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There’s little doubt that high heels affect lower extremity and spine kinematics. However, many patients ask whether they should wear high heels if they are in a current episode of lower back pain? Looking through the research has changed my mindset that I would like to distribute to this readership.

High heels adversely affect joint load from the tip of our toes through the spine. (1) However, depending on the wearer’s experience, high heels have differing effects on the regions of our body. Interestingly enough, I dug up these four papers that refute my past opinion.

  • Different heel heights do not change spinal posture or muscle activity as measured in kyphotic angle, trunk inclination, and pelvic inclination. (2)
  • The posture of younger wearers, measured via kyphotic angle, remains unchanged. (3)
  • There are no statistically significant changes in thoracic kyphosis or lumbar lordosis in those wearing high-heels. (4)
  • The frequency of high heel usage and shoe type does not influence body posture among adult women. (4)

Take-Home Points

1. Wearing high heels does not come without compensation. The above studies show that experienced high heel wearers can spare adverse joint load to the spine. Novel wearers of high heels may not be able to spare such loads, resulting in a negative effect on spinal conditions.

2. The above studies were short in duration. Long-term use of high heels may negatively affect lower extremity and spinal kinematics.

3. High-heeled shoe wearers must walk with increased knee flexion and sustained ankle plantar flexion. If hip and knee muscles fatigue, compensations may negatively affect the spine. 

Sullivan et al. demonstrated that patients with limited ankle dorsiflexion have a significantly higher foot and heel pain incidence. (5) Furthermore, Csapo et al. found that long-term use of high-heeled shoes induces shortening of the gastrocnemius muscle fascicles and increases Achilles tendon stiffness, thereby reducing the ankle’s active range of motion. So, those patients suffering from diagnoses such as Heel Pad Syndrome, Achilles Tendinopathy, and Plantar Fasciitis should refrain from high heels use during the symptomatic stage to avoid excessively loading injured tissue. These patients may benefit from proper shoe wear selection to reduce lower extremity joint loads and resultant pain.

Shoe Wear Selection

Download this infographic to give to your patients about shoe wear selection.

Increasing Ankle Dorsiflexion

To measure ankle dorsiflexion and correct any limitations, take 2 minutes to read this past blog.

Patient care is often simple, requiring the proper diagnosis and corresponding treatment. Most treatments are done in the office and are incredibly effective. However, sometimes our management strategies must also change patient behavior outside our four walls. Never be afraid to dig into each patient’s life to identify possible contributors to the etiology of their diagnosis or factors limiting their ability to heal!

ChiroUp remembers many of these critical contributors for you for over 106 diagnoses. You probably saw that we had our New Year’s Special this month, but perhaps you are still not sure what we do or how valuable ChiroUp is. Let us show you how you can leverage ChiroUp to grow your practice, get better outcomes, and get higher patient satisfaction.

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  1. Barnish, M., and Barnish, J. (2016). High-heeled shoes and musculoskeletal injuries: a narrative systematic review. BMJ Open 6:e010053. doi: 10.1136/bmjopen-2015-010053
  2. Elsayed, W., Alhufair, A., and Alghamdi, S. (2018). Impact of different heel heights on spinal posture and muscle activity in young adult women. Bull. Fac. Phys. Ther. 22, 118–123. doi: 10.7547/0990512
  3. Schröder, G., Dahms, C., Boldt, R., Schulze, M., Hornung, A., Blaas, V., et al. (2019). Influence of wearing personalized high heels on the posture of women of different ages: a clinical cross-sectional study. Int. Med. Care 3, 1–8. doi: 10.15761/IMC.1000127
  4. Iunes, D., Monte-Raso, W., Santos, C., Castro, F., and Salgado, H. (2008). Postural influence of high heels among adult women: analysis by computerized photogrammetry. Rev. Bras. Fisioter 12, 454–459. doi: 10.1590/S1413-35552008000600005
  5. Sullivan J, et al. Musculoskeletal and activity-related factors associated with plantar heel pain. Foot & Ankle International. 2015, Vol. 36(1) 37 –45.
  6. Csapo R, Maganaris CN, Seynnes OR, Narici MV. On muscle, tendon and high heels. Journal of Experimental Biology. 2010 Aug 1;213(15):2582-8.

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