Kitten heels, pumps, stilettos — they’re fashionable, trendy and, in some cases, even required by company dress code. But no matter the height, shoes with heels on them can be harmful to your back.

How heels hurt your back

Your feet are the foundation of your entire body, so when the whole of your foot isn’t planted firmly on the ground, it can throw your entire skeleton off and change your center of balance. Wearing heels shifts your body weight to the balls of the feet. As a result, your knees and hips shift forward while your back hyperextends to help maintain balance. This unnatural sway puts unnecessary stress on your lower spine.

Long-term consequences of this posture can range from chronic lower back pain to back spasms and even arthritis. While your legs may look good when you wear heels, is it really worth the damage to your back?

Heels and foot damage

And it’s not just your back that suffers when you wear high heels. In heels, your feet are at risk of nerve and bone damage. With all your weight shifted to such a small part of your body, it’s easy to see how your feet can take the brunt of the damage. According to the College of Podiatry, women have approximately four times as many foot issues as men.

Walking in heels also stiffens your Achilles tendons, and over time, wearing high heels can shorten the tendon, making walking painful. Your knees can take an extra hit from all the added stress, increasing your risk for knee problems and osteoarthritis and your hips are thrust forward, which can cause lower back pain.

Health tips for heel-wearers

If you choose to wear heels (or if they are required at your office), here are a few tips to help your feet and back:

Limit the time you spend walking in heels to about three hours a day. Give your back a rest and stick with flats most of the day.
Alternate between heels and flats. If you wear heels one day, wear flats the next. Varying the height of your heels can also help, as it allows the Achilles tendon to stretch.
Choose shoes with a wider toe box to give your feet more room and help prevent foot problems like bunions and hammertoe.
Opt for wedges. The platform helps lower the incline of the shoe, which can reduce stress on your feet, knees, hips and back.

Of course, the best option is to wear flats whenever possible and avoid the undue stress on your feet, knees, hips and back.