by Jennifer Mohns, DPT
“Your legs look so sleek”… “Your heels are so cute”… “You’re calves look amazing.” These are a few of the many things us women love to hear when we wear high heels, BUT to what price should we put beauty above health? Most women do not realize the detrimental effects that high heels can have on the human body. High heels can cause various foot injuries but can also create many problems up the chain of the body including the knees, hips, and back/pelvis. Few women are born with foot pathologies, most women instead acquire them due to neglect for their foot health.
As a physical therapist, I see many foot, knee, hip, and low back injuries as a result of women wearing high heels. I also have quite a few patients who are hell-bent on wearing their cute new pair of pumps even while trying to recover from a lower body injury. I would like to break it down for you, as I do for my female patients: posture, gait, balance, and each body part affected by these poisonous pumps.
A high heel puts your foot in a plantarflexed positioned (toes pointing downward). This position shifts your legs and pelvis forward and places most of your body weight on the balls of your toes. In order to counteract this shift, your upper body leans backward to keep you balanced. This posture puts a lot of unhealthy pressure on your low back and sacroiliac joint, which is explained in greater detail below.
As your posture changes in heel highs, so does your walking pattern. Due to the plantarflexed position of your feet, your calf muscles cannot generate the force needed to push off the ground. Therefore, your hip and knee muscles must worker harder in order to propel you forward. Your knees tend to stay bent during the entire gait cycle due to the increased weight shifted forward at your lower body.
Walking in a high heel requires a significant amount of balance and lower leg strength. The higher the heel, the further your body weight is pushed forward, and the more instability created. There is also minimal support at the ankle joint if you take a wrong step or walk on an uneven surface.
Low back pain is a common injury caused by and exacerbated by wearing high heels. High heels increase the normal forward curve of the back and cause the pelvis to tip forward. This change in pelvic position alters the alignment of the spine and makes it difficult for the body to maintain its normal center of gravity. However, this position is generally desired by women because the exaggerated curve of the back makes the buttocks more prominent.
The hips, knees, and ankles are also affected by wearing high heels. As mentioned above, the hip flexors and knee muscles must work harder to propel the body forward. Over time these muscles can become fatigued and overused, and subsequently weak and prone to injury. When the thigh muscles are overworked, extra strain is put on the knee joint and the patellar tendon, making you more susceptible to knee injury. Adding a heel to a shoe increases the pressure on the inside of the knee by as much as 30 percent. By increasing the height of the heel of a shoe, the hamstring muscles become shortened and cannot work optimally.
There is a large variety of foot injuries that can arise from wearing high heels, including hammer toes, blisters, bunions, neuromas, and skin breakdown leading to infection. The plantarflexed position in the heel causes the foot to become more supinated, or turned to the outside. This causes a change in foot posture and biomechanics of the foot and ankle joints during gait. This then effects the line of pull and function of the achilles tendon, which works to push the foot off of the ground.
I could go on forever about the detrimental effects of wearing high heels. Each and every person is different, and therefore has different postural deficits. A physical therapist can help you to determine your strengths and weaknesses and then adjust your posture and activity accordingly. It is important to remember that postural awareness and supportive comfortable shoes are key to injury prevention and recovery. As cute as those new hot pink pumps are…is it worth chronic low back pain or having to sit out your next marathon?
Dr. Mohns is a Physical Therapist at Boston Sports Medicine