For many women, wearing heels is almost second nature. They're not just a way to make an entrance at an evening party, wedding, or birthday celebration, they instantly elevate your look, adding height, poise, and confidence.
But beneath the glamour, every step in heels changes how your body moves. Worn for long periods, they can lead to back pain, frequent sprains, and even subtle shifts in your posture that, over time, become hard to reverse.
To understand why this happens, Dr Lumbasi Lutomia, a consultant Orthopaedic Surgeon at Aga Khan Hospital, explains that the ankle is a mortise joint, made up of the shinbone (tibia), the lower leg bone (fibula) and the ankle bone (talus).
"Just like in carpentry, the carved-out slot holds a perfectly shaped block that sits snugly to keep it steady, yet still able to move when you walk," he explains.
The talus is shaped so that it's wider at the front and narrower at the back. When your foot is flat on the ground, roughly a 90-degree angle between your leg and your foot, the wider front part sits in the slot, locking the joint firmly in place.
This makes the ankle stable, with the bones in solid contact on both sides.
But when you wear heels, Dr Lumbasi says, your foot points downward and that 90-degree angle disappears.
"The narrower back part of the talus moves into the slot, leaving extra space around it. With less grip from the surrounding bones, the ankle becomes looser and less stable — which is why it's much easier for it to roll or twist, leading to sprains."
Additionally, your whole posture changes. The natural curve that runs from your hips down to your knees becomes shorter, which affects how your knee moves and often makes you lean slightly forward.
This shift also affects your hamstrings, the muscles at the back of your thighs, which in turn pull on your pelvis, causing it to tilt. Because the pelvis and the back are closely connected, tilting the pelvis also tilts your lower back.
Over time, what started as a change in your foot position can lead to a misaligned back, and if you keep it that way for long periods, you may start experiencing back pain.
"As you get older, your body's ability to compensate for these posture changes becomes less effective. You might find that whether you wear flats or heels, you still feel discomfort because your muscles and joints have adapted to an unnatural position."
Dr Lumbasi sees about 15 patients in a week, half being women, with issues from shortened muscles that need stretching, back pain."
For many of these patients, physiotherapy helps retrain the body; teaching proper posture, stretching tight muscles, and strengthening the lower back.
"Like, people who sit in offices for long hours often shorten their hamstrings. When they finally stand, the sudden stretch can cause discomfort. To compensate, they may hyperextend their knees, which tilts the pelvis and alters their posture even more, creating a cycle that can worsen back pain over time."
So, if you sit for long, Dr Lumbasi advises stand up for an hour and stretch a bit. "Alternatively, in the evening, try to stretch your hamstrings, walk around, tone your back…do some exercises."
What about kitten heels or broad heels, do they have similar effects? "It is about the height of the heel. The higher it goes, the more likely it will start causing problems. The rule is don't make it a habit."
