when trying to propel the foot forward.
The altered position of the ankle can also cause the contraction of the Achilles tendon where it attaches to the heel bone (calcaneus). Over time, a common consequence of this is an inflammatory condition known as insertional Achilles tendonitis.7
When the foot is placed in a downward position, significant pressure will be exerted on the plantar (bottom) portion of the forefoot. The pressure will increase in tandem with the height of the heel.
The increased pressure can also cause pain or foot deformities such as bunions and neuromas. The supination of the foot can also alter the alignment of the Achilles tendon and lead to a condition known as Haglund's deformity (a bony enlargement of the heel).8
High heels will also cause the tendons and ligaments that support the arch to tighten. This can lead to pain in the arch of the foot, a condition called plantar fasciitis.9
By wearing high heels, your toes will be forced into the toe box of the shoe by the sheer force of gravity. If the toe box in narrow, your toes will be pressed together, causing the inner and outer toes into an abnormal fixed position, known as hammertoe. Even the toe box is wider, the pressure against the toes and skin can lead to unsightly corns, calluses, and blisters.9
A Word From Verywell
So long as high heels remain a fashion statement, it is unlikely we'll see women tossing out their Christian Louboutins or Jimmy Choos anytime soon. As such, you need to take measures to mitigate the damage if you choose to strap on a pair of heels.
How to Wear Heels Safely
Reserve high heels for special occasions.
If you want to wear heels to work, carry them in your bag and put them once you arrive.
During the day, take them off occasionally to stretch and relax.
At all other times, wear flats with insole supports or heels no higher than 1½ inches.