Are Your Shoes Causing Your Back Pain?

Inspired by the Boston Marathon runners? Before you head out on your first run, check out these tips from Dr. John Giurini, Chief of the Division of Podiatric Surgery at BIDMC, who 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 your feet are mechanically unsound, they can change the alignment of all the structures above them. I often see patients with mechanically "unsound" feet who are experiencing knee, hip and back pain. By wearing shoes that don't give the proper support, they can make the problem worse. Part of any evaluation for low back pain should be to look below, including the feet.

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

A. It's possible. 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, how it functions in gait and how your 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 the lower extremity alignment. 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.

Q. So are sneakers your best bet?

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

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

A. You should really look at the rigidity of the heel. The heel counter–the structure that wraps around your heel to help hold it in place–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.