High heels aren't the only culprit, either.

By Deanna deBara
December 17, 2019

Shoes serve a variety of purposes. They can be functional (think running sneakers, which help you train for a marathon) or fashionable (like a great pair of joggers or sandals that showcase your personal style). Regardless of their place, choosing the wrong pair, for whatever activity, can lead to an unintentional, and seemingly unrelated, ailment—serious aches, pains, and issues with your back. Ultimately, your shoes have a major impact on the way your back feels. Ahead, exactly how your go-to pair of heels or commuter flats might be aggravating your overall alignment, according to the experts.

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Related: Strengthening Exercises to Help Prevent Lower Back Pain

High heels are the leading cause of back pain.

If you're someone who loves a sky-high stiletto, we have bad news. "High-heeled shoes are the biggest culprit for causing back pain," says Dr. Melissa Galli, DPM, of The CORE Institute. "In general, the higher the height of the heel, the greater the risk the shoe poses. Our foot fashion alters the position and stresses through the body's foundation and, thus, affects other joints in the lower extremity and spine." As for how stilettos cause this? "High-heeled shoes will relax some muscles while creating excess tension in others. This imbalance from simple height differences is often reflected in the lumbar spine," explains Lance M. Silverman MD, FAAOS, of Silverman Ankle & Foot in Minnesota. "As the pelvis tilts abnormally, whether front or back, to the left or the right, more than a dozen joints in the lumbar spine must accommodate. Longer term positioning leads to over-strengthening of one set of muscles and relaxation of a whole other set. We define this as torsion ([or] twisting), and constant torsion is not healthy to bones and joints."

Unsupportive shoes are also unsafe.

Shoes without enough arch support are also a recipe for back pain—especially if you overpronate. "If patients have a foot that overpronates (becomes flatter when walking), a flip-flop, sandal, or shoe that doesn't support the arch of the foot can have extremely deleterious effects," says Galli. "This causes the ankle and knee to become valgus, which throws off the center of gravity and perpetuates existing problems." In addition to finding supportive shoes overall, it's also important to choose a pair that gives you the right level of support for the surface you're going to be walking or running on. "If there isn't enough support in shoes when you are running on loose sand, you can exacerbate the lower spine and lower extremity muscles. This can cause excessive cramping," says Galli. "Likewise, if you work on concrete floors all the time and do not wear padded shoes, your legs and back can become more lethargic quickly."

Changing your go-to shoe can also cause problems.

It's not just the type of shoe you wear that can lead to back pain: Changing your shoes (whether you're swapping out your favorite worn-out joggers for a new pair or transitioning from wearing sandals in the summer to boots in the fall) can also lead to increased levels of back pain—sometimes temporary, sometimes more long-lasting. "All shoes encourage a different foot strike than a bare foot. Anytime we make a change, there will be unpredictable effects," says Silverman. "Many people and athletes notice back pain when they change their footwear; sometimes it is a breaking-in period, sometimes it creates significant dysfunction."

Ultimately, choosing the right shoe is critical.

Clearly, shoes can play a big role in how your back feels—which is why choosing the correct ones for long-term use is critical. "The best types of shoes for avoiding back pain are ones that are flat-bottomed or rocker-bottom soles that are stiff without a heel," says Galli. "These shoes prevent movement of your center of gravity and require less push-off strength while walking, thus encouraging correct alignment without fatigue."

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