PT Tip of the Month Archive


Many individuals, particularly women, tend to sacrifice foot comfort for fashion. But, studies have shown that towering shoes can be costly in more ways than one, taking their toll on your feet, ankles, knees, hips, and spine due to alterations of your posture and gait. Additionally, a study published by the American Orthopaedic Foot and Ankle Society found that a staggering 88% of women squeeze into shoes that are too small. Whether this is to maintain a look or because they are the last pair available in store, these shoes can result in long term negative effects to your body.

High Heels

Our feet are our base of support and act as the foundation to the remainder of our body. When wearing heels, the height alters how your weight is distributed through your feet and changes your posture.


When the heel height increases, more pressure is placed on the forefoot, or the balls of your feet. In a 1 inch heel, there is a 22% increase of weight on your forefoot. In 2 inch heels this rises to a 57% weight increase, and in a 3 inch heel the pressure increases to 76%. This increased weight, particularly in an ill-fitting shoe can result in a number of foot deformities. A narrow shoe can result in a bony growth on the side of the big toe, which causes the toe to angle inward. This is known as a bunion. With the addition of a bunion, the front of the shoe can become even more narrow. This positions the middle joint of the toes in a bent position, known as hammer toes. With prolonged time these muscles can shorten causing a permanent bend in the toes.


As the height of the heel increases, and the base of support becomes smaller, the wearer is at a greater risk of trip and falls. This can cause severe ankle sprains or even fractures. The American Orthopaedic Foot and Ankle Society also published a study that found wearing heels daily for a little as three hours can result in a shortening of the achilles tendon and calf muscles.


The altered positioning of high heels on the knee increases pressure on the inside of the knee joint, an area that is already highly susceptible to osteoarthritis. This pressure can increase by about 26%, causing increased risk of joint wear and tear.

Lower Back/Hips

High heels push our center of gravity forward to the front of our foot, causing other joints to adjust and maintain balance. This results in the hips being pushed forward, rolling the pelvis up to 10 to 15 degrees forward, and therefore hyperextending the lower back. This misalignment can lead to lumbar spondylolisthesis, or the slipping of one vertebrae forward over another. With time, the space in which the nerves travel out of the spinal cord can narrow causing shooting pain in the legs, numbness, tingling, or even weakness in the legs.

High Heel Solutions

If you still intend to wear heels, there are some recommendations that will help to avoid the negative effects of heels:

  • Avoid wearing high heels for long periods of time
  • Try to avoid heels with more than a 2 inch lift or with a pointed toe
  • If shoes are uncomfortable when trying them on, they are not a good fit. Shoes are not meant to be "broken in" first.
  • Try on and purchase shoes in the afternoon or evening as gravities and fluid cause the feet to swell. There should be about half an inch of space between your longest toe and the front of the shoe.
  • Purchase shoes with a leather insole to prevent the foot from sliding forward and cramping the toes into the front of the shoe
  • Stretch leg muscles, particularly the calves, before and after wearing heels

In short, being kind to your feet can prevent a variety of preventable orthopedic conditions from occurring. If you feel that you have signs or symptoms of a condition related to ill fitted footwear, and you would like to schedule an evaluation, call 617-232-PAIN for our Brookline office, and 617-325-PAIN for our West Roxbury office.


  1. Coughlin MJ. The high cost of fashionable footwear. J Musculoskel Med. 1994;11:40-53.
  2. Opila KA, Wagner SS, Schiowitz S, Chen J. Postural alignment in barefoot and high-heeled stance. Spine. 1988 May;13(5):542-7.
  3. Esenyel M, Walsh K, Walden JG, Gitter A. Kinetics of high-heeled gait. J Am Podiatr Med Assoc. 2003 Jan-Feb;93(1):27-32.
  4. The Real Harm in Heels. American Orthopaedic Society.
  5. University of Texas Science Center. Hazards of Heels.
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