High Heels and Foot Health

There is no denying that high heels are attractive, not only to look at but for the instant effect they have on improving appearance. They offer women an instant confidence boost by increasing the height, improve the line of the legs, the shape of the buttocks and help to push out the chest and arch the back.
Men find them sexy, women love the effect that a pair of spikes has on their posture and few other types of shoes can give such an instant confidence boost. However, if you wear high heels regularly you need to spare a thought for your feet and lower body health. High heels may look good, but as far as foot health goes they can be a recipe for disaster.
Wearing high heels too often can lead to a wide range of foot health problems developing. High heels are a leading cause of big toe and tailor’s bunions, foot arch problems, hammertoes, corns, calluses and much more. The burning heels and painful sore feet you experience after a night in spikes should be enough of a warning sign that all is not right with your favorite shoes. The problem is that these temporary painful foot episodes can just be the start and more serious problems can develop from extensive use. Fortunately however, good foot health does not mean never wearing high heels, and even 5-inch stilettos are not going to cause lasting damage if worn for short periods of time.

Why High Heels Are Bad for the Feet

Walking in high heels is unnatural. The musculature in the feet and lower body is forced to work outside its comfort zone when the feet are positioned in a fixed plantar-flexed position. When the heel is raised, many of the positive benefits which women seek from the shoes has a detrimental effect on the hips, knees, lower and upper back. The muscles in these parts of the body have to work harder. The knees are required to take a great deal more strain when the foot is plantar-flexed. Walking also places an increased strain on the hip flexor muscles as well as the lower back.
While the body can cope with these inconveniences and most women are happy to put up with some discomfort for the positives which high heels provide, over time these postural changes can have a detrimental effect on the body and high heels have been implemented in the development of osteoarthritis in the knees.

Tailors Bunions and Hallux Valgus

Although high heels have not been proven to be a direct cause of tailor’s bunions, they are certainly bad news if you already have a tailors bunion. They can cause a tailor’s bunions to become more problematic and bunions of the great toe (hallux valgus) are aggravated by wearing high heeled shoes. Many studies have been performed on footwear choice and foot health and evidence suggests a strong relationship between high heels and the development of foot problems such as bunions.
The American Academy of Orthopedic Surgeons (AAOS) claims that high heels are a major causative factor in the formation of bunions and tailors bunions. It is not always the heels which are the problem, but the fact that high heeled shoes are often combined with a narrow and highly restrictive toe box. When the toes are pushed out of position and are subjected to extra pressure bunions are more likely to develop.

Sesamoiditis and Metatarsalgia

The good news is that if you want to keep your feet and lower body in good health, you do not have to totally avoid shoes with a heel. A heel of up to 1.5 inches is unlikely to cause you major foot problems, even if worn on a daily basis. However any increase in heel height greater than this has potential to cause problems. A study conducted on the pressure increase in the forefoot when wearing heels indicated that just a 1 ¾ inch heel increased the pressure on the forefoot by 50 percent. As the heel increases in height, the pressure similarly increases.
A pressure increase in the balls of the feet can result in two painful ball of foot conditions developing; metatarsalgia and sesamoiditis. Metatarsalgia is inflammation in the balls of the feet, with sesamoiditis involving inflammation of the two small sesamoid bones at the base of the big toe. Both of these conditions are overuse injuries, with a strong link with excessive wearing of high heeled shoes. There is no need to throw away your high heeled shoe collection, just as long as you wear the shoes in moderation. If you have 4 or 5-inch heels, you really need to restrict their use considerably and alternate between low heels and flat shoes.

Tightening of the Achilles Tendon and Plantar Fasciitis

Prolonged use of high heeled shoes can lead to tightening of the Achilles tendon, which in turn can result in the development of Achilles tendinopathy; damage or inflammation of the Achilles tendon in the calves. A tight Achilles tendon also places a greater strain on the plantar fascia in the sole of the foot, which increases the risk of developing the highly painful condition of plantar fasciitis. Excessive wearing of high heels can cause tightening of the Achilles tendon to such a degree that it may not be possible to walk barefoot comfortably.

Tips for Choosing Healthier High Heeled Shoes and Pumps

The American Podiatric Medical Association recommends choosing high heeled shoes which only start to narrow in the toe box after the first joint of the metatarsals. Women should also opt a more rounded toe box which doesn’t require the toes to be forced out of position. A wide heel is recommended rather than thin spikes so as not to affect balance. A slip in heels can easily cause an inversion sprain or broken bone.
Look at the inside of a pair of high heeled shoes before you buy them and check to see how much the shoe pitches forward from heel to toe. Not all 4-inch heels mean that the foot is placed in an extreme plantar-flexed position. The more gentle the slope from heel to toe, the better it will be for your feet.
Avoid buying high heels over the internet, or at least be prepared to return them if they do not fit perfectly. You should really have a proper fitting to make sure that the shoes fit snugly, as if the feet slide forward and there is a gap at the back between the shoes and the heel, this means more pressure will be exerted on the toes. The chance of developing a toe deformity such a tailor’s bunion or hammertoe will be much higher.
Open toe high heels are much less likely to cause corns and callused skin and result in less pressure being placed on the toe joints. Make sure that the shoes are secure and your foot is held firmly in place because any rubbing will increase the chance of hard and unsightly skin forming.
Finally, remember that high heels are for occasional wear and restrict the time you spend in your heels if you want to make sure that your feet will remain in full working order in later years. Also alternate your heels with flats and you are more likely to be able to keep foot problems at bay.


The High Price of High-Fashion Footwear- F.M. Thompson; M.J. Coughlin; J. Bone and Joint Surgery; V76-A, 10, (1994)
Effect of heel height on forefoot loading; J.P Corrigan; I.P. Moore; M.M. Stephens; Foot and Ankle International 14 (1993)