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Health & Exercise Forum

High Heels Look Like Heaven But Feel Like Hell!

Jun 28, 2010

Dr. Mackarey's Health & Exercise ForumLouis XIV, King of France, donned high heels in the late 16th century as did many men and women in aristocracy as a status symbol. But, these high status shoes were never meant to be comfortable to walk in because only the peasants walked. The wealthy took carriages. I am afraid not much has changed in shoe design and comfort in the last 400 years because high heels continue to be uncomfortable. Today, women have suffered great physical pain to continue this fashion trend popularized by every Playboy model and Miss America swimsuit contestant. High Heels – Look Like Heaven But Feel Like Hell! Recent research supports the fact that these fashion stilts are unhealthy. To the makers of Ferragamos, Maglis, and Louboutins, mea culpa!

The fact that I am vertically challenged has in no way influenced my opinion about the material presented in this column. In fact, whether my wife wears high heels or flats, she still must duck to avoid decapitation when we swing dance.

It turns out that several studies clearly demonstrate that the higher the height of the heel, the more likely one will develop osteoarthritis in the knee and stress on the lower back, among other health problems. Researchers at Harvard University studied women wearing heels 2.7 inches high. Two groups, both wearing 2.7 inch high heels, were studied to determine if heel width would influence joint stress. One group wore heels ½ inch wide and another wore heels 1.75 inches wide. Both groups displayed significant torque stresses on the joints of the lower body, specifically the knee and lower back. Furthermore, a 3 inch heel height was determined to place 7 times the force on the joints than a 1 inch heel. Researchers concluded that low-heeled shoes or no-heeled shoes (less than 1.5 inches) were the best choice to prevent health problems such as osteoarthritis of the knee and lower back. Moreover, flat shoes were not found to be ideal. The ideal shoe has a low heel (½ to ¾ inches) to distribute forces equally from the back to the front of the foot and knee. Also, it was concluded that a square-toed shoe with a roomy toe box can also prevent many foot and toe deformities and problems.

Health Problems Related to High Heels

Lower Back Pain

High heels shift the center of gravity forward and force the lower back to sway backwards to overcompensate. The shoe is the only contact between your foot (and the entire body) and the ground. Therefore, if the point of contact (foundation) is shifted off center or is unstable, then the entire body will compensate in its struggle for stability. An excessive sway back will cause torque and shifting of the vertebrae, unevenly compress and wear down the discs of the spine, and lead to degeneration and arthritis.

Hip and Knee Pain

As found in the Harvard study, high heels lead to changes in gait patterns that cause excessive torque in the joints of the lower extremity, such as the hip and knee. This torque over time leads to wear and tear and arthritis.

Blisters, Corns or Calluses

When you where heels and your weight is shifted to the balls of your feet, excessive force and friction can cause blisters, corns and calluses.


The shift of weight forward when wearing heels can also inflame the nerves in the ball of your foot or toes and cause a neuritis called metatarsalgia or neuroma. Symptoms include sharp pain, tingling, or numbness.

Balance Problems/Ankle Sprains

High heels create andunstable platform for gait and can lead to poor balance. Moreover, this instability, worsened by a narrow or spiked high-heel, can lead to rolling the ankle and spraining the ankle.

Adaptive Achilles Shortening/Tendonitis

Walking in high heels puts the calf muscle and its achillies tendon in a shortened position. Over time, this can lead to a permanent shortenening of the tendon that makes walking in bare feet or flat shoes uncomfortable.

Pump Bump/Hammertoe/Big Toe Drift

Pump bump is also called “Hagland’s Deformity,” and is associated with wearing high heels that cause excessive pressure on the back of the heel bone which creates a bump on the bone. Hammertoe, a deformity that causes the toes to look like a hammer, is caused by a narrow, pointed shoe that forces the toes to curl. A narrow shoe can also cause a drift deformity of the big toe, also called “Hallux Valgus.” Both deformities are associated with arthritic changes and pain in the joints over time.

Tips for Healthy High Heel Use

  • Change it up! Alternate flats and heels in your daily wardrobe. Make sure you have a variety of heels to choose from. A ½ to ¾ inch heel is ideal.
  • Heels for Heaven! Save the heels for special occasions when you want to look heavenly. Bring a pair of comfortable shoes to change into once the photo session is finished.
  • Flats for Function! Wear flats when you will be walking any significant distance and change into dress shoes later.
  • Small Steps! Take smaller steps when you wear heels to limit joint instability.
  • Strap the Back! Buy heels that have a strap or back to give more stability to your foot and leg when walking.
  • Stay Limber! Make time to stretch you calf muscle and Achilles tendon every day, especially after wearing heels.
  • Keep Fit! Exercise and diet for weight control will lessen the negative impact of wearing heels.

**SOURCE: Lower Extremity Review,

Read “Health & Exercise Forum” – Every Monday.  This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliate faculty member at the University of  Scranton, PT Dept.