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Helpful Rehab Hints

Tottering on Heels

Physical Therapists Say Tottering on High Heels Puts Women at Risk for Foot and Back Problems

ALEXANDRIA, Va, August 20, 2000 – This fall, "fashion forward" women will buy footwear in a wild profusion of prints, patterns, and colors. Unfortunately, these eye-catching concoctions are rarely foot-friendly. That attractive pair of python pumps requires a balancing act on stiletto heels. And those thigh-high boots in sumptuous suede often sit upon heels the size of a dime. Once again, American women will sacrifice comfort at the altar of high fashion, donning spikes while suffering pain and discomfort. And according to the American Physical Therapy Association (APTA), high heels can lead to a lot more than just sore feet.

Women make up the majority of the 43 million Americans who experience foot problems such as bunions, calluses, and hammertoes. Prolonged wearing of high heels can lead to ankle injuries, nerve irritations (neuromas), and even back and neck problems. “Centering the body’s weight on the ball of the foot instead of distributing it over the entire sole while shoving the toes into a narrow toe box may feel stylish, but it will likely cause posture problems and a host of other difficulties,” said APTA member Jayne Snyder, PT, MA.

In their quest for the new look, shoemakers have pushed the heel ever higher and thinner. “The higher the heel, the worse for your body,” said Snyder. “A three-inch heel creates seven times more stress on the forefoot than a one-inch heel,” she explained. “This can result in a pinched nerve at the ball of the foot called a neuroma. In some cases, the bones of the foot may even shift.”

The outwardly attractive effect of high heels is precisely what makes them uncomfortable and potentially hazardous. Walking in high heels forces the back to arch and the chest to thrust forward. “Basically, high heels cause the back and neck to hyperextend,” said Snyder. “The body compensates by flexing, or forward bending, the hips and spine. While some women enjoy this look, they pay the price with problems of the back and neck, hips, legs, and feet.”

To maintain balance in high heels, the calf, hip, and back muscles become tense. This leads to increased muscle fatigue by the end of the day and is especially true for stiletto heels that narrow to a point, because the muscles must work harder to keep balance. Also, wearing high heels causes the calf muscles to bulge, giving legs more definition and contour but contracting rear-leg ligaments. Over an extended period of time, this will cause muscle fatigue and cramping.

When only a high heel will do, keep in mind:

  • Avoid wearing them for long periods of time, and stretch the muscles in the back of your leg before and after putting them on.
  • “High” is a relative term. Try and set your limit at two inches.
  • Pelvic tilts and calf stretches will also minimize any muscle cramping and shortening.
  • Buy shoes in the afternoon or evening, as feet swell during the day.
  • Change into low heels whenever you can.
  • Don’t go for the pointed toe. Use this rule of thumb: the higher the heel, the wider the toe box.
  • Buy shoes with leather insoles to keep the foot from slipping.
  • Buy a wide variety of shoes, including sneakers, oxfords, and sandals, and vary your footwear day-to-day.

The American Physical Therapy Association (APTA) is a national professional organization representing nearly 70,000 members. Its goal is to foster improvements in physical therapy education, research, and practice.