Are High Heels Bad for Me?

By William Olsen, DPM

Question:

Lately it seems like all the shoes I see in the stores have high heels. Frankly, I like the way they look, but aren't they bad for my feet?

Answer:

May 22, 2000 -- Yes, they are. Of course, that doesn't stop the high-heel frenzy. As long as heels have been available, they've been a fixture in women's fashion, clogging closets around the world and causing women to teeter as they go searching for taxis. In fact, more than 55% of women wear high-heeled shoes at some time every day. But the prevalence of high heels doesn't mean they can't hurt you. They can wreak havoc on your entire body -- not just your feet.

According to the American Orthopaedic Foot and Ankle Society, people take an average of 10,000 steps a day. High heels shift the force of each of those steps so that the most pressure ends up on the ball of the foot and on the bones at the base of the toes. (If you wear flats, the entire foot would absorb this impact.) A 3-inch heel -- most experts consider a heel "high" at 2 inches or more -- creates three to six times more stress on the front of the foot than a shoe with a modest one-inch heel.

As a result, heels can lead to bunions, heel pain, toe deformities, shortened Achilles tendons, and trapped nerves. In fact, women account for about 90% of the nearly 800,000 operations each year for bunions, hammertoes (a permanent deformity of the toe joint in which the toe bends up slightly and then curls downward, resting on its tip), and trapped nerves, and most of these surgeries can be linked back to their high-heeled shoe choice.

The problems can travel upward, too. The ankle, knee, and hip joints can all suffer from your footwear preferences. When you walk in flats, the muscles of the leg and thigh have an opportunity to contract as well as to stretch out. However, when wearing your high-heeled shoes, the foot is held in a downward position as you walk. This keeps the knee, hip, and low back in a somewhat flexed position, which prevents the muscles that cross the backside of these joints to stretch out as they normally would. Over time, this can lead to stiffness, pain, and injury. High heels can also cause lower back strain, because the heel causes your body to pitch forward more than normal, putting excess pressure on the back.

My advice for women who simply can't give up their high heels: Try not to wear them every day and opt for the lower ones, if you can. (While 2-inch heels are somewhat safer than the 3-inch variety, the increased pressure on the front of the foot is still significant -- two to three times that of flats.) Alternate days in those spiky stilettos with days in flats or low-heeled pumps. When you're shopping for shoes, avoid ones that pinch and crowd the toes into a little triangle.

Even the trendy platform shoe, which has a uniformly raised height all over, may be a better choice. Unlike a standard high heel, the platform doesn't force the foot and toes to bend as much as high heels do and may offer more wiggle room in the toe area. Just watch your step: Both platforms and high heels can make for an embarrassing, if not painful, spill.

William Olson, DPM, is on the clinical staff at the Center for Sports Medicine at Saint Francis Hospital in San Francisco, is president of the American Academy of Podiatric Sports Medicine, and is the team podiatrist for the University of California at Berkeley athletic department.

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