High heels – high risk for injury?

We all have that beautiful pair of had-to-buy-them, outfit-enhancing, agony inducing high heels. Confession: I am a shoeaholic and I have way too many shoes! The perfect pair of heels can undoubtedly set off any outfit, but are they doing more harm than good?  And what can be done to counter the effects of these torturous beauties?

Changes that occur whilst wearing high heels:

  • Pressure on the foot is shifted from the heel to the ball of your foot.  High heels or restrictive shoes can force the ball of the foot into a small amount of space.  This will cause an aching or burning pain, especially after a long night out, as there is increased pressure on the area. Foot pain This pressure through the toes can build up, causing metatarsalgia (toe pain), resulting from inflammation from the foot bones.  Continuing to wear restrictive footwear can cause bunions, Morton’s neuromas as well as increasing the risk of osteoarthritis in the feet.

  • Wearing high heels regularly can alter normal alignment, causing extra force to be transmitted through the knees.   Your quadriceps (thigh muscles) have to work harder than usual to maintain your knee position, resulting in strain.  When you wear flatter shoes, your heel is closer to the floor, meaning your quads don’t have to work as hard to stabilise your knee.  This reduces the risk of anterior knee and patellofemoral pain.  Quads strengthening exercises (in particular for the vastus medialis oblique/VMO muscle) will help provide stability for the knee.

  • Lumbar lordosisHigh heels get a bad rep for causing back pain.  Physiotherapists have historically warned against wearing heels, as they can cause an increase in lumbar lordosis, the natural curve at the base of your spine. Lumbar lordosis - postureWearing heels causes the hips to angle forwards, arching the back and increasing the angle of lordosis.  This makes the paraspinal muscles in the back work harder, causing them to fatigue more quickly.  Activating your core whilst walking and trying to maintain a neutral spine will help to support the low back muscles.  [Click here to read about how to prevent poor posture.]  Lordosis has been linked to low back pain, although the jury is still out on the extent of damage wearing heels can cause.
  • Wearing high heels can, over time, tighten the calf muscles and Achilles tendon, resulting in an inefficient walking pattern.  Over time, the calf muscles lose their elasticity, so they are unable to lengthen to reach the ground altogether. This explains why some women who constantly wear heels claim that they are more comfortable in heels than flats.  Chronic heel-wearing can cause heel pain and tendonitis, which can be very painful and tricky to manage.
    High, Heels


Clearly, our high heels can potentially wreak havoc for our joints, alignment and posture, and can cause a wealth of musculoskeletal injuries.  However, if you’re anything like me, knowing the risks isn’t realistically going to deter you from wearing those gorgeous heels.

How to prevent footwear-related injuries

Follow these few tips to counter the harmful effects of high heels and reduce your risk of injury.

  • Ideally, limit the amount you wear your heels and opt for comfy shoes wherever possible.  If this is a total no-no, minimise the amount of time you wear your heels for.

  • High heel painMassage your feet after wearing heels, paying particular attention to the balls of your feet and the big toe area (which takes a lot of pressure)

  • Chunky heels put less pressure through the metatarsals, ankles and knees and are much more stable than stilettos.  Aim for wider, well-fitting heels to reduce pressure through your lower limbs.

  • Stretch!  Regularly stretching the calf muscles, feet and Achilles to help counter the shortening of these muscles.Calf stretch
  • Exercise your feet and core.  Try doing Pilates and some foot stretches to keep to stabilise your feet and reduce the stress going through your ankles, knees and back.

    Ruby slippers

  • Dorothy tottered around Oz all day in her ruby slippers, but knew that there’s no place like home to rest your weary feet.  Try and spend some time in flat but supportive shoes (such as trainers).  This will allow your feet to breathe and recover from the restriction that heels tend to cause.

  • Completely flat shoes such as ballerina pumps can be even worse than heels as they offer no support at all for your feet.  Try and ensure any shoes have some cushioning and good arch support.

  • Foot with arch supportIf you are struggling with footwear, speak to a physio or Podiatrist.  Many people have reduced medial arches or ‘flat feet’, which causes an over-pronation at the ankle, which increases the risk of sprained ankles and knee pain.  Wearing shoes with inner-arch support can provide huge relief from the pain associated with flat feet and plantarfaciitis.  A health professional will be able to advise on whether your footwear has sufficient support.



High heelsIn conclusion, there are ways to enjoy your favourite footwear but be aware of the risks to your joints.  Consider taking the steps above to reduce the risk of pain and injury whilst enjoying your best shoes.

Happy high heel-wearing!!


Naomi Sofer, Specialist Physiotherapist

May 2017

Slipped Disc and Back Pain explained

What is a slipped disc?

Slipped disc MRI -KB annotated
An MRI of a lumbar spine, demonstrating a slipped disc. The disc fluid bulges out, putting pressure on the spinal cord, causing pain in the back and/or the buttock, thigh or feet.

The spine is made up of 24 vertebrae, with soft, gel-like intervertebral discs that sit between each spinal vertebra.  The discs act as padding, absorbing impact and reducing shock to the spine during daily movements.

A ‘slipped disc’ is usually associated with trauma or an accident.  The outer-shell of the intervertebral disc becomes damaged, allowing the gel inside to leak out. The discs lie directly over the spinal nerve root, causing the protruding disc fluid to pressurise the nerve, causing localised back pain. When the nerve is pressed or irritated, people can experience neural symptoms, including numbness, tingling or weakness in the affected area.  Often, the sciatic nerve is compressed, resulting in sciatica or nerve pain into the buttocks, thigh or feet.  A ‘slipped’, ‘herniated’ and ‘bulged’ disc all refer to the same type of injury.  The diagnosis indicates the percentage of leaked disc fluid, and whether or not the nerve has been affected.

What causes a slipped disc?

A slipped disc is often but not always associated with trauma or a bending forward motion. With age, the discs lose some of their water content, making the disc less spongy, and more susceptible to injury following minimal strain. Sometimes twisting or turning whilst lifting heavy objects can cause a sudden sharp back pain.  The pain can be specific to the lower back, or cause burning or tingling down the leg.  Typically, people feel pain on one side only, however it can be more generalised across the lower back.

Management of a slipped disc

According to NHS statistics (2016) a third of UK adults experience some form of low back pain, although only 1 in 20 have a diagnosed disc issue.  Although anyone can suffer with low back pain, slipped discs typically affect people aged between 30-50.  Men are twice as likely to be affected by a slipped disc as women.

If you have slipped a disc, there are different management options available. Often, the pain improves naturally over time as the disc eventually shrinks away, reducing pressure and relieving pain on the nerve (see the Case Study at the bottom of page). This can take 6-8 weeks, or sometimes longer. A combination of pain-relief and physio can usually help to relieve the inflammation, tightness and pain in the back and legs.   A Physiotherapist will assess you and use a range of techniques to speed up healing, reduce pain and increase flexibility.  In severe cases, patients may need to consult an Orthopaedic Surgeon who will advise whether surgical procedures or steroid injections are necessary.

Self-management of a slipped disc or low back pain

If you suspect that you have a slipped disc, try to keep mobile and doing your usual activities. If you rest for too long, your joints may stiffen up further, exacerbating your back pain. You may need to take pain killers or anti-inflammatories and rest from the aggravating factors. This will keep your spine flexible, keep your muscles strong and help to speed up healing.  Pilates is an excellent way to help manage low back pain in the long-run.  This type of exercise has been shown to strengthen the core muscles, improve lumbar stability and control, and consequently prevent recurrent injuries.  A physiotherapist can advise when to start core strengthening exercises as part of your treatment programme.

Case Study:  The scan below belongs to a 29 year old woman who presented with pain and tingling in her right leg.  The patient had a steroid injection, as well as a course of physiotherapy, including massage, stretches and core strengthening. Within five months, her disc herniation had resolved, the pain and paresthesia had gone.  (Hong, J & Ball, P (2016) N Engl J Med 2016; 374:1564)

MRI of a lumbar spine showing slipped disc before and after treatment
MRI of a lumbar spine showing slipped disc before and after treatment Figure A: MRI at the time of injury; the yellow arrow shows a lumbar disc herniation and nerve root compression. Figure B: MRI at 5 months post-injury; the green arrow shows the disc is no longer compressing the nerve or spinal cord (white/grey column next to the vertebrae), with complete resolution of the slipped disc.


If your back pain is worrying you, please contact us to discuss how physiotherapy could help you.

Naomi Sofer, Specialist Physiotherapist

March 2017