I’ve always loved wearing heels. Not only do they make me feel a little taller (I need all the help I can get!) but I also feel a bit more confident. I admit to being an absolute shoe addict pretty much all. my. life. I remember admiring my mom’s collection of kitten heels. Carrie Bradshaw’s shoe collection made me swoon. I also remember that time I ran out to buy a pair of Jimmy Choos to celebrate a promotion. Heck, even my wedding shoes were more important than my dress. But I’ve learned to pay closer attention to how the shoes feel. Remember when salespeople told us, “oh, you’ll get use to them and they will stretch”? Whatever. If they’re not comfortable from the moment I slip on those Cinderella slippers then it’s a no go. I’m not going to give up wearing heels just yet, but I recently turned to chiropractor and registered acupuncturist Dr. Nekessa Remy for some healthful advice.What are the most common injuries associated with wearing heels?

As fashionable as heels are, it is important to understand the potential hazards associated with wearing them, especially for long periods of time. There is no part of the body that is unaffected by high heel use. The lower extremity however, takes the brunt of most injuries.

  • Knee Pain – Wearing heels forces your center of gravity to move forward, this places increased pressure toward the knee and kneecap. This increased pressure can lead to wear and tear of the cartilage in the knee or strain in the tendons around the knee. Arthritis and other degenerative issues can occur causing knee pain.
  • Calf Strain – I think we can all agree that heels do make the calves look good. However, the reason they look good is because they are forced to contract. They are literally working overtime while in heels. This can lead to spasms and cramping of the calf.
  • Achilles Tendonitis– The Achilles tendon is the large tendon that is found at the back of the ankle. When in heels the Achilles is shortened and tightened. Continued use of heels can lead to permanent shortening of the tendon which causes inflammation and ultimately tendonitis.
  • Plantar Fasciitis – High heels distribute your weight unevenly and force the arch of your foot into an unnatural position. The tension and strain in the arch can lead to plantar fasciitis, which is inflammation of the muscles in the arch of the foot.
  • Pain in the balls of the foot – wearing heels shifts your body weight forward placing more pressure under the balls of your foot. This can lead to a condition called metatarsalgia.

But we LOVE wearing our heels! What should we be looking for? 

You can’t deny that heels are important to any outfit. So, if you have to wear heels there are few things to consider. Look for heels that have a platform. Thin soles, lack cushioning and can cause pain on the bottom of the foot. You want a thicker sole or platform to offset some of the pressure when walking. A rubber sole is a great idea as it will absorb pressure as well as offer more stability. Wedges can also be a more comfortable option. They offer more a more stable base of support and will distribute body weight more evenly.

Do brands matter? And is it true the more expensive the better? 

Brands do not matter. In fact, some of the most expensive shoes can be the most uncomfortable. When you try on a shoe it should be comfortable from the get go. There is no such thing as “breaking in” a pair of shoes. Choose a shoe that fits. It may mean going a size up, or perhaps looking for a wider width. When trying on shoes make sure to walk at least 10 to 15 steps and ensure those steps are all pain free before making the purchase.

Lastly, its best to purchase heels at the end of the day since our feet tend to be a bit swollen by the day’s end. This will help to ensure a better, more comfortable fit.

Anything we should be doing (e.g. stretches) before or after slipping on our favorite heels? 

Prepping your body before you wear heels is a great idea. Consider stretching out your calves and the arches of foot. To stretch your calf, stand away from a wall and put one foot behind you and be sure your toes are facing forward. Lean forward at the ankle while bending the front knee and keeping your heels on the ground. You should feel a stretch towards the back of the calf. Hold this for 25 seconds. To relieve tension in the arch try rolling your bare foot back and forth from your heel to your mid-arch over a golf ball or tennis ball. Repeat for 3 to 5 minutes.

Does the type of heel make a difference (e.g. stiletto, kitten, chunky, flat) 

Heel height plays a significant role in injury. For instance, the higher the heel the more pressure on the balls of the foot. A 3-inch heel place 76% more pressure on the forefoot. A 2-inch heel places 57% while a 1 inch heel adds 22 % more pressure. Heel width is also an important consideration. The wider the heel the more stable the shoe. A stiletto heel can create more of an imbalance leading to an increase chance of ankle sprains.

Flats aren’t always necessarily the best for us either, we’ve heard? 

Flats shoes are not always the best especially for individuals with flat feet or very high arches. Shoes should have adequate arch support, you will not get that in a pair of ballet flats. Look for shoes that have a high instep, that can be an indication that there is arch support in the shoe. If you still have difficulty finding a comfortable shoe, consider getting custom made orthotics. These devices can be put in your shoes and provide additional support and/or cushioning specific to your foot.

Can you tell us about some long-term effects of wearing heels?

Wearing high heels can cause chronic conditions that result in deformities of the foot.

A Haglunds Deformity, aka “pump bump”, is a bony enlargement on the back of the heel. This is the result of chronic tension of the Achilles tendon which attaches to the bone at the back of of the heel. This enlargement can cause continued inflammation and pain in that region.

Another common long-term deformity is known as hammer toes. This deformity causes your toe to bend or curl downward instead of pointing forward. Heels that are very narrow or too small in size can cause pressure on the toes resulting in this deformity.

This is amazing advice! All of it! Thank you Dr. Remy, um…wanna go shopping?

Dr. Nekessa Remy is the owner of Mississauga’s The Chiropractic Office, a comprehensive injury management clinic focused on sports related injuries and women’s health issues. She also runs a practice in downtown Toronto at Integra Health Centre where she works with other leaders in the healthcare profession.