Heels are not Always Good for the Sole

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As physio's we often see a link between high heels and pain, but so many people are attached to their heels and these fashion items have been worn for many centuries. Did you know that men used to wear high heels? According to historians, way before the famous high heel was part of the female wardrobe, they were used by soldiers in the 16th century to give them stability in stirrups while riding on a horse so they could shoot their bows while standing up.

High heeled shoes have evolved over the centuries with Christian Dior making them popular after World War II and today they are a part of most women’s wardrobe. But apart from being a fashion statement, what do heels do for you?

The HIGH behind the high heels

A recent study by Morris and colleagues studied female gait patterns in flat and high heeled shoes. They found when females wore heels, their perception of attractiveness was increased. They started to walk in a more feminine way with greater pelvic rotation and increased lateral pelvic tilt. Smith in 1999 reported that wearing high heels indicated status for women. No wonder researchers also found that the number of pairs of high heeled shoes owned by study participants was a minimum of 4 and maximum of 25. These may be the good reasons to own a few pairs! How many pairs of heels do you own?

The DOWNSIDE of wearing high heels

Wearing this type of footwear does have its ups, however long term they do take a toll on the body. Several studies have shown that long term high heel use impacts on the whole lower body, from the lower back all the way down to the feet.

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High heels and lower back pain


Researchers  have reported that in a survey they conducted with 200 females who had been wearing high heels regularly for 1 year, 58% of them were complaining of low back pain (Lee et al 2001). This is not surprising considering standing and walking in heels has been shown to result in changes in the curvature of the lower back and increased levels of activity in the back muscles, both potentially amplifying loads on the joints of the lower back and fatigue in the back muscles.

High heels and hips


When wearing heels, weight is transferred forward towards the forefeet. This forward shift of the bodyweight at the feet means that the trunk and head need to shift relatively backwards to balance the body weight. This changes where the weight is transmitted through the hip and potentially places larger loads particularly through the front of the hip. The increased in rotation and tilting of the pelvis that occur while walking in heels can also place adverse loads across the hips joints and tendons. Even when sitting, high heels push the knees up higher than normal which can result in higher compressive loads across the hip joint. All of these factors may explain why wearing high heels often aggravates hip pain.

High heels and knees


The knee joint is also affected with increased compressive forces around the patellofemoral joint (kneecap) (Kerrigan et al 1998) and the inner compartment of the knee joint with forces increased by 23% (Kerrigan et al 1998, Stephanyshyn et al. 2000, Simonsen et al 2012). Landing on those heels while walking also means your quadriceps have to work harder as the foot tends to accelerate more quickly to its impact with the ground (Stefanyshyn et al 2000). Too much activity of your quadriceps can contribute to the higher compressive forces around the knee. Some researchers suggest that the wearing of high heels may make females more vulnerable to developing knee osteoarthritis (Kerrigan et al 1998, Simonsen et al 2012).

High heels, calves and ankles


The forward shift in bodyweight can lead to unstable postures (Lee et al 2001) and an increased rate of falls and ankle sprains. In the lower leg, calf muscles shorten while the Achilles tendon, the tendon at the back of the heel, stiffens up resulting in decreased active range of motion of the ankle (Csapo et al 2010). This can explain why regular heel users have discomfort when walking in flats.

High heels and forefoot pain


The biggest impact however occurs at the forefoot. Wearing high heels creates a doubling of pressure under the balls of the feet compared to walking barefoot (McBride et all 1991, Speknijder et al 2005). Bunions and callouses under the feet have also been associated with wearing narrow and shorter shoes (Menz 2005).

Physiotherapy Recommendations

From a health perspective, high heels are not the greatest footwear. As physiotherapists, we commonly see lower back, hip, knee and foot problems aggravated with the use of heels.

Our recommendations:

  1. Avoid or minimise use of high heels
  2. Save those heels for special occasions rather than wearing them on a daily basis
  3. Don’t walk to/from work in heels – change into sports/walking shoes
  4. Keep the heels to < 2 cm heel height (Ko et al 2009)
  5. When sitting, if you can slip those heels off and place your feet flat on the ground, do so.
  6. Take some ballet flats with you when going out so you can easily slip them on to dance

So, here’s your excuse to go out and buy some new shoes ladies!

Do your body a favour and choose the flats or the lower heels.


Do you experience pain when wearing heels? Our physiotherapists can assist you with your pain and get your standing more comfortably again.

Under the supervision of one of our experienced dance physios, you will be professionally guided along the way, in a safe and effective manner, with a program specifically design for you.



Csapo et al (2010)On Muscle Tendon and High Heels. Journal of Experimental Biology, 213,2582-2588

Kerrigan, Todd, O Riley (1998)Knee Osteoarthritis and high-heeled Shoes. Lancet, 351:1399-1401

Ko et al (2009) Relationship Between Plantar Pressure and Soft Tissue Strain Under Metatarsal Heads with Different Heel Heights . Foot and Ankle International , 3,11

Lee, Jeong,Freivalds (2001) Biomechanical Effects of wearing High Heeled Shoes. International Journal of Industrial Ergonomics, 28,321-326

McBride et al (1991) First Metatarsophalangeal Joint Reaction Forces during High- Heel Gait. Foot and Ankle International

Menz, Morris (2005) Foot Characteristics and Foot Problems in Older People. Gerontology, 51(5): 346-351

Simonsen et al (2012)Walking on High Heels Changes Muscle Activity and the Dynamics of Human Walking Significantly. Journal of Applied Biomechanics,28,20-28

Smith (1999) High Heels and Evolution. Psychology, Evolution and Gender ,1.3,245-277

Speksnijder et al (2005) The Higher the heel, the igher the forefoot –pressure in ten healthy women. The Foot,15, 17-21

Stefanyshyn et al( 2000)The Influence of High Heeled Shoes on Kinematics, Kinetics and Muscle EMG of Normal Female Gait. Journal of Applied Biomechanics, 16, 309-319

Thompson, Coughlin (1994) The High Price of High- Fashion Footwear, The Journal of Bone and Joint Surgery 76A,1586-1593

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