Muscles, tendons, and high heels


Ladies, this one is especially important for you, but men, don’t think you’re exempt from reading and learning. 

Nothing spells sexy and glamorous like a sleek pair of patent high heeled pointed shoes under some dress pants or a skirt, but have you ever noticed how sore your feet get after 30 minutes–even if you can walk in them and they’re reasonably comfortable shoes?

You may be feeling great, but chances are your feet aren’t…

While we’re taking it to the extreme end of toe crunching with the sexy 4” stilettos for the ladies, men also experience the same kind of toe-crunching effect when they throw on the long, semi-pointed toe dress shoes. At the end of the day, both shoes create the same effect--shifting the big toe laterally and ultimately creating misalignment.

So, if you thought it was difficult to walk in pencil-thin high heels, imagine trying to walk, balance, jump, or any other movement when your big toe is completely out of place…

It becomes a bit more challenging than you thought, and throwing on those gorgeous heels for a night out with your girls may not seem like the best idea after all--and it may not actually be worth it. 

The issue with heels

For anyone that’s ever thrown on a pair of heels, you know darn well that they’re not the most comfortable shoes out there. Your toes are squished, your arches are stretched, and your foot is in one of the most unnatural positions it can be in. But the pain of heels extends far beyond just the physical pain you feel after a couple of hours on your feet. 

Those pumps that you thought were so perfect can actually create the perfect storm for permanent health problems. If you frequently walk around in heels, you’re essentially setting yourself up for long-term issues if you’re not working on corrective exercises when you aren’t wearing them. Not only does wearing heels bend the toes into a completely unnatural position, but it can also cause a wide range of problems like ingrown toenails, leg tendon issues, nerve damage, and bunions. Heels have also been linked to overworked or injured leg muscles, osteoarthritis of the knee, plantar fasciitis, and low back pain.

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The reason why is because those gorgeous 4” heels you’re rocking cause your foot to slide forward to the toe, which forces the toes closer together into an unnatural shape, thereby redistributing your weight incorrectly. Increased weight on the toes causes your body to tilt forward and to compensate for this, you lean backwards and overarch your back, creating the perfect posture for adding stress to your knees, hips, and lower back. This change in position of your spine puts pressure on nerves in the back and can lead to sciatica. Over time, wearing heels can also shorten the muscles in the calves and back, which can result in pain and muscle spasms. 


Simply put, any time you wear shoes that restrict the natural shape of the foot–whether heels or not–you’re drastically increasing the risk of pain, malformation, and dysfunction of the entire kinetic chain above it. Many times this can result in shortening of the Achilles tendon because once the heel is pointed upwards, it tightens, so switching to flat shoes where it needs to be back in its natural position can be really uncomfortable and painful, and can even lead to plantar fasciitis. This tendon is designed to be flexible so that the foot can lie flat or point, but with repetitive wear, you increase the risk of developing unhealthy movement patterns in the feet that can persist even when you’re not wearing heels.


Long story short, heels are one of the most common causes of:


  • Forefoot injuries: Unlike flat shoes that distribute body weight evenly across the foot, high heels shift all of the bodyweight towards the ball of the foot, which increases pressure on the ends of the metatarsal bones and the joints between the toes and feet, thereby increasing the risk of stress fractures and neuromas.
  • Arch strain: It’s pretty obvious to the naked eye that the arch isn’t in a natural position in heels, which strains the arch of the foot and positions it so that it is always pointing downward. Over time, this can contribute to intense pain when barefoot or wearing flat shoes. 
  • Heel pain: Heels also cause an increase in pressure on the back of the heel bone and can lead to the development of Haglund’s deformity, a bony growth that you sometimes hear referred to as a “pump bump.” Not only that, but heels cause shortening of the Achilles tendon, which increases the risk of plantar fasciitis.
  • Toe injuries: Aside from causing pain, pointed-toe shoes squish the toes together in an unnatural V shape, which can lead to foot deformities like hammertoes, bunions, and ingrown toenails.
  • Sprained ankles: The awkward positioning of the foot inside the shoe can make it difficult to walk normally and alter balance. For some people, heels contribute to numbness of the foot or toes, along with heels that become stiff, which shifts your weight and can increase the risk of twisting your ankle when you walk.
  • Posture and gait problems: Heels don’t just change the way your foot functions, they can actually impair the entire body mechanics of how you walk, stand, and carry your weight. These changes in the kinetic chain lead to changes in posture, which can place undue stress on the knees, hips, and lower back, thus causing pain and complications throughout the entire body--not just in the feet.

On muscle, tendon and high heels: The study

A 2010 study published inThe Journal of Experimental Biology looked at the relationship between muscles, tendons, and high heel wearing [1]. They suggested that wearing high heels places the calf muscle-tendon unit (MTU) in a shortened position, and because the muscles and tendons are highly malleable tissues, the chronic wearing of heels can lead to structural and functional changes in the calf MTU. 

Researchers tested this hypothesis using 11 women who regularly wore high heels against a control group of 9 women. They assessed the relationships of the following factors:

  • Gastrocnemius medialis (GM) fascicle length, pennation angle, and physiological cross-sectional area (PCSA)
  • Achilles’ tendon (AT) length, cross-sectional area (CSA) and mechanical properties
  • Plantarflexion torque–angle and torque–velocity 

They found that the group wearing heels exhibited shorter gastroc fascicle lengths, which resulted in greater tendon-to-fascicle length ratios. As well, because there was greater Achilles’ tendon length and cross-sectional area, ths also increased stiffness in the group wearing heels. 

But interestingly, they didn’t find any difference between both groups with respect to GM PCSA to AT CSA ratio or torque–angle and torque–velocity. As such, they concluded that long-term wearing of heels induces shortening of the GM (calf) muscle fascicles and increases Achilles’ tendon stiffness, thereby reducing the ankle’s active range of motion. When the ankle becomes tight and immobile, it throws off movement in the rest of the body and leads to compensation and dysfunctional movement patterns. 

The fix

So, how do you fix this?

The first step is pretty obvious--avoid wearing heels whenever possible! But we totally understand that sometimes throwing on pumps are necessary for a meeting, night out, or another event, and even if they are, opt for lower heels as opposed to the 4-5” platform stilettos. 

Otherwise, here are a few tips:

  1. Find the right fit: A good fit for any shoe is critical, but you want to find a heel that is comfortable when standing and won’t cause your foot to slide forward when walking. Rounded or open-toe shoes are generally better than pointed toe boxes, and adding a soft insole can help to reduce pressure and strain on the foot.
  2. Take a break: If you’re going to be on your feet for hours on end, consider wearing flat shoes instead of heels. If wearing them is necessary, stretch your feet every so often; bend your toes, flex your Achille’s tendon, and relax your calf muscles.
  3. Switch it up: If you wore heels to your last event, opt for flats this time. Switching between flat shoes and high heels gives your feet a chance to recover and reduces the risk of pressure injuries like blisters and corns.
  4. Go barefoot: When you’re walking around home or at the gym, take your shoes off. This allows your feet to be in their natural position and gets the toes splaying and properly aligned as they should. If you want to take it a step further, use yourToe Spacers. They’ll help to counteract the unnatural toe box shape of most high heels and support the realignment of the big toe into the proper position.

Stretch: Once you kick off your heels, don’t forget about stretching and strengthening your feet. While it can be tempting to just throw them off and leave it at that, you want to focus on stretching out all your feet and leg muscles that have just been squished and cramped into poorly fitting shoes.