Footwear and Spine Health

If you've been recently experiencing back pain and don't know the exact cause behind it, try to look down, specifically at your feet—and what type of shoes do you often wear? The shoes you wear can have an immense effect on your spine, leading to debilitating back pain and an overall detrimental impact on your spine and body. Although this is conventionally considered a "female problem," some men's shoe styles have heels and are unsafe. However, generally, high heels are notorious for inflicting significant discomfort and effects on spinal health. 

However, that doesn't stop people from wearing them, as many consider high heels to be the perfect shoes to complete most outfits, with some wearing high heels every day. Several studies have shown that high heels can adversely affect your spine health long-term, alongside other body parts. 

The Truth Behind High Heels

High heels are notorious for the significant discomfort they inflict on one's feet. However, not many know that it also affects your spinal health. Research studies have shown that wearing high heels for long periods can alter the spine's natural alignment, causing severe back pain and postural issues long-term. These happen due to the body's attempt to compensate for the unbalance caused by high heels, flexing, and bending the spine. 

When you wear heels, to maintain your body's balance, your calf, back, and hip muscles become tense, causing further strain on your spine. Wearing high heels can also damage your joints, back ligaments, and vertebral discs. One study showed that wearing high heels for extended periods can cause the spine to become hyperlordotic, meaning your spine's lumbar and cervical areas become too curved. This condition can be excruciatingly painful due to the strain placed on your lower back and legs. 

High Heels and Its Other Side Effects 

Besides causing detrimental effects to your spine, wearing high heels for prolonged periods can also cause other side effects to other parts of your body, resulting in the following issues: 

  • Posture

Wearing high heels place your feet in a plantarflexed or downward extended position, putting more pressure on your forefoot, forcing you to adjust the rest of your body to keep up with the sudden shift in balance. As your lower body naturally goes forward to maintain your center of balance and overall posture, your upper body needs to lean back to act as a counterweight. 

As a result, your body's alignment gets thrown off, creating a stiff and unnatural posture rather than a relaxed and neutral one. The detrimental effects on your posture become worse the taller the heels get. Even in those who wear high heels often, extra-tall high heels will force the body to lower its center of gravity at the hips, causing bad posture. 

  • Balance

Walking using high heels resembles the sensation of walking on a balance beam, requiring lots of balance and precision in navigating various surfaces, inclines, and elevations. If moving too fast, you'll need to place more weight on the balls of your feet to stay steady. Essentially, walking in high heels increases your risks of damaging your bones and connective tissues. 

In fact, according to research, more than 120,000 high-heel-related injuries led to sprains and strains of the foot or ankle and had to get treated in emergency rooms. Stilettos are by far the worst when it comes to balancing since it can be challenging to balance with little support and stability, inherently forcing your feet and ankles into a supinated or outward splaying position—increasing the risk of falls and sprains. 

  • Gait

Normal strides using regular shoes involve the feet rolling from the heel to the ball, pushing off with the toes. However, in high heels, the extended downward position of your feet can prevent you from pushing off the ground comfortably. This sudden change in position forces the hip flexor muscles to propel the body forward and keep knees flexed, causing it to work harder than usual—and the higher your heels are, the worse this issue gets. 

  • Back

Every healthy person has a typical "C-curve" shaped back, which is meant to act as a shock absorber, reducing the weight-bearing stress on your spine's vertebrae and pelvis. High heels can cause the lumbar spine of your lower back to flatten, all while forcing your thoracic spine in the mid-back into a hyper-curved position. To compensate for these, especially if you've worn your high heels all day, you'll need to lean forward to ease some pressure in your back. 

General poor alignment of the spine invariably leads to the overuse of the back muscles, increasing your risk of developing chronic back pain. 

  • Hips

Your hip flexor muscles are situated on the upper front of your thighs, and wearing heels forces them into a persistent flexed position. Although this exercises your hip flexors, chronic uses can lead to the shortening and contracting—causing severe lower back and hip pain as it leads to the progressive flattening of your lumbar spine. 

  • Knees

Knee osteoarthritis, commonly known as "wear and tear arthritis," happens more in women than men, as more females wear high heels than males. Wearing high heels increases your knee's distance from the floor, resulting in excess knee torque or force of rotation and compression. When using high heels, your knees' persistent flexed position can cause your tibia or shin bone to go inward, balancing your body. 

This unusual position can cause excess compression on your medial or inner knee, a common site of osteoarthritis. That's why if you have existing osteoarthritis, it's best to avoid wearing heels altogether. 

  • Ankles

Using high heels can limit the motion and power of your ankles' joints since the calf muscles get shortened due to the excess height, causing your ankles to lose control when trying to propel your feet forward. This altered and awkward position can cause your Achilles tendons' contraction—and eventually lead to an inflammatory condition known as insertional Achilles tendonitis. 

  • Feet

When your feet are placed in an extended downward position, there will be excess pressure exerted on the plantar or bottom portion of your forefoot. The pressure increases in tandem with your heels' height, meaning the taller it is, the worse the effects. Additionally, the increased pressure on your forefoot can cause pain and feet deformities, including bunions and neuromas. The supination of the feet may cause the alteration in the alignment of your Achilles tendon, leading to Haglund's deformity, the bony enlargement of the feet' heel. 

Finally, wearing high heels can cause the tendons and ligaments supporting the arch to tighten, leading to severe pain in the arch of your feet, a medical condition called plantar fasciitis.

  • Toes

When wearing high heels, you'll be forcing your toes into the toe box of the shoes by the sheer force of gravity. Since the toe box of high heels tends to be narrow, your toes will be forcibly pressed together, causing your inner and outer toes to be placed in a fixed position known as hammertoes—leading to unsightly corns, calluses, and blisters.

So, Are Flat Shoes Better than High Heels?

So, with all those effects produced by wearing high heels, are flat shoes any better? When you compare flat shoes to high heels, the former is significantly better, especially in maintaining posture and spine health. Flat shoes can keep your spine straight, and calf muscles relaxed, effectively distributing your body weight more evenly through your whole feet compared to pushing your weight to the balls of your feet. 

Buying Spine-Friendly Shoes

Besides opting for flat shoes whenever possible, keep these tips in mind when shopping for back- or spine-friendly shoes: 

  • When determining the overall length and width of the shoes, it's best to do it while standing. 
  • Every time you buy shoes, make sure to get your feet measured to get perfect fitting footwear every time. 
  • When purchasing new shoes, always walk around in them and stand to see if it's comfortable enough and doesn't affect your posture. 
  • Choose shoes that offer ample foot support and have arch support. 
  • Never settle for shoes that are too wide, narrow, long, or short. 
  • When choosing shoes, let the size be a guide and not a rule. Gauge your shoe size by comfort and not numbers. 

Remember, shoes aren't accessories. They're tools that help protect your more than just your feet, so wear them well and minimize your high-heel-use as much as possible. Following the tips mentioned can help you find more comfortable and safe shoes for your spine and overall body if you need to wear them. 

If you've tried the pain-relieving tips mentioned and still feel back pain or general unease due to high heels, it's time to see a specialist about your condition, and Dr. Dominic Lupori is one of the best in the field. Dr. Lupori is a chiropractor in Greenville, SC, using modern techniques to find the source of your pain and offer the relief you deserve. Contact Dr. Lupori today to offset the biomechanical problems presented by high heels and help you discover the keys to optimal health and performance.

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