High heels – high risk for injury?

We all have that beautiful pair of had-to-buy-them, outfit-enhancing, agony inducing high heels. Confession: I am a shoeaholic and I have way too many shoes! The perfect pair of heels can undoubtedly set off any outfit, but are they doing more harm than good?  And what can be done to counter the effects of these torturous beauties?

Changes that occur whilst wearing high heels:

  • Pressure on the foot is shifted from the heel to the ball of your foot.  High heels or restrictive shoes can force the ball of the foot into a small amount of space.  This will cause an aching or burning pain, especially after a long night out, as there is increased pressure on the area. Foot pain This pressure through the toes can build up, causing metatarsalgia (toe pain), resulting from inflammation from the foot bones.  Continuing to wear restrictive footwear can cause bunions, Morton’s neuromas as well as increasing the risk of osteoarthritis in the feet.

  • Wearing high heels regularly can alter normal alignment, causing extra force to be transmitted through the knees.   Your quadriceps (thigh muscles) have to work harder than usual to maintain your knee position, resulting in strain.  When you wear flatter shoes, your heel is closer to the floor, meaning your quads don’t have to work as hard to stabilise your knee.  This reduces the risk of anterior knee and patellofemoral pain.  Quads strengthening exercises (in particular for the vastus medialis oblique/VMO muscle) will help provide stability for the knee.

  • Lumbar lordosisHigh heels get a bad rep for causing back pain.  Physiotherapists have historically warned against wearing heels, as they can cause an increase in lumbar lordosis, the natural curve at the base of your spine. Lumbar lordosis - postureWearing heels causes the hips to angle forwards, arching the back and increasing the angle of lordosis.  This makes the paraspinal muscles in the back work harder, causing them to fatigue more quickly.  Activating your core whilst walking and trying to maintain a neutral spine will help to support the low back muscles.  [Click here to read about how to prevent poor posture.]  Lordosis has been linked to low back pain, although the jury is still out on the extent of damage wearing heels can cause.
  • Wearing high heels can, over time, tighten the calf muscles and Achilles tendon, resulting in an inefficient walking pattern.  Over time, the calf muscles lose their elasticity, so they are unable to lengthen to reach the ground altogether. This explains why some women who constantly wear heels claim that they are more comfortable in heels than flats.  Chronic heel-wearing can cause heel pain and tendonitis, which can be very painful and tricky to manage.
    High, Heels


Clearly, our high heels can potentially wreak havoc for our joints, alignment and posture, and can cause a wealth of musculoskeletal injuries.  However, if you’re anything like me, knowing the risks isn’t realistically going to deter you from wearing those gorgeous heels.

How to prevent footwear-related injuries

Follow these few tips to counter the harmful effects of high heels and reduce your risk of injury.

  • Ideally, limit the amount you wear your heels and opt for comfy shoes wherever possible.  If this is a total no-no, minimise the amount of time you wear your heels for.

  • High heel painMassage your feet after wearing heels, paying particular attention to the balls of your feet and the big toe area (which takes a lot of pressure)

  • Chunky heels put less pressure through the metatarsals, ankles and knees and are much more stable than stilettos.  Aim for wider, well-fitting heels to reduce pressure through your lower limbs.

  • Stretch!  Regularly stretching the calf muscles, feet and Achilles to help counter the shortening of these muscles.Calf stretch
  • Exercise your feet and core.  Try doing Pilates and some foot stretches to keep to stabilise your feet and reduce the stress going through your ankles, knees and back.

    Ruby slippers

  • Dorothy tottered around Oz all day in her ruby slippers, but knew that there’s no place like home to rest your weary feet.  Try and spend some time in flat but supportive shoes (such as trainers).  This will allow your feet to breathe and recover from the restriction that heels tend to cause.

  • Completely flat shoes such as ballerina pumps can be even worse than heels as they offer no support at all for your feet.  Try and ensure any shoes have some cushioning and good arch support.

  • Foot with arch supportIf you are struggling with footwear, speak to a physio or Podiatrist.  Many people have reduced medial arches or ‘flat feet’, which causes an over-pronation at the ankle, which increases the risk of sprained ankles and knee pain.  Wearing shoes with inner-arch support can provide huge relief from the pain associated with flat feet and plantarfaciitis.  A health professional will be able to advise on whether your footwear has sufficient support.



High heelsIn conclusion, there are ways to enjoy your favourite footwear but be aware of the risks to your joints.  Consider taking the steps above to reduce the risk of pain and injury whilst enjoying your best shoes.

Happy high heel-wearing!!


Naomi Sofer, Specialist Physiotherapist

May 2017

Pain-free Pesach Preparation




Try to divide up heavy loads.



Don’t risk a fall by over-stretching


Watch your lifting technique



Protect yourself from old injuries and try to de-stress




Break tasks down and pace activities


Surviving Seder without injuring yourself



Listen to your body and don’t ignore pain




Happy Pesach

Naomi Sofer, Specialist Physiotherapist

March 2017