Are My High Heels Causing My Chronic Back Pain?

By Kaliq Chang, MD

Every day, millions of women dress according to the dictates of fashion – right down to their toes – and complete their outfits with high-heeled shoes in every possible color, fabric, and style. Most women are well aware of discomfort, the difficulty of running for a bus, and the toll on their feet as they kick their shoes off under every table and minister to blisters every night. But it isn’t just the feet that pay the price for high fashion. Wearing high heels regularly can cause long-term damage to the hips, knees, and – especially – the spine. High heels alter the spine’s natural alignment and put you at risk for back pain.

The spine is made up of bones (vertebrae) stacked on top of each other, with jelly-filled discs that act as cushions between the vertebrae. Its natural shape is a gentle S-curve that leaves room for nerves and blood to run smoothly through the spine’s central canal. With the support of muscles and ligaments, the spine is designed to support the entire body evenly. When the spine’s alignment is compromised. the body tries to compensate for the imbalance by bending or flexing the spine and hips and tensing the muscles of the calves, hips, and back. This is a recipe for fatigue and strain and uneven wear and tear on back ligaments, joints, and vertebral discs.

There are many ways to hurt your back. Poor diet, lack of exercise, and lazy posture contribute as do the way you sit, turn, and lift. But high heels, worn regularly over years, also can play a significant role in causing changes to the anatomy like thickening tendons, shortened calf muscles, even curvature of the spine. Other problems include sciatica or pinched nerves, muscle spasms, and displacement of parts of the upper spine that cause the back and shoulders to hunch forward. 

There are two primary anatomical reasons that high heels can cause back pain. The first is that high heels force all the muscles from your foot to your back to tighten. The plantar fascia, one of the main ligaments of the foot, forms the arch on the sole of your foot. It connects to the calf muscles which connect to the hamstrings which connect to the pelvis and lower back. So when your shoe causes the plantar fascia to stretch, everything from your foot to your back tightens up putting strain on the lower back and causing pain.

The second anatomical problem is that wearing high heels forces you to walk on the balls of your feet. In flat shoes, your weight is evenly distributed across the foot. But in heels, your weight and center of gravity are shifted forward, the upper body has to lean back to maintain balance, and the resulting prolonged arching causes back pain.

Wearing high heels alters the shape of your spine, and it can’t do its proper job of absorbing shock when you walk. Over time, uneven wear on vertebral discs, joints, and ligaments causes pain.

The best way to reduce or avoid damage from high heels is to stop wearing them. But unless you already have serious back problems, you don’t have to give them up entirely. You can do a few simple things to reduce the strain on your feet and spine. I recommend these tips:

• Stretch before and after wearing high heels. Stretching the plantar fascia and calf muscles will loosen the hamstrings and reduce the risk of back pain. Try rolling your foot on a golf ball or get a professional foot massage like reflexology.
• Avoid wearing high heels every day. Try alternating days with flats or lower heels.
• The higher the heel, the more the risk of damage. Avoid heels more than 2 inches high. If you must wear higher heels, do so only for limited periods.
• Choose shoes with rounded rather than pointed toes. Make sure your shoes fit properly and have leather insoles to reduce slipping.

You don’t have to live with pain or the risk of permanent damage to be fashionable. Pay attention to your body. Don’t let minor discomfort escalate to a serious problem. Treat your feet and back well and they’ll support you for the long haul.

Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC. http://www.atlanticspinecenter.com, www.atlanticspinecenter.nyc

Kaliq Chang, MD, is an interventional pain management specialist board-certified in anesthesiology in practice at Atlantic Spine Center.