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Are Your Shoes Causing Your Back Pain?

Dr. John M.Giurini, Chief of the Division of Podiatry at Beth Israel Deaconess Medical Center, talks about the importance of choosing the right shoes, not only for your feet, but for the health of your back.

Q. Dr. Giurini, can you explain how your shoes affect your spine and back?

A. Feet are like the foundation of a building; they are the foundation of the body. If the feet are mechanically unsound, they can change the alignment of all the structures above them. I often see patients with a mechanically "unsound" foot who are experiencing pain. By wearing shoes that don't give the proper support, they can exacerbate the problem. Part of any evaluation for low back pain should be to look at the structures below, including the feet.

Q. So your shoes can contribute to or exacerbate back pain?

A. It's a definite possibility. If a person is having low back pain and the physician can't find a cause within the back itself, we need to look at the foot and how it functions in gait and how the entire lower extremity is aligned. In some cases, more supportive shoes or a shoe insert may help solve the problem.

Q. What do high heels do to the alignment of the body? Is there a "safe" heel height for women?

A. High heels throw off your alignment. They change the center of gravity, causing extra stress and strain on the lower back, so you're not walking in a natural position. The lower the heel, the better. I advise my patients that a one- to one-and-a-half inch heel is acceptable, but anything beyond that is too much.

Also keep in mind that heels aren't made for long durations or distances. I see a fair number of women who need to wear heels in a professional environment, and I advise them to wear these shoes as little as they can. When walking to work or to-and-from the subway, wear sneakers, then switch to heels once you're in the office.

Q. What about less supportive shoes, like flip flops?

A. If you wear flip-flops for a long period of time, the lack of support can lead to stress and strain on joints and tendons. If you have a mechanically unsound foot to begin with, wearing flip flops can actually lead to a host of lower extremity problems, such as arch pain, heel pain, ankle pain or knee pain. In my opinion, flip flops are for the beach and the pool and that's it, not for walking for any length of time and certainly not for any kind of exercise.

Another example is the popular "Crocs" shoes. While they may provide some shock absorption, they do not provide much in the way of arch support or ankle support. They essentially have no heel counter (which is the back of the shoe).

Q. So are sneakers your best bet?

A. Yes. Sneakers or any shoe with a rigid heel counter (the back of the shoe) and a rigid midsole provide the best support, and shoes with laces typically provide better support than loafers or shoes with Velcro straps.

Q. Can using insoles or inserts help with back pain?

A. They can help, and certain foot types will benefit from the extra support.

Q. Finally, what should you look for when shopping for shoes?

A. You should really look at the rigidity of the heel counter (back of the shoe). The heel counter should be vertical, not tilting to one side or the other. Shock absorption is also important, because the shoe will absorb more shock and transmit less shock to the entire lower extremity, including the back. Most good walking and running shoes incorporate many of these factors into their design.

Above content provided by Beth Israel Deaconess Medical Center.
For advice about your medical care, consult your doctor.

Contact Information

Spine Center
Beth Israel Deaconess Medical Center
Shapiro Clinical Center, Second Floor
330 Brookline Avenue
Boston, MA 02215
617-754-9000
spinecenter@bidmc.harvard.edu

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