How to Wear High Heels and Avoid Injury

High-heeled shoes are a popular fashion choice, but wearing them can lead to foot pain and injury. Some common injuries and pain associated with wearing high heels may be prevented with the following steps. 

Foot Pain and Stress Fractures

High heels are designed to point the foot down to give your leg an attractive slender look. However, this position puts a lot of pressure on the ball of the foot, and the toes must bend up to mee​t the ground. This moves the natural padding out from under the ball of the foot, adding to the pressure placed on the ball of the foot (metatarsal heads). The pain created at the ball of the foot is called metatarsalgia.
The higher the heel, the higher the pressure on the ball of the foot. In fact, the force on the bones over time may cause the metatarsal bone to break without injury. This is called a stress fracture.
Tips to avoid metatarsalgia and stress fractures:
  • Wear a lower heel height – the lower the heel, the less pressure on the ball of the foot
  • Look for a wider toe box with a shape that matches your toe shape – the more pointed the toe of the shoe, the more the toes are crowded together, with more pressure on the ball of the foot
  • Limit the amount of time wearing high heels – longer time in high heels puts more pressure on the bones of the feet, which increases the risk of pain and stress fracture 

Heel Pain

Heel pain can occur after frequent wearing of high heels as the higher heel leads to shortening of the calf muscles. The tight calf muscles must then stretch when walking in a flatter shoe or barefoot. This can create a painful pulling sensation at the rear or bottom of the heel.
Tips to avoid heel pain:
  • Limit the amount of time wearing high heels and not everyday – the more time in the high heels, the more likely the calf muscles will become contracted

Toe and Toenail Deformities

While wearing high heels, the foot slides down until the toes jam in the front of the shoe. The toe box is often pointed, further crowding the toes and toenails. Bunions and hammertoe deformities (crooked toe positions) can occur from the crowding of the toes. Bunions and hammertoes are not only cosmetically ugly, but may be associated with pain. Once these deformities become painful, changing shoes or surgery is often the only treatment.
As the toenails rub against the shoe, there may be damage that causes deformity and makes the nail prone to fungal infection. This fungal infection is called onychomycosis, and it is very difficult to treat.
Tips to avoid toe and toenail damage:
  • Wear a lower heel height – this will reduce sliding and lower the pressure on the toes and toenails
  • Look for a wider toe box – the more pointed the toe of the shoe, the more crowded the toes will become, and as a result, the more the toenails will rub against the shoe
  • Consider a more open, strappy, sandal-like shoe – these shoes do not touch the toenails
  • Limit the amount of time wearing high heels – the more time in high heels, the more the toenails will be damaged 

Sprains and Fractures

Ankle and foot sprains as well as fractures may happen when wearing high heels. In high heels, the foot is pointed down, which makes it easy to sprain or turn the ankle. The higher the heel, the more the body weight is pushed forward. The wearer must lean backward and use more lower leg muscle power to maintain balance. The higher the heel, the higher the risk of losing balance and injuring the foot or ankle. Ankle sprains, ankle fractures, or even foot fractures can occur and some may be serious requiring surgery.
Tips to improve your stability when wearing high heels:
  • Strengthen your lower leg muscles to improve balance
  • Wear a lower heel height – the higher the heel, the more unstable
  • Consider a heel with a wider sole – the more narrow the heel, the more unstable
  • Practice walking in high heels – some shoes require more balance
  • Use caution in crowded conditions, when drinking alcohol, and when fatigued, as well as on uneven ground, wet surfaces, and ice
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon​" tool at the top of this page to find a foot and ankle orthopaedic surgeon in your area or contact your primary doctor.