Keeping your joints healthy is important, right? Most people take it for granted that their joints work smoothly when they’re young, but as age sets in, joints become noisier, stiffer, and sometimes painful. The most common form of knee joint damage, unrelated to a direct injury, is osteoarthritis, a degenerative form of arthritis that eats away at the cartilage that lines the tips of your bones and helps absorb shock. While osteoarthritis is primarily degenerative or related to “wear and tear, “experts now believe there’s an inflammatory component as well and this inflammation contributes to the destruction of the joint cartilage.
Regardless of the cause, there’s a good chance you’ll have osteoarthritis at some point in your life. In fact, over half of people over the age of 65 have evidence of osteoarthritis on x-ray. Age is the biggest risk factor, but biomechanical factors, injury, genetics, body weight, and gender are risk factors as well. Osteoarthritis is two-fold more common in women and in people who are overweight or obese.
So, you say you’d like to lower your risk? First, control your body weight. We know that obesity places more biomechanical stress on the knee joints and alters body alignment. Plus, fat tissue produces inflammatory chemicals called cytokines that can hasten the development of knee arthritis. But, there’s one factor that orthopedic specialists believe may contribute as well and that’s wearing high heels.
Are Your Shoes Damaging Your Knee Joints?
You probably don’t think of shoes as placing you at risk for knee pain due to arthritis but wearing them day in and day out may eventually lead to joint issues. We already know that osteoarthritis is twice as common in women relative to men – and women are the gender that wears ultra-high heels. So, there is a correlation between heels and arthritis, although correlation doesn’t necessarily show causation. But is there a causal link between wearing high heels and the risk of developing arthritis of the knee? That’s a hard one to prove, although heels can impact how you walk and stand.
In one small study, researchers asked 14 healthy women to walk in various types of footwear from high-heels of various heights to flat, comfy athletic shoes as they monitored their gait. They challenged the participants to vary their walking speed and to wear a weight vest during some trials. The weight vest increased the weight the women carried by 20%.
The results? The women’s gait changed when they wore high heels and the heels also altered knee biomechanics in a way that placed extra strain on the knee joints. Based on these observations, the researchers hypothesize that, over time, these gait changes could damage knee cartilage and increase the risk of osteoarthritis. While this study didn’t show that wearing heels causes osteoarthritis since they didn’t follow the women longer term to see if and when they developed the disease, it suggests that heels alter walking gait in a way that could be damaging to cartilage. Also, keep in mind that this was a small study.
The take-home message? Walking in heels changes how you walk and seems to place added stress on the knees. If you combine this with other risk factors, like obesity and genetics that favor osteoarthritis, wearing high heels could speed up the process. So, wearing heels could be one more stress on knees that are already predisposed to developing osteoarthritis.
Why do heels place more stress on knee joints? Wearing heels changes your entire body alignment by pushing your weight toward the balls of your feet. Your lower back pushes forward to compensate and this places added pressure on your knees. Your back bears some of the burdens too and you might end up with a bad case of lower back pain if you wear them often.
How high is too high? You’re pretty safe with heels that are two inches or less. You probably won’t boost your risk of knee osteoarthritis by wearing higher heels once in a while but wearing them most days and for an entire workday creates a lot of added stress your knees don’t need. If you combine that with being overweight or obese, the stress on your knees is amplified even more. If you have to wear heels daily due to work, visit a podiatrist and get shoe inserts that help refocus your weight back toward your heels. Also, make sure you stretch your calves after wearing high heels.
Keep Your Joints Healthy with Movement
Did you know that movement is what delivers nutrients to the joint? Within the joint capsule is synovial fluid, a fluid that helps absorb friction and nourish the cartilage the lines the bones within the joint. When you contract muscles, it circulates the synovial fluid, so it can better nourish the cartilage. That’s why moderate exercise is a joint-friendly activity. In fact, an Australian study that followed almost 300 middle-aged men and women, comparing their level of physical activity with knee imaging studies, found that those who took part in vigorous weight-bearing activity had the healthiest knee cartilage.
Although not all studies show people who exercise have better knee cartilage, they also don’t show harm in people who already have healthy knees. In fact, a study among runners found that running doesn’t boost the risk of osteoarthritis of the knee. According to the Arthritis Foundation, exercise even turns on genes that help repair joint cartilage. So, lacing up a pair of exercise shoes, rather than high heels, may be your best defense against knee osteoarthritis.
The Bottom Line
Moderate exercise is good for your knee joints but wearing high heels probably isn’t. Wear them on occasion but don’t strap on higher heels every day of the week. Studies also show that we tend to move less and burn fewer calories when wearing high heels. So, heels can be damaging to your health in more ways than one. Make friends with a snazzy pair of flats and wear them often.
Osteoarthritis Cartilage. 2010 Jan;18(1):24-33. Epub 2009 Sep 2.
NHS Choices. “Wearing Killer High Heels Could Lead to Osteoarthritis, Study Warns”
Harvard Health Publishing. “Exercise and Your Joints”
Arthritis Foundation. “How Exercise Helps Your Joints”