Killer heels may be killing your back, and high heels and back pain often go together.
There are many types of high heels available on the market today, from the pump, platform, and cone, to the peep toe, t-strap and open toe, from the d’orsay, stiletto, and slingback, to the kitten, chunky, and wedge, and the spool, scarpin, and lobster claw.1 There are even heels without a heel. These no heel shoes are structured like high heel shoes, but they have no support under the heel of the foot. These heels without heels are similar to wearing heels, but they require more practice to wear them and they are not supportive.2 Despite the discomfort of high heels, many women will wear shoes that cause pain, and a large proportion of those have shoe-related foot issues. Feet in heels may look good, but they do not necessarily feel good.3
Tips for Wearing Heels
In order to wear high heels, there are several tips. It is important to wear proper fitting shoes, such as making sure the heel is narrow to prevent the foot from sliding forward and injuring the toes. It may be beneficial to buy “silicone metatarsal pads for a shock absorbing cushion”, or even a “full shoe gel insert”. It may be best to purchase shoes with a gradual slope instead of a drop straight down. Thicker heels lead to more stability. Open-toed shoes can alleviate pressure on calluses and corns. There are many tips on how to wear heels. When wearing heels, it is important to stand up straight, walking heel to toe, and if you can “lift yourself up out of the heels (1 inch)…the pitch and height are good for you”. If a shoe is not comfortable when it is first worn, it will not be comfortable later. Dancing shoes or t-strap heels may be some of the best shoes for back pain for people who regularly wear heels since they “distribute the stress of walking in heels”. For dancing shoes, rubber soles may need to be installed.4 More coverage on the top of the foot is better, as are thicker heels and platforms, instead of thin soles. It is important to take breaks when wearing heels and to stretch the feet after shoe removal. It is always best to make sure to wear the correct shoe size and shape. There is a difference between feet with high arches and flat feet.5
High Heels and Back Pain Issues
The feet are not the only body parts to suffer pain from wearing heels. While foot damage could be permanent (including nerve damage, bunions, and even leg tendon damage), back pain may also be caused by wearing these types of shoes. In fact, “one in 10 women wear high heels at least three days a week and a third have fallen while wearing them”. Leg injuries, knee osteoarthritis, plantar fasciitis, and low back pain are all linked to high heels, according to Natalie A. Nevins, DO. Any heel that is two-inches or higher slides the foot forward, “forcing the toes into the unnatural shape of the shoe and redistributing your weight incorrectly”. As a result, the body compensates for the forward tilt, leading the person to lean and overarch the back. This is a stressful posture for the hips, knees, and lower back. The pressure on the back’s nerves leads to sciatica, a nerve entrapment that causes numbness and pain down to the feet. Over time, the calves and back muscles shorten, leading to spasms and pain. Also, the Achilles tendon shortens, which means that switching back to flats can be painful and could trigger plantar fasciitis. Unhealthy patterns from wearing heels “can persist even when you’re not wearing heels”. Dr. Nevins recommends sensible, low heels, with a wide base, wearing soft insoles, making sure the shoes are a proper size, with a toe box that is wide enough. Heels should be worn on days that limit standing or walking, and shoe types should be alternated each day or throughout the day. It is also important to stretch the muscles.6 With high heels, the chest and lower back are pushed forward, creating spinal and hip misalignment. There is pressure on the knees, and walking in heels mimics walking on a ramp, putting excess “pressure on the balls of the feet”. This leads the body to overcompensate for the awkward posture, and spondylolisthesis (vertebra slipping forward) may result, especially in the lower back (lumbar) region. Foraminal stenosis may also occur, which leads to shooting pains, tingling, numbness, spasms, muscle weakness, cramping, and radiating pain, such as sciatica, which is due to the compression of the sciatic nerve. Muscles should be stretched before and after wearing the shoes, and they should not be worn for long periods of time. It is best to buy shoes in the afternoon, because that is when the feet are largest, and people should vary their footwear.7
Orthotics and Chiropractic
Chiropractors often recommend orthotics to patients. One type is Foot Levelers. They offer a variety of orthotic solutions for every type of shoe, including “Dress Length Orthotics”, such as “Sassy 1” Heels” and “Sassy 2” Heels”, which are “designed for women’s shoes”.8 Foot Levelers are not over-the-counter products; they are made for the specific customer. The company says their products are “designed for your unique postural problems — not just problems with your feet” and that “correcting imbalances in your feet can properly align your spine and pelvis”.9 SOLS are another brand of custom orthotics, made with “ULTRA”, a “proprietary foam”. Fitting can be done without a doctor, according to their website.10 A third orthotic brand that chiropractors may recommend or sell are called Solelutions. This company also offers a variety of orthotic styles, for various types of shoes.11 In general, chiropractors recommend getting rid of the high heels, because of the poor alignment, muscle overuse, back pain, and risk of losing balance and spraining the ankle. A permanent deformity called a “pump bump” (Haglund’s deformity) may also develop, affecting the Achilles tendon. The S-curve of the spine might also flatten, leading to a “backward displacement of the head and spine” and interfering with the normal S-curve’s ability to act as a shock absorber. The overuse of the hip flexors can also flatten the spine.12 If the patient continues to wear heels, the chiropractor can provide adjustments, but the pain will keep recurring. The compromise may be to have the patient wear heels less than two inches in height. They should wear comfortable shoes and switch to flats whenever possible, such as using them under the desk or while commuting. Shoes need to have good support. If a shoe is not comfortable to stand in, it is not good for walking or running, and it can affect posture and body movement. It is important to pay attention to how the body feels and to take breaks from wearing heels. Fashion may not be worth the “increased risk of osteoarthritis, spinal disc degeneration, low back, mid back and neck pain, ankle and heel pain, bunions, knee pain, achilles tendonitis, Morton’s neuroma, permanent shortening of the calf muscle, metatarsalgia and hammer toes”.13
Find out more about Foot Levelers.