Are high heels bad for your feet?

What damage are high heels doing to your feet? Photograph: Getty Images/Untitled X-Ray

I have one pair of high heels, and they hurt. The pain is mostly in my feet because they are forced into an unnaturally extended position with my toes bunched upwards and heel sticking up. My lower back isn’t too happy either. But who cares? I’ve joined the 78% of women who wear them almost daily, despite them causing pain, on average, after one hour and six minutes. High heels are perceived to be worth the pain because they make legs look taller, feet smaller and the body thinner. But research published this month from South Korea in the International Journal of Clinical Practice suggests that high heels may actually alter the muscle balance around the ankle joint, leading to instability and balance problems. The Journal of Foot and Ankle Surgery has reported that the number of high heel related injuries in America doubled from 7,097 in 2002 to 14,140 in 2012.

Most of these injuries were foot and ankle sprains in women between the ages of 20 and 30 in the evening: alcohol and high heels are not a good mix. High heels push the centre of gravity forwards and upwards so you have to constantly change your posture to keep your balance.

Professor Neil Cronin of the University of Jyvaskyla in Finland, author of a review of the long-term effects of high heels, warns that they increase the changes in length that a muscle goes through when you walk. Usually that change is small. But wear high heels and it is larger, and the strain goes more through the tendon joining the muscle to the bone, as it usually does. The Achilles tendon at the heel can shorten and get stiff. Cronin says women who wear heels for years develop such chronically short muscles and tendons that when they try to wear flat shoes again their calves hurt. Studies have also suggested high heels increase the risk of arthritis, but it’s difficult to prove. So should you stick to flats?

The solution

It’s hardly news that you can fall over in high heels but the evidence of ankle instability suggests some care is needed. Cronin advises thicker heels (wedges anyone?) as they help balance, and keeping heels to 4cm or below. Wearing soft insoles can reduce pressure on your knees. You should alternate with flats (Cronin advises limiting high heels to two to three days a week) take them off if you sit at work and do stretching exercises for your feet and calves (for example, pick up a pencil from the floor with your toes). Or not walk in them at all.