On Wearing High Heels: Advice from a Physical Therapist Who Loves Cute Shoes

“I need to get back to wearing my heels.”

I frequently hear this from my female patients recovering from an ankle injury. High heels not only make us taller, but they can also make us feel more sophisticated and complete that professional look. However, when it comes to our health, wearing these beautiful shoes can come with a price. 

Health Effects of Wearing High Heels

Posture changes: High heels cause of center of gravity to shift due to the smaller heel. They also cause us to stand more on our toes.  These changes result in us changing our posture in order to decrease our risk of falling. When we wear heels we stand with increased lordosis or “butt out” position, which leads to increased curves in the spine, rotation of our hips, and bending of our knees. The pressure on our feet shifts to the ball of the foot as well as the outside of the foot which can lead to more ankle sprains (2).

Musculoskeletal changes: Walking or standing in heels on a regular basis for prolonged periods of time can lead to your Achilles tendon becoming tight. The calf muscle also tightens, which leads to decreased range of motion in the ankle, especially with lifting your toes upwards. These changes in anatomy can cause problems such as plantar fasciitis, bunions, ankle sprains, chronic low back pain, knee arthritis, and pain around the knee cap (4).  Wearing heels frequently for a few years can actually strengthen your ankle, but around four years a muscular imbalance begins to occur which can lead to ankle injuries. The balance between the strength of pushing up (dorsiflexion) and pushing down (plantarflexion) as well as pushing inwards (inversion) and outwards (eversion) changes and performing strengthening/stretching exercises as well as limiting the frequency of heel wearing is important to decrease injuries (3).

Balance changes: Since standing in heels shifts your weight to the ball of your foot there can be changes in your muscle fibers which help you stay balanced; this can lead to an increased likelihood for slipping or falling (4). Standing in heels causes the calf muscle, and particulary the middle portion of this muscle, to work harder. This overuse of the calf can lead to increased muscle fatigue and decreased efficiency of that muscle increasing the likelihood for a fall (1).

Tips for Healthy Wearing of High Heels

So how can you wear heels and still keep good foot health? The best way to address this is to break down a typical day.

Commuting: Commute while wearing flats or sneakers. Sneakers are your best bet as they give the best support.

At work: Opting for a lower heel 1-2 inches throughout the day, picking a pair of wedges, or wearing your taller heels for just part of the day can go a long ways towards better foot and body health (4). 

Happy hour: Wear your commuter flats to the event and switch back into your heels when you arrive at the event. Afterwards switch back into your commuter flats especially walking on the cobblestone and brick sidewalks which can increase the risk of falling or twisting your ankle.

Exercises for Foot Health

In addition to these lifestyle tweaks there are also a few simple exercises you can do to preserve your foot health after a long day in heels:

Stand with one leg in back, one in front. Lean against a wall and bend front knee. Keep back knee straight, foot pointed forwards and ankle on the floor. Do this three times for 30 seconds.

Stand with one leg in back and one in front.  Bend both knees slightly and lean against a wall. Make sure to keep the back knee bent and the ankle on the floor. Do this three time for 30 seconds.

While standing or sitting, pull your toes back towards your heel to form a dome with your foot. Make sure your heel and toes stay on the floor.

Tie the band to the leg of a table or sturdy chair and pull your foot up towards you. Do not let your knee bend.

Cross your opposite leg over top of the leg with the band. Wrap the band around the top foot and rotate your bottom foot inwards. Only let your ankle move, not your whole leg.

With both legs parallel to each other, wrap the band around the outside of the opposite foot. Pull the foot with the band outwards moving only with your ankle and not letting your whole leg move.

Resources

1. Cronin, Neil J., Rod S. Barrett, and Christopher P. Carty. "Long-term Use of High-heeled Shoes Alters the Neuromechanics of Human Walking." J Appl Physiol 112 (2012): 1054-058. Print.
2. Xiong, Shuping, and Vaniessa D Hapsari. “Effects of Heel Height and Wearing Experience on Human Standing Balance.” Journal of Foot and Ankle Research 7.Suppl 1 (2014): A97. PMC. Web. 1 Aug. 2016.
3. Kim, M.-H., Choi, Y.-T., Jee, Y.-S., Eun, D., Ko, I.-G., Kim, S.-E., Yi, E.-S. and Yoo, J. (2015), Reducing the frequency of wearing high-heeled shoes and increasing ankle strength can prevent ankle injury in women. Int J Clin Pract, 69: 909–910. doi:10.1111/ijcp.12684
4. Ko, Dong Yeol, and Han Suk Lee. “The Changes of COP and Foot Pressure after One Hour’s Walking Wearing High-Heeled and Flat Shoes.” Journal of Physical Therapy Science 25.10 (2013): 1309–1312. PMC. Web. 1 Aug. 2016.

Cristin McGetrick is a physical therapist at Washington Orthopedics and Sports Medicine. She received a Doctor of Physical Therapy degree from George Washington University in 2012 and she enjoys running, triathlons, and a great pair of heels.