While they may seem like a modern convention, shoes that elevated height have been a fashion statement for literally thousands of years. In ancient Egypt, while the lower classes went barefoot, murals dating from 3500 B.C. show upper class women—and some men—wearing a clear precursor of the modern high heel. Egyptian butchers also wore heels to keep their feet above the blood of dead animals. In ancient Greece, platform sandals called kothorni were popular. In ancient Rome, prostitutes were easily identified by their high heels. During the Renaissance, shoes made with high wood or cork soles were used in theater productions: the taller the height of the actor, the greater the social status of his character.
Today’s women wear heels to make them look taller, feel more glamorous, and to be fashionable. The trade-off is pain. High-heels shoes affect the body’s center of gravity and negatively impacts back support and posture. Heels can also cause foot problems as well as exacerbating existing issues.
Wearing high heels puts a woman’s feet in a downward position, which places additional pressure on the forefoot. The wearer has to adjust the rest of their body to compensate and keep their balance. The lower part of the body leans forward but the upper body has to lean back. This kind of poor alignment can cause muscle overuse and back pain.
High-heeled shoes can also cause feet and ankles to turn outward, putting the wearer at risk for losing balance and spraining ankles. The change in position puts pressure on the back of the heel, where it can affect the Achilles tendon and causes Haglund’s deformity, also called pump bump.
The back’s natural curve acts as a kind of shock absorber, reducing stress on the vertebrae. Wearing heels flattens the low-back spine flattening and causes a backward displacement of the head and spine.
The legs joints are also impacted. The downward position of the feet force the hip flexor muscles in the thigh have to work much harder. Chronic overuse of the hip flexors can cause the muscles to shorten and the spine to flatten. Because heels increase the distance between the floor and knee, there’s an increased danger of osteoarthritis. And the regular pressure on the bottom of the forefoot can cause bunions, hammer toes, and neuromas.
If you must wear heels try to minimize the potential damage. Avoid ultra pointy shoes and open back or slide-on shoes that require the toes to grip a lot. The former cause bunions and neuromas; the latter brings on hammer toes and foot tension.
The best heel is no heel but the next best thing is a two-inch heel, which will cause less long-term damage than your average stiletto.