Heels more than 2.5 inches high possible cause of back pain- Say experts

High heels and back pain by Naas Physio Clinic

Stilettos are an integral part of a woman’s wardrobe. While they may do wonders for your iage, this may come at a price. The majority of women reported increased discomfort or pain in the low back after wearing heels. It’s not only the back but also the knees, ankle and foot that bear the brunt of the strain.

What does the evidence suggest?

Numerous studies cite the damaging effects of high heeled footwear on the low back. A study carried out to examine the effects of high heels on the erector spinae muscle activity (the major muscle of the back) in young and middle aged women confirms this. Analysis revealed increased muscle work in women wearing 10 cm heels as compared to those who wore flats or 4 cm heels. Excess muscle activity results in early fatigue and consequently inceases the risk of pain. Younger women in this study also reported increased pelvic movement which also contributes to low back pain.

Another study assessed the relation between back and hip extensor muscles activation timing during forward bending tasks. It was found that wearing 10cm heels affected the normal muscle activation patterns during forward bending activities leading to abnormal spinal loading. This puts the entire spine at risk. The risk was lower with lesser height heels.

Wearing high heels for long hours also increases the arch of the low back. This puts stress on the facet joints (intervertebral joints) which contributes to back pain. Chiropractors and physiotherapists have come across female patients complaining of pain in the buttocks sometimes radiating to back of thigh (piriformis syndrome) as a result of high heels.

Affects Foot, Ankle and Knee too!

The literature also reveals that wearing high heels puts undesirable stress on the knees and may compromise ankle stability resulting in recurring ankle sprains. The ankle foot complex is structured to bear our entire body weight and absorb shock while walking. A flexible calf and achilles tendon is vital for this ankle foot movement but donning those high heels causes the achilles tendon to tighten and sabotages this subtle ankle foot biomechanics.

Wearing high heels can also give rise to imbalance between the anterior muscles of the leg and the calf muscles causing the former to work more resulting in forefoot deformities such as hammer toes, claw toes, hallux valgus etc.

In addition high heels also disturb the normal 50-50 weight distribution between the forefoot and heel. While standing on high heels, more weight is borne on the forefoot as compared to the heel which increases pressure on the balls of the foot, eventually leading to painful conditions like metatarsalgia, neuritis, bunions etc. Another problem with wearing high heels is shortening of the plantar fascia present on the underside of the foot. This makes it difficult to wear flat shoes as the fascia pains while stretching.

Solution to the Footwear problem

Investing in a good pair of shoes is important for a healthy back and body as a whole.

A few tips to keep in mind to avoid footwear related back pain:

  • Keep them short: Chose everyday sandals with heels not more than 2.5 inches.
  • Wider the better: Go easy on the back and select platform or wedge heels over stilettos. Shoes with a wider toe box are better than the pointy ones as they avoid forefoot compression.
  • Comfort is the key: Choose well-fitting shoes score over stylish ones as they are more comfortable. Go for footwear that has straps for proper support and soft insoles.
  • Haste makes waste: Take your time while purchasing a new pair of shoes. Wear them and walk around to see if they are the right pair. Do not hurry!
  • Lesser the better: If you absolutely need to wear heels more than 2.5 inches, make sure you wear them for a shorter time period.
  • Stretch out: Make sure you sit and take off your shoes to stretch your calf and plantar fascia from time to time while at work.
  • Keep a change: Always keep a pair of flat shoes with you when you need to walk long distances. Walking long distances in heels is certainly not comfortable.
  • Flat at home: Pamper your feet at home and move around in flats.


Just as a good base makes for a stronger building, comfortable shoes make for a healthy spine. However if a change of footwear doesn’t resolve your pain, you should always consult a Physiotherapist or a Chiropractor early for a speedy recovery.

This blog is brought to you by Naas Physio Clinic.

For more information contact the Physio Clinic on (045) 874682
or email us at info@physioclinic.ie

read more about back pain at: www.physioclinic.ie/conditions/back-pain/