If you’ve ever been to physical therapy, then you might have noticed that posture is often a topic of conversation… and usually it’s more about your bad posture. Posture affects things from range of motion, strength potential, and even pain. Let me demonstrate how posture can be affected by something as simple as footwear, and we’ll also look at the implications it has on our joints.
If you’ve been treated at PhysioDC, you may have heard our beloved leader, Dan Baumstark, say that you should never wear high heels. This is a touchy subject for some. For many women in corporate Washington, D.C., not wearing heels is just not an option. And for some women who think that their life is a runway show, not wearing heels is also just not an option. Lastly, if you are a man running in D.C.’s annual high heel races, well, I think you get my point.
The pictures to the right demonstrate a wonderful and talented therapist in athletic sneakers on one side and the same amazingly beautiful therapist in 4 inch high heels on the other side. Notice that in high heels, there is some compensation in posture due to the change in base of support. The head is now forward, the chest is forward, there is increased curvature throughout the lower back, hyperextension of the knees, a non-neutral position of the ankles, and increased pressure on the balls of the feet.
Effects of Wearing High Heels
We will look at the effects of wearing high heels, literally from head to toe.
Forward head: This posture is known to cause generalized neck pain, sensation of stiffness, decreased range of motion, headaches, jaw pain, and can even cause numbness/tingling or weakness down the arm and into the fingers by exacerbating symptoms from a disc dysfunction.
Forward chest: The forward/lifted chest is a compensatory movement to help keep balance. Anatomically, the thoracic spine is actually increasing extension, which can cause muscle tightness and pain.
Increased low back curvature: This is an extension of the forward lifted chest. The buttocks shoot backwards, causing some shortness of the hip flexors and some back muscles. This posture is known to cause generalized low back pain, sensation of stiffness, decreased range of motion in the back and hips, and numbness/tingling and weakness in the legs down to the feet due to possible exacerbation of a disc dysfunction.
Hyperextended knees: This posture tends to happen as a result from increased low back curvature. With hyperextended knees, one can expect generalized achiness from stress on knee ligaments, pain in the kneecaps (patellae) particularly with walking up/down stairs or squatting functions.
Non-neutral ankle: The ankle is now resting in what is called plantar flexion. While this is a normal movement position for the ankle, it is not normal for resting there. This is an open packed position, which basically means that it is where the ankle is least stable. There is increased lateral movement in the ankle here, which can increase the risk of spraining the ankle. This position also maintains shortness of the calf muscles and that shortness can cause cramping, weakness, plantar fasciitis (foot pain), and even an Achilles tendonitis or eventually an Achilles tear.
Weight on the balls of the foot: The position of the toes being extended is necessary with the ankle being in plantar flexion. This position causes pain, as full body weight is now less dispersed throughout the foot, and can also be the cause of painful and unsightly bunions.
Benefits of Wearing High Heels
Now that I have gone through all the awful things that happen when you wear heels, let’s talk about the good things.
- increased height,
- appearance of longer legs
- increased sashay in your step (because the bad posture is making your hips sway from side to side too much, but it’s still cute)
Wearing Heels Responsibly
Because high heels are often times a necessary evil, let’s learn how to wear heels responsibly.
1. Pick the shoe that is right for you.
Figure out if you have a wide or narrow foot. Don’t try to stick your double wide into a narrow pointy toe boxed stiletto. Stick with a wider toe box.
2. Know your limitations.
If you have weak ankles, maybe go for a kitten heel before you go skyscraper high. Also, a chunkier heel will give you a bit more support. A stiletto heel has such a narrow base of support that if you have weak ankles, you had better get acquainted with the pavement, because you may end up there soon. Yes, stilettos are cute and sexy and sassy, but it’s not cute if you look like a baby giraffe trying to walk down the street for the first time, because you are weebling and wobbling all over the place.
3. Prepare yourself.
Wearing a fierce pair of five inch Christian Louboutin heels could be looked at like a marathon. You don’t wake up one day and decide to get off your couch and run 26.2 miles. You train for that. Well, it’s the same thing here. Start small and work your way up if that is what you really want. Strengthen your ankles by doing lateral ranges of motion using resistance bands and/or do balance activities on unstable surfaces like a BOSU.
Hopefully you have been enlightened and will make better choices. If you prepare and choose the right shoe for you, beauty does not have to be painful. But if you don’t, you may call PhysioDC between 9 am and 6 pm to schedule an appointment for when you start complaining about the pain that you are inflicting on yourself.
Image credit: Top © Yuri Arcurs/Fotolia.
Hi, can you recommend business flats that are comfortable and supportive? I’ve been searching for such a brand for years without much luck.
Dan Baumstark, MSPT, CHT says
Dansko’s are great, but they are clinical and a bit ugly I have been told. Some PT’s have said good things about “Franco Sardo” (not sure if that is the right spelling)? They tend to have more accommodative toe boxes and some of them have good support.