High Heels: Impact on Feet, Ankles, Knees, Hips, and Spine

What are the side effects of wearing heels?

Wearing high heels significantly alters the body's natural biomechanics, shifting the center of gravity and placing undue stress on various musculoskeletal structures, leading to a cascade of potential issues from the feet up to the spine.

The Biomechanical Impact of Elevated Footwear

High heels fundamentally change the way the human body interacts with the ground. By elevating the heel and forcing the foot into an unnatural plantarflexed position, they redistribute weight, alter joint angles, and demand compensatory adaptations throughout the kinetic chain. Understanding these biomechanical shifts is crucial to appreciating the wide range of potential side effects.

Impact on the Feet

The most immediate effects of wearing heels are felt in the feet, which are forced into an unnatural and often compressed position.

• Increased Forefoot Pressure: The elevated heel shifts the majority of body weight onto the ball of the foot (metatarsal heads). This excessive pressure can lead to:
  • Metatarsalgia: Pain and inflammation in the ball of the foot.
  • Bunions (Hallux Valgus): A bony bump that forms on the joint at the base of the big toe, often exacerbated by narrow, pointed toe boxes.
  • Hammer Toes and Mallet Toes: Deformities where toes bend abnormally at the middle or end joints due to cramped space.
  • Corns and Calluses: Thickened areas of skin that develop in response to friction and pressure.
• Nerve Compression: The tight, often pointed toe box can compress nerves between the toes, leading to:
  • Morton's Neuroma: A painful condition affecting the nerve between the toes, most commonly between the third and fourth toes.
• Achilles Tendon Shortening: Chronic heel elevation keeps the calf muscles and Achilles tendon in a shortened position, which can lead to:
  • Achilles Tendinopathy: Pain and inflammation of the Achilles tendon.
  • Haglund's Deformity ("Pump Bump"): A bony enlargement on the back of the heel, often irritated by rigid heel counters.
• Plantar Fasciitis: While not a direct cause, altered gait mechanics and increased arch strain can contribute to the development or worsening of plantar fasciitis.

Impact on the Ankles and Lower Legs

The ankle joint and surrounding musculature are significantly affected by the altered foot position.

• Ankle Instability and Sprains: The elevated heel and narrow base of support compromise ankle stability, increasing the risk of lateral ankle sprains, especially on uneven surfaces.
• Calf Muscle Shortening and Tightness: The gastrocnemius and soleus muscles remain in a shortened state, leading to chronic tightness. This can restrict ankle dorsiflexion (the ability to pull the toes towards the shin), affecting natural walking patterns even when not wearing heels.
• Altered Gait Mechanics: Walking in heels forces shorter, more rigid strides. The natural ankle rocker motion is inhibited, reducing the propulsive force from the calf muscles and shifting workload to other areas.

Impact on the Knees

The knees absorb significant impact and compensate for the changes in ankle and foot mechanics.

• Increased Knee Joint Compression: Studies have shown that wearing high heels increases the compressive forces on the knee joint, particularly on the medial (inner) compartment.
• Altered Patellofemoral Mechanics: The change in gait can affect the tracking of the kneecap (patella) within its groove, potentially contributing to patellofemoral pain syndrome.
• Increased Osteoarthritis Risk: Over time, the chronic increase in joint stress and altered mechanics can accelerate cartilage degeneration, increasing the risk of knee osteoarthritis.

Impact on the Hips and Pelvis

The compensatory chain reaction extends upwards to the hips and pelvis.

• Anterior Pelvic Tilt: To maintain balance, the body often compensates by tilting the pelvis forward, increasing the natural curve of the lower back (lumbar lordosis).
• Hip Flexor Tightness: The anterior pelvic tilt can lead to chronic shortening and tightness of the hip flexor muscles.
• Gluteal Inhibition: The altered posture and mechanics can reduce the activation and effectiveness of the gluteal muscles, which are crucial for hip extension and stability.

Impact on the Spine and Posture

The cumulative effects on the lower body ripple up to the spine, impacting overall posture.

• Exaggerated Lumbar Lordosis: The most common spinal compensation is an increased inward curve of the lower back, placing excessive stress on the lumbar vertebrae and intervertebral discs.
• Thoracic Kyphosis and Forward Head Posture: To counterbalance the exaggerated lumbar curve and maintain upright posture, the upper back may round (thoracic kyphosis), and the head may jut forward, increasing strain on the neck muscles and cervical spine.
• Muscle Imbalances: Chronic heel wear contributes to a pattern of muscle imbalances, with tightness in the lower back extensors and hip flexors, and weakness in the core stabilizers and gluteals.
• Chronic Back Pain: The altered spinal alignment and muscle imbalances are significant contributors to chronic lower back pain, neck pain, and headaches.

Systemic Effects and Other Considerations

Beyond the direct musculoskeletal impacts, wearing heels can have broader implications for health and well-being.

• Impaired Balance and Increased Fall Risk: The elevated and unstable platform of high heels significantly reduces proprioception (the body's sense of position in space) and narrows the base of support, increasing the risk of falls and related injuries.
• Circulatory Issues: Tight shoes can restrict blood flow in the feet and lower legs, potentially contributing to swelling and discomfort.
• Increased Fatigue: The constant effort required to maintain balance and compensate for altered mechanics can lead to greater muscle fatigue in the legs and back.

Mitigation Strategies

While the side effects are significant, minimizing their impact is possible:

• Limit Wear Time: Reserve high heels for special occasions and avoid wearing them for extended periods.
• Choose Lower, Wider Heels: Opt for heels under 2 inches (5 cm) with a wider base of support to reduce pressure and improve stability.
• Prioritize Comfort and Fit: Ensure shoes fit well, with adequate toe room and cushioning.
• Stretch and Strengthen: Regularly stretch calf muscles, hip flexors, and perform exercises to strengthen foot intrinsic muscles, glutes, and core.
• Vary Footwear: Alternate between different types of shoes, including flats and athletic footwear, to allow the feet and body to return to a more natural alignment.

Conclusion

While high heels are a fashion staple for many, it's critical to understand their profound and often detrimental effects on the body's intricate biomechanical system. From foot deformities and ankle instability to knee pain and chronic spinal issues, the cumulative stress can lead to significant discomfort and long-term health problems. By making informed footwear choices and incorporating compensatory stretches and strengthening exercises, individuals can mitigate some of these risks and prioritize long-term musculoskeletal health.