Why high heels are worse than smoking

How to kick the habit before you get sick

Teetering on the brink of bad health

Photograph by Jessica Darmanin

Are high heels as bad for you as smoking? Biomechanist and foot expert Katy Bowman thinks so. She realizes that is a bold statement, but she stands by the analogy. “The cigarette was once very fashionable. It was very alluring. It was sexy,” says the author of Every Woman’s Guide to Foot Pain Relief: The New Science of Healthy Feet. “Now we look differently at people who smoke. I think within our lifetime we’re going to start seeing a high heel as a reflection of low self-esteem.”

At five foot six inches Bowman no longer wears heels. In fact, many of her shoes have “negative heels,” where the shoe slopes downward from the ball of the foot.

In the book, she explains how “positive-heeled” shoes are causing chronic health problems, from nerve damage to arthritis. “The heel is quickly becoming the most researched component of footwear, as this particular part has the ability to radically change the geometry of the human body,” she writes. “Just placing a little wedge under our foundation causes compensatory actions in the ankle, knee, hip and spine, and can knock our natural gait pattern off kilter—and it does this in an instant!”

She claims this misalignment may also contribute to osteoporosis, because it tilts the body forward and decreases the weight put on the hips. This reduces the signal the body needs to build bone, so the part of the hip most sensitive to bone loss builds less bone. “All because of your footwear choice,” the author writes.

For lifelong wearers of heels, chances are your calf muscles have shrunk. “That’s why I say don’t just throw away your heels,” Bowman says in an interview. “You’re going to have to do an exercise training program and buy a heel that’s a little bit shorter.” An abrupt switch from high heel to flats may rip the Achilles tendon, she warns.

In the book, Bowman writes about a female news anchor she saw interviewing a doctor about the health risks of wearing heels. The anchor was adamant she would never give up her heels. “I couldn’t help but think that this attitude of knowingly doing harm to one’s own body is, let’s face it, really stupid. The science is there. The research is there. The pain is there. The visits to the doctor are there.”

In Manhattan, podiatrist Dina Tsentserensky confirms most of her clientele are women suffering chronic pain after wearing too-tight shoes like pointy high heels. Customers ask if their baby toe can be amputated so they can fit into narrower shoes, or if they can make their feet smaller. “We can’t reduce the size of the foot, but we can make the foot more narrow,” says Tsentserensky. Several times a week, women pay the clinic, NYC FootCare, $1,750 for a “toe tuck,” where they straighten the baby toe and thin it out by shaving the bone down.

“Ew! Elective removal of foot parts speaks volumes to how poorly people understand the role of feet in balance, pain-free walking, and knee and hip function,” Bowman responds in an email. “Sacrificing healthy tissue for the sake of a fashion trend means that, as a culture, we haven’t moved beyond the days of foot-binding and other self-mutilation.”

Bowman urges women to go barefoot at home as much as possible. For outside, there are “barefoot shoes” that are completely flexible and flat. “Just to come out of a two-inch wedge and put on a nice little new barefoot training shoe that’s cute, you’ve done a huge service to your knees and hips and your feet and all the nerves that come from the sacrum to the toes.”

Avoid flip-flops, mules and slide-on sandals, which require a gripping action with the toes to keep them from flying off. “This gripping action is the same muscle pattern that deforms toe joints into the ‘hammertoe’ position,” she writes.

Women often tell Bowman they are too short to go without heels, but she doesn’t understand that. “Can you not reach the ATM machine? What is your height truly interfering with?”

In the book she says, “Just say ‘No!’ to harmful shoes and ‘Yes!’ to beautiful shoes that not only complement you and your outfit but also the long-term function of your human machine.”

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Why high heels are worse than smoking

  1. I am 59 years old and was nearly crippled with an inflamed achilles tendon. I took pills and had ultrasound therapy to no avail. I researched this condition and most recommended wearing a slight heel all the time. It took a long time but it eventually got better. Now I wear a short heel shoe all the time.

  2. I wear heels when I have a dressier occasion to go to. But I often end up taking them off partway through. I am not trained to wear heels and they always hurt. I am off balance and the tops of my feet seem to take so much stress from holding me up.

    Most importantly, you can’t run away from zombies in high heels! ;)

  3. I work at a restaurant where it is mandatory to wear heels for hours on end- they must be 2.5 inches high. I soak my feet every night after work because it is so painful but my other choice is unemployment. 

    • Maybe you should post this article up at work!

  4. Is it possible….that at long last….this piece of cultural nonsense is OVER?

  5. If you decide to wear high heels for long periods, your best options are probably to learn how to apply therapy to the body parts that are compromised.

  6. Being almost six foot tall and having size eleven feet means wearing tall heals isn’t realistic…thank goodness.  They are cute but defintely not practical.  You can find very nice flats and kitten heels if you search around.  In the meantime a tennis ball works great….you position it along the floor and roll your food over it.  It stretches out the tendons and helps prevent problems like plantars fasciitis (saw it on tv…a tip from a podiatrist).

  7. “The anchor was adamant she would never give up her heels. ‘I couldn’t help but think that this attitude of knowingly doing harm to one’s own body is, let’s face it, really stupid.'”
    Well, perhaps, but it’s a choice many make – I’d argue most do.  Not every decision we make is rational and driven by health concerns, and I suspect they shouldn’t be, either.  We should be informed, and aware of the trade-offs we’re making by, for example, choosing a doughnut over a pear, or choosing to have a piercing, a tattoo, or to wear high heels, all of which come with some increased risk.  But it’s disrespectful to call others “stupid” for orienting their priorities differently.

    “…most of her clientele are women suffering chronic pain after wearing too-tight shoes like pointy high heels.”
    Although not specifically speaking against the heels themselves in this case, sure there’s a connection with putting fashion over comfort.  But again, to argue against this practice is to argue against all cosmetic surgery – which is a perfectly valid position, but again, it is denigrating others for the choices they make.  In this case, it presumes those choosing to go this route are lacking in understanding, or lacking in the fortitude to stand up to cultural pressure.  I dislike it when someone presumes to know the motivations of others – it’s an annoying brand of arrogance: “my position is unassailable, the only way you could disagree is if you’re too stupid to understand”.

    Not sure why this article set me off in this manner, it’s hardly the worst example ever seen of an expert going beyond knowing the science to knowing the best choices for everyone.  Guess it’s a slow day!

    • “We should be informed, and aware of the trade-offs we’re making by, for
      example, choosing a doughnut over a pear, or choosing to have a
      piercing, a tattoo, or to wear high heels, all of which come with some
      increased risk.”

      There’s a huge difference between eating junk food and wearing heels, or worse yet, shaving off part of your toe so you can wear even skinnier heels.  Eating the occasional doughnut is not that big of a deal.  However, wearing heels or removing part of your toe (really think about what that means!) changes your gait and ultimately impacts your knees and hips, and in turn the rest of your body.  When you throw off how you walk you’re asking for pain.

      If a woman only wears heels on a special occasion, it probably won’t have any more lasting effect than eating dessert one night then returning to your healthy diet the next day.  However, most people don’t choose to eat dessert for every meal because everyone knows that would be disastrous for your health.  Wearing high heels every day is just as awful for you.  It boggles my mind when I see “health-conscious” women who refuse to give up their heels despite the chronic pain that they cause.  They are truly crippling themselves for the sake of vanity and/or insecurity, which in my mind makes it even worse than foot binding because it’s self-inflicted.

      • “There’s a huge difference between eating junk food and wearing heels”
        Well yes, the first is much more likely to kill you.

        To make the comparison fair, “eating the occasional doughnut” has to be
        compared with “wearing heels occasionally”, but your first paragraph
        compares occasional snacking to regular heel wearing.

        The second paragraph is fair, but again, this takes us to an area where
        there are choices to make, and the more cautious choice is often not the
        one chosen.  Many people do choose to eat dessert often, and choose to
        eat fast food often, if not for every meal.  Of course this is a bad
        choice, health-wise.  I wouldn’t recommend it, but I don’t think this
        makes these people stupid.

        “They are truly crippling themselves for the sake of vanity and/or insecurity”
        I suggest you commit the dual sins of exaggerating (many women, even
        chronic users, are not “crippled” by heels, though there certainly is a
        risk), and the peeve that brought me here, claiming to know the motives
        of others, denying them respect as autonomous human beings.  “vanity
        and/or insecurity” are the only choices, are they?  What a weak, foolish
        group these high-heel-wearing women are!  Thank heavens we know better
        how to maximize their happiness.

        Yes, I think surgical alteration is extreme.  But then, I also dislike
        tattoos and pierciings, both of which are practiced by many people I
        respect.  Laser eye surgery is unnecessary, is not inexpensive or risk-free, and I find
        it utterly horrifying to picture, but I don’t think those who do it are
        idiots or fools.

    • always thought that women who wore heels were stupid.  my guy friends also laugh at these women.  it’s amazing how easily weak-minded (i.e. dumb) people can be manipulated by advertising and peer pressure!  if everyone jumped off a bridge, would you??  intelligent and secure people think for themselves and do not wear heels!  people say heels are cute – sure, on a shelf, but if you teeter on red heels down the sidewalk, all the guys (and all the smart women) are laughing to themselves at your ignorance.  really just feel sorry for these people making fools of themselves – nothing you can do for them.

  8. I gave up on heels a loooong time ago. Sore feet are just not worth it. But negative heels gave me what many call heel spurs (inflamed tendons) and tons of pain.