© 2019 by Spinal Symmetry Pty Ltd


How to survive high heels

September 2, 2016

The silly season is fast approaching and our weekends will soon be filled with festivities. So of course the number one fashion accessory that makes every outfit is the 3-inch bright red high heel.


But are they worth it?


What possible damage could they be doing to you?


Are there ways in which we can survive all these parties and not have issues to the rest of the body and still enjoy our favorite heels?



Research shows us that high heels really do cause many issues, not only to our feet but our whole body. In the US, the total number of injuries reported to hospitals due to high heel wearing has doubled from 2002 to 2011 (1). Not only are they causing issues in America, but in a four year study of injuries in Victorian hospitals, there were 240 injuries as a direct result of high heels (2).


And its not just acute injuries presenting to hospitals that are the issue, research on long term use of high heels have found that the actual mechanics of walking in heels shows changes in the muscle efficiency and strain patterns in the legs of wearers, in a study comparing high heels regular wearers versus not at all (3).


So why are high heels the number one enemy to our body?


What exactly happens when we wear them?


What are High Heels doing to your foot and the rest of your body?


The first thing that happens when you put on a high heel is that your body weight shifts forward away from the heel and towards the front of the foot.


It is this shift that causes all the issues.



The normal sequence of our gait when we walk, is to first land on our heel, then transfer the weight along the outside of the foot, then onto the ball of the foot and along the toes from outside in, where we finish with our big toe propelling the foot forward.


This however, is not how we walk in high heels.


Because the weight has shifted forwards in the foot when wearing high heels, it makes the foot more rigid and less able to absorb shock from the ground. It also places more pressure on the toes and limits the movement they have to function when walking, especially the big toe. The big toe’s function is to not only propels us forward when walking, but it is also vitally important in our balance.


When we wear high heels, the increase weight on the toes affects how they can stabilize the foot, making us more likely to lose our balance and fall.


Pointed toe shoes make this even worse. Our toes are designed to be wider than the knuckle of our foot.

If you look at a babies foot and see their little toes, you’ll find they are evenly spaced and fan out from the foot.

If you look at your toes, you might find that they are likely to be cramped together and coming inwards rather then out.


This is because you have been putting your feet into tight shoes your whole life.

As we mentioned earlier in the article, our toes are designed to move gravitational force (weight) through them and then into the big toe in a wave like motion.


If they can’t grip and move in the shoe they cannot do this. This is why high heel shoes with a pointed toe box are the worse option by far to wear as they load the toes incorrectly and then also push the toes together. Often a result of continuous wearing of heels with tight toe boxes can lead to bunions.




The ankle joint is also affected by wearing high heels. When the weight of the body is shifted forwards it incorrectly loads different parts of the ankle joint that aren’t built to take that load. This can lead to ankle injuries and also stiffening of the joint.


This has a flow on affect by also tightening the Achilles tendon and calf muscle, which both attach to the heel of the foot and go up the back of the leg.


One of the reason high heels are worn is because it creates shape to the leg and definition in the calf, which may look attractive, but is unfortunately not very kind to your body.


Long term use of high heels causes these tendons and muscles to remain in this tightened, short position so that even when you aren’t wearing heels, you can still have aches and pains and even strains when you wear flats, especially while playing sport.


The use of EMG (electromyography) tests the electrical activity of muscles and how they are effectively they are working. EMG studies of people wearing heels have shown that muscles throughout the body especially in the low back, knee, calf and foot all work much less effectively while wearing heels (3).



Here at Spinal Symmetry we start at the hips and pelvis as the foundation of your body. We start by correcting your hip angles and use the Dynamic Therapy to maintain this correction by changing the ligaments of the hips.

We have spoken about when heels are worn, your weight shifts forward onto the front of your foot- this also has an affect in your pelvis and low back.


If your weight has shifted forward, you need to tilt your pelvis forward to stop you falling forward.

This creates the perception that your bottom is more defined because it is sticking out more to stop you falling over, which again is seen as attractive, but actually causes an increase in the load to your hips and low back.

This posture causes you to lean backwards in order to keep you up straight which then pushes your chest forward.


As you can imagine, these perceived positive aesthetic changes in your posture can be the reason why people wear heels, however it’s the consequences, which they cause that can lead to a breakdown to the biomechanics in your skeletal system, which ultimately can lead to pain and dysfunction.



Wearing heels not only causes new issues in the hips and pelvis, but due to an increased load in the area, it can actually slow down the healing time of any dysfunction you may already have in the area, that we at Spinal Symmetry are working towards correct.


What this means is that your body is unable to move towards a healing process while using the Dynamic Therapy which could mean a continuation of aches and pains.


Ways we can avoid all these issues and still wear heels!


So it looks like it’s the end of wearing high heels!


Well, perhaps not- the good news is that it is still possible to wear high heels by following these guidelines:

  • Wear a lower heel – the higher the heel the more pressure that is placed onto the ball of the foot and toes.


  • Wear a shoe with a wider toe box – As discussed earlier your toes need to be able to grip and move to do their job. The tighter the toe box the more pressure placed on the toes and the more likely your are to be off balance which can lead to bunions.




  • Wear a more open, strappy, sandal like shoe – These shoes place less pressure on the toes and toe nails, reducing the load on them.



  • Wear high heels for only a limited time – The more time you are in heels, the more pressure there is placed on your body. So if you need to wear heels to an event or work, take flats with you to wear while walkingto and from the event/work. Also while sitting down take them off and move your toes and feet around to stretch them.

  • Strengthen your lower leg muscles – So they are able to cope with the extra load going through them to reduce strains and soreness. The extra strength also increases your balance.




  • Wear a heel with a wider heel – The more narrow the heel, the more unstable.





  • Be cautious in crowded areas, drinking alcohol or when fatigued – The research shows the majority of the injuries occur when alcohol is involved (3).

If you do all of the above you can still enjoy your favorite heels and perhaps not be as affected by the negative effects they can cause.

If you have any questions about your shoes just ask any of our practitioners.





  1. Moore, Justin Xavier et al. Epidemiology of High-Heel Shoe Injuries in U.S. Women: 2002 to 2012. The Journal of Foot and Ankle Surgery (2015), Volume 54, Issue 4 , 615 – 619

  2. Chien, Hui-Lien et al. Effects of long-term wearing of high-heeled shoes on the control of the body’s center of mass motion in relation to the center of pressure during walking. Gait & Posture (2014), Volume 39 , Issue 4 , 1045 – 1050

  3. Cronin NJ, Barrett RS, Carty CP. Long-term use of high-heeled shoes alters the neuromechanics of human walking. J Appl Physiol. (2012) Mar;112(6):1054-8

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