Health Check

Killer heels

Some women confess to feeling more confident in heels, but at what cost to the feet and body?

Written by Liam Rothwell

You may have overheard a girl describing a new pair of shoes as ‘killer heels.’ While high heels won’t actually kill you, although reports suggest stilettos have been used as weapons, what is common knowledge is that when worn for long periods of time, high heels can cause damage.

The position that high heels put the body in is not natural. Firstly, the height of the heel tilts the lower part of your body forward and to compensate for that, the upper body leans back to keep balance. This in turn causes lower back flattening and a backward lean of the head and thoracic spine. The foot is locked in a flexed position, resulting in the hip flexors working harder so you can continue to move forwards. This unnatural movement leads to overuse and contracture, causing more strain on the lower back.

As we move down the body it becomes more concerning. Knee osteoarthritis is more common in women and high heels may be a contributing factor. Wearing high heels, the knee is constantly bent and the legs tilt slightly inwards, putting a greater compressive force on the inside of the knees. If you have knee problems, it is best to avoid high heels. The locked position of the foot also reduces movement and power at the ankle joint, making it hard to walk on uneven surfaces or on stairs. The gastrocnemius and soleus muscles that make up your calf are shortened because of the increased heel height, resulting in a loss of power when trying to push the foot off of the ground. There is also evidence to suggest that this position of the ankle may cause a shortening of the Achilles tendon.

With the foot facing downwards, wearing high heels significantly increases the pressure on the balls of the feet (metatarsals). Studies have shown a correlation between the size of the heel height and the pressure on this metatarsal area. A heel of 8cm was shown to increase forefoot pressure by 76%. This increase in pressure is a cause of common problems such as bunions, bunionettes, hammer and clawed toes, soft tissue injuries and neuromas.

Most high heels have a poorly constructed toe-box, which is usually too narrow for the toes and results in compression and friction complaints. Corns, calluses and blisters are the skins defensive mechanisms trying to protect the foot when too much pressure is placed on it. While you may not experience these problems when you first start wearing heels, with constant wear over time they may become more chronic.

A few ways to limit high heel damage:

-If you walk to work in your heels, try and swap them for runners

-Try to limit wearing time to 3-5 hours. Kick the shoes off at the desk and stretch out your feet and calves

-If you wear high heels often, the smaller the height, the better - under 5cm is recommended

-Take smaller steps when walking in them to try and limit strain

-Try and stretch your calf muscles as often as possible in high heels. With no stretching, calf muscles will contract making them tighter and increasing the risk of foot and lower limb injuries

-Get your shoes properly fitted. Platform shoes with a smaller heel to forefoot ratio are better, as are heels with straps around the midfoot and back of the heel to hold the foot in the shoe when walking

-If any painful areas or hard skin build up, see a podiatrist immediately. Bring the shoes that are causing the problem, as the podiatrist may be able to stretch or add padding

Some women confess to feeling more confident and glamorous in heels but at what cost to the feet and body?

To find a Medibank Members Choice podiatrist visit

Written by Liam Rothwell

Liam Rothwell is a leading podiatrist who specialises in biomechanics and sporting injuries.

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