Women don’t have to be a slave to fashion to admit that they like how high-heeled shoes look. Pumps, stilettos and other high heels offer the illusion of longer legs and can literally elevate an entire outfit – but do they also hurt people’s backs? Indeed, heel height can directly impact the spine and promote back injuries, according to Erica David, MD, a board-certified specialist in physical medicine and rehabilitation Physiatrist at Atlantic Spine Center.
Generally described as a heel height of 2 inches or higher, high heels are indisputably popular. According to the American Podiatric Medical Association, nearly half of U.S. women wear high heels, and those who do own an average of 9 pairs apiece. Women also tend to wear them regularly even though the shoes hurt their feet.
But those perfect pumps may also not be perfect for your back, says Dr. David. “We need to be more concerned with function than fashion,” she says. “Women need to consider the toll regular high heel use takes on the entire musculoskeletal system.”
Significant risks to the spine from wearing high heels
Since proper posture or spine alignment maximizes our chances of maintaining good spine health, high-heeled shoes threaten that ideal, Dr. David notes.
“High heels force you to alter the alignment of the spine, automatically putting you at risk of developing back pain,” she says. “As soon as you put them on and stand up, your body tilts forward, so you lean backwards – overarching your back – to make up for that. This adds tremendous strain to the lower back as well as the hips and knees.”
Beyond the resulting back pain – which may or may not be temporary – donning high heels can actually cause chronic injury or worsen existing back problems. According to the American Osteopathic Association, up to one-third of long-term high-heel wearers suffer from permanent problems, including low back pain.
“The unnatural posture high heels promote can place pressure on nerves in your back, leading to sciatica, a condition causing pain and numbness that can travel down to your feet,” she says. “In the longer term, wearing high heels can even shorten the muscles in the back, leading to muscle spasms. It’s not worth it.”
Tips to prevent heel-related back problems
The siren song of longer legs and a leaner profile may be too strong for some women to give up wearing high heels altogether. But beyond going cold turkey, Dr. David offers these tips for preventing or minimizing back problems resulting from high heel use:
- Alternate wearing high heels with other flat-soled shoes.
- Select shoes with a heel height of 1.5 inches or lower and a thicker heel, which will spread the load more evenly.
- Reserve high heel use for occasions that don’t involve extended periods of standing or walking.
- Bring high-heeled shoes to your special event, put them on when you arrive, and change into more comfortable shoes when you leave.
- Add a gel or foam insert to heels you already own, which can act as a shock absorber and help reduce strain.
- Stretch your calf muscles and feet regularly while your high heels are off.
“Not every woman who wears high heels will develop back problems, but in general, the less you wear high heels, the better off your spine is,” Dr. David says. “Ultimately, it’s best to opt for comfort over style.”