How Bad Are High Heels Really?

How Bad Are High Heels Really?

While Podiatrists advise patients to avoid wearing high heels, the reality is many patients will continue to wear them.

So to help you enter the party season but look after your body, here’s a few tips to reduce the damage caused by those killer heals!

Podiatrists treat foot and ankle problems daily that are created when women wear high heels. These include bunions, hammertoes, metatarsalgia, corns, calluses, neuromas, ankle sprains and ingrown toenails to name a few.  All directly caused by or, at the very least, made worse by tight-fitting, high heeled shoes.

I’ve seen it before, the minute my female patients walk out of our office, their sensible shoes come off and the towering Jimmy Choo’s go back on their feet.

To help meet you halfway, it is important that Podiatrists are able to teach women how to make better choices when purchasing high heels and also how to improve the fit of these otherwise ill-fitting shoes.

Most patients understand that shoe sizes vary from manufacturer to manufacturer but there is a common misconception, especially among women wearing high heels, that sizing and fit within a brand are consistent and uniform, this is not the case.  For example, patients will often say, “I can only wear Nine West” or “I can only wear Steve Madden shoes” because they believe that all other brands of high heels do not fit their foot correctly. Nothing could be further from the truth. With any given brand, there will usually be some shoes that fit and others that do not fit. As a Podiatrist it is my job is to educate patients about this fact and guide them toward styles or features appropriate for their particular foot type.

Changing Foot Sizes

Feet measured as a teenager, will not be the same when you are in your thirties, so how long ago did you have your feet properly measured?  I doubt since you were a child if you were honest! Several things change your foot size, these include a woman has had children or patients that gain or lose a significant amount of weight.

Equally patients when asked what size shoe they wear, I often will hear them say a size 9 in athletic shoes and size 8 in high heels. As I gasp, wearing shoes smaller than their measured foot size is one of the worst offenses I see women make when wearing high heels.  You should not need to go smaller in order to keep a high heel on it means there is something wrong with the design of the shoe not the size.

Women are often shocked to learn that when they are correctly measured, they are one to two sizes longer than they thought they were. This in reality is only 0.88cm for each full size increase and 0.44cm (less than half a centre metre) for each half size increase goes a long way to calming anxiety about having larger feet

A large percentage of women I see in my clinic are wearing the wrong size shoe, especially when it comes to high heels. Why? They are relying on heel-to-toe measurements. Unfortunately, heel-to-toe measurements are impossible to use as a guide due to the variability of toe-box lengths. When fitting high heel shoes, the only measurement that matters is heel-to-ball.  Wearing the wrong size can cause metatarsalgia, sesamoiditis or plantar fasciitis.


A short heel-to-ball fit typically occurs in one of two ways.

  1. The arch of the shoe is too short for your patient’s arch either by style or size. This is the case where the foot measurement says size 9 and the patient is wearing a size 8 shoe. No matter how much padding is provided underneath the ball of the foot, this mismatch will always produce metatarsalgia.
  2. The volume of the shoe exceeds the patient’s foot volume and her foot slides forward, losing heel-to- ball support. This is one of the main reasons high heels feel great in the shoe salon but are painful when people wear them outside. There are no hills in the shoe salon. There is only soft cushioned carpeting. Sliding does not occur until the patient walks down the first hill or quickly crosses the street. In this case, the height of the heel pushes the patient’s forefoot forward as she goes.


Volume mismatch will always produce heel slippage and applying heel grips to the inside counter of the shoe will do nothing to help in this case.

This will also result in hammertoes due to the toes gripping as an attempt to stop the slide. Neuroma and bunion formation due to forefoot compression and metatarsalgia due to loss of support, it’s all sounding great don’t you think?


When buying high heels, the exact fit is required.  Not the sale price, as you will no doubt pay the price for ill-fitting shoes later on, either with pain of by visits to see your Podiatrist.

Similar to an orthotic, the more surface area contact a shoe makes with the foot, the more support the foot will have. Women who are otherwise unable to wear a pair of 3-inch high heel pumps can be perfectly comfortable in a pair of 3-inch high heel boots if the heel-to-ball fit is exact. For many women, especially those needing to stand and walk for hours on end, this is a perfectly acceptable option.

T-strap styles styles with an adjustable strap to secure the foot are also good choices for high heels. They keep the foot centered on the arch and prevent it from sliding forward into the narrower toe box part of the shoe.


The outsole width is a frequently overlooked part of the shoe yet it is crucial to proper fit and comfort when one wears a high heel. Many high heel outsoles taper in the waist and this is where midfoot support is needed the most. If the waist of a high heel significantly hourglasses in this area, gait will be unstable and the foot will fatigue more quickly due to a lack of support. Often, the difference between comfort and non-comfort high heels is the width of the outsole. Some high-end designers aware of this fact have recently begun to add a small medial flange to the insole of the shoe just for this reason.

Another way to improve stability is to make sure the pitch of the high heel is perpendicular to the ground. Some high heels are pitched forward, making the heel unstable and prone to breakage or shoe insecurity. The more posterior the heel is positioned, the better the stability.

The most stable high heel is one that has an inflexible forefoot, a firm heel counter and torsional stability. Platform styles in this regard are great as they give the illusion of height as well as torsional stability. Platforms typically have a wide outsole as well. Similar to when we show patients how to twist and flex their running shoes, we should do the same with high heels. The principles of motion control are one and the same.


Women who wear high heels invariably have some that are comfortable and some that are not. To increase the odds of fit success, it is easy to teach your patients how to visually match future high heel purchases to current comfortable high heels in terms of design and fit.

In regard to the comfortable pair of high heels, what is the heel height (2 inches, 3 inches or 4 inches)? What is the design of the heel? Is it narrow and tapered, or chunky and squared? How wide is the waist in the comfortable pair? Does the waist hourglass? How wide is the forefoot in the comfortable pair? I try to teach patients to pass on heels that are not at least as wide in the forefoot as their most comfortable pair.

Shoe Stretchers.

Most shoe repair stores sell a limited variety of shoe stretchers. For patients who have bunions and hammertoes, a high heeled shoe stretcher can mean the difference between comfort and pain. Most patients are not aware there are a variety of shoe stretchers available for almost every challenging foot fitting need.

I recommend that patients use a shoe stretch spray first. Then I have them use the shoe stretcher and instruct them to leave the stretcher in overnight. If the shoe needs to be stretched more, they can repeat this process and leave the stretcher in place for another 24 hours. A shoe repair store can also do this but it is much more cost effective and convenient for patients to do this themselves.

Finally to clarify…

The above recommendations are by no means exhaustive but are instead intended to bring awareness as opposed to adversarial relationship with high heels. Unfortunately, designers are not podiatrists designed high heels. It is also unfortunate that making a shoe look fashionable is not the same as making a shoe fit comfortably, but with a little common sense and gentle guidance, even the most adamant high heel wearing patients can have increased comfort.

If at the end of the day, I can teach you how to avoid the pain but save the style then that is a good thing, so remember this when you hit the post Christmas sales… Keep following as next up I will tell you more about those cute little shoes for babies, again more knowledge you can’t afford to miss!


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