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Woman tying her shoes and getting ready for train

Most women know that high heels are not good for their feet. Clearly, a high heeled shoe forces women to adjust their posture unconsciously as they stand and walk. Today, I want to talk about the effect that a heel of ANY height can have on our entire body. So men this article applies to you too!

Any Heel Height is Too High

When I talk about a high heel, I am talking about any shoe that causes your heel to sit higher than the ball of your foot. This is the kind of high heel found on running shoes, walking shoes and even some women’s “flats” and male dress shoes. effect of low heel on our bodyIn simple terms see the diagram above, which shows how even the smallest heels can cause us to tip forward (or even fall forward!).

Of course, most of us do not tip forward because our joints, muscles, ligaments and other soft tissues adjust. These unconscious adjustments take our body from its natural, aligned position to a highly  unnatural, misaligned position. Unfortunately, it is a posture that many people who have heels on their shoes are “normally” positioned in when standing and walking. 

In the short term these adjustments may seem minor but given that most Americans walk an average of 6000 steps a day (even though we should do at least 10,000), walking in shoes with a heel of even a low height creates a cumulative, detrimental effect on our body over time. The process is slow. But when it occurs day after day, week after week, it’s effects begin to add up.

The Biomechanical Effects of Heels

Wearing a shoe with a heel of any height increases muscle and joint strain throughout our entire body. Most running, walking and dress shoes with a low, 1 inch heel height, acts to tilt the average person about 12 degrees forward.

To stay upright most every joint in our body that bears weight moves out of its correct position. Specifically, our ankle joints bend, our knees and hips will flex, and our back muscles work harder.

What Do These Compensations Mean For Us?

When we use our body in ways that nature did not intend (i.e. walk around with our heels an inch or more off the ground) we put ourselves at increased risk for pain, injury, and even arthritis. Running shoes with even the most minimal heels, cause:

1. Excessive knee flexion and moderate hip flexion acts together to reduce shock absorption. Less shock absorption puts our bones, joints and soft tissues at risk for stress and injury.

Beyond shock absorption, our muscles must work harder when we wear a shoe with a high heel.

Very briefly, a team of scientists in the UK led by Edwards looked at muscle activity around the knee joint in persons wearing shoes with a increased heel height. At a heel height of a mere 3cm, the researchers found significant increased muscle activity. A group of scientists led by Mika found similar findings for lower back muscles with shoes that had heels. They found increased muscle activity in the small muscles of our back and suggested that this could lead to low back pain.

2. Joints throughout our body endure abnormal force. That is, the point in the joint that was meant to take on the force of walking or running is now misaligned; force impacts the joints elsewhere. This chain reaction of abnormal joint position and force going through the joints abnormally can lead to cartilage destruction, increased risk of injury, and even arthritis.

3. The achilles tendon and related calf muscles tighten, impacting the flexibility of our legs and contributing to hamstring tightness.

4. Lastly, heels throw your weight onto the front of your foot, increasing the strain on your toes and causing problems such as hammertoes and pinched nerves.

A Common Foot Problem

Many people develop pain in their big or great toe joint. Often, they begin to get a very localized form of arthritis in this joint. The medical term for this problem is called hallux limitus or rigidus. The problem is often caused or worsened by wearing a shoe with a heel (even a low heel).

The increase in heel height raises the force on the big toe joint with every step. In cases where the degree of damage to the joint is mild, many of these people who have come to me as patients have had good success at alleviating the pain simply by switching to shoes without a heel. The key has been in catching this problem early, before shoes have done irreversible damage to the joint.

Given that many common foot problems are related to wearing improper shoes, this solution should not be surprising.

What Shoe Is Best?

I get this question a lot. The answer is simple; barefoot is best. But in our world of concrete and rusty nails, some protection is often required. Plus, some people have medical issues, deformities or are overweight, and because of these issues, cannot or should not go barefoot. I always suggest anyone with medical, health or weight issues, work with a podiatrist when transitioning to a more healthy shoe.

In my office, I wear Terra Plana dress shoes. When I am walking around my neighborhood, I wear Altra or go barefoot. For running, I generally go bare or wear Vibram Five Fingers.

All of these shoes are lightweight, flexible and most importantly, the heel is the same height at the forefoot. Some people refer to these types of shoes as “zero drop.”

Whatever shoe you choose to wear, the bottom line is you should wear as low a heel height as you are able. With this simple change, you will walk, run and stand with much improved posture. Your joints will thank you, and with your chance of injury reduced, you may just save yourself a doctor visit.  

Step Well!

References:

Edwards L, Dixon J, Kent JR, Hodgson D, Whittaker VJ. Effect of shoe heel height on vastus medialis and vastus lateralis electromyographic activity during sit to stand. J Orthop Surg Res. 2008 Jan 10;3:2.

Mika A, Oleksy L, Mika P, Marchewka A, Clark BC. The effect of walking in high- and low-heeled shoes on erector spinae activity and pelvis kinematics during gait. Am J Phys Med Rehabil. 2012 May;91(5):425-34.

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