Written by: Lily Hoog-Fry and John Baker
You might think, “How much are my shoes affecting the posture of the other joints in my body?” While individual reactions to footwear vary, given our unique physiologies, certain predictable patterns emerge.
Imagine the body as a series of interconnected blocks. The stability of each block is influenced by factors like past injuries, habitual movement patterns, and genetics.
If one of these blocks is adjusted—for instance, a change in your foot and ankle joint position due to footwear—the surrounding blocks must also adapt to maintain balance. Although your body isn't literally made of blocks, this analogy highlights how a change in one joint initiates a compensatory adjustment throughout your entire structure. In essence, a modification at one joint has a ripple effect on every other joint.
Therefore, shoes that alter your ankle joint can consequently impact the alignment and function of all your other joints.
While we can't delve into every way that habitually wearing shoes adjusts your body’s reorientation, we will highlight key areas. Read on to discover how adopting a barefoot approach might be the most effective way to alleviate pain in your ankles, knees, pelvis, back, AND neck.
Heels Keel You Over
First, let’s draw a mental image and explore the differences between being barefoot and wearing shoes, even "non-heeled" shoes, which often have a subtle heel unless explicitly labeled "zero-drop." Visualize a bare foot, where the leg extends upwards from the ankle at approximately a 90-degree angle to the foot.
Now, temporarily set aside the fact that our bodies are a complex system of joints with varying degrees of flexion and extension. Instead, imagine your body as a static pole connected to your foot on the ground. This simplified mental image allows us to visualize the significant displacement caused by heels.
If the heel of the foot attached to our pole were elevated by just 2 inches, to maintain the natural ankle-foot angle, the pole would lean forward, bringing it 20 degrees closer to the ground (Rossi, 1999)!
With that striking mental image firmly in mind, let’s replace the static pole with the dynamic system of legs and an upper body.
When heels are elevated, our body doesn't simply lean 20 degrees forward. Instead, it subtly adjusts the angles of various joints to allow us to stand upright.
This compensation leads to straightened knees, a forward tilt of the hips, an increased curvature in the lower back, and constant, increased muscular activation in the neck. This continuous effort in the neck muscles can contribute to chronic tension and discomfort over time.
What Happens at your Ankle
Walking barefoot allows your ankle joint and the surrounding soft tissues to naturally absorb and distribute load. In contrast, a heel lift reduces natural ankle motion, leading to a gradual shortening of the Achilles tendon and calf muscles over time (Rabusin et al, 2019; Rossi, 1999). This phenomenon, known as "creep," means our tissues adapt their shape to the most frequent loads placed upon them.
When these soft tissues become chronically shortened, your ankle mobility decreases, specifically your ability to dorsiflex. This restricted movement prevents your foot from landing evenly, altering the natural arch mechanics and reducing the surface area available to disperse impact forces. This is similar to how you can walk on a bed of nails but not a single nail; narrowing the contact area dramatically increases pressure at specific points, leading to microtrauma and, eventually, macro problems (Rabusin et al, 2019).
Beyond affecting mobility and force dispersion, chronically shortened calf muscles also hinder your ability to propel yourself effectively during movement, thereby decreasing power output (Rabusin et al, 2019; Rossi, 1999; Franklin et al, 2015).
These anatomical alterations also compromise the side-to-side stability of the foot (pronation/supination), making you feel less stable and more susceptible to external forces and ankle sprains (Wan, 2018; Foster et al, 2012).
Furthermore, heels make even basic tasks like standing and balancing more challenging (Hapsari & Yong, 2016). Essentially, heels can make merely existing more demanding for your body!
Our soft tissues are designed to disperse load by "squishing" wider, much like gummy bears. However, when compressed within overly narrow shoes, which are often designed to make feet appear smaller, this natural load dispersion is inhibited. This significantly increases the force exerted on non-muscular structures like your ankles, knees, and back (Franklin et al, 2015).
What Happens at your Knees
Even small heels on your shoes (as little as 0.6 inches in one study) can induce greater extension at your knee—a further example of the body re-arranging its "blocks" to maintain an upright posture. This significantly increases the load on the patellofemoral joint (the joint between the kneecap and femur) (Zhang et al, 2022). Notably, patellofemoral pain syndrome is one of the most frequently diagnosed knee pain disorders in individuals under 60 (Gaitonde, 2019).
Walking barefoot also reduces the force transmitted through the medial compartment of the knee (tibiofemoral joint). This area is a common site for knee osteoarthritis, often resulting from repetitive micro-traumas—like the slightly increased force on every step when wearing shoes—which lead to joint degeneration (Franklin et al, 2015).
Ultimately, removing your shoes could be a critical step toward experiencing pain-free movement for a longer duration.
What Happens at your Pelvis
The forward tilt caused by heels shortens our calf muscles, hyperextends our knees, and, perhaps most significantly, anteriorly tilts our pelvis to compensate. Understanding pelvic tilt can be a bit nuanced, so let's clarify.
Place your hands on your hips and imagine your pelvis as a bowl. Now, "pour" the contents of the bowl onto the floor in front of you by pushing your hip points forward and your pubic bone back. Notice how this action shortens your lower back. Your shoes are likely inducing this posture throughout your day (Rossi, 1999).
While individual responses to the same stimulus vary, a study involving 153 participants showed that the pelvis’s orientation changed when heels were introduced.
Although the spinal angle (the spine's curvature for balance) showed slight changes in all participants, researchers concluded these changes were not statistically significant enough to definitively correlate with heel use over the short term.
This finding warrants clarification, especially since the relationship between pelvic and spinal orientation is well-established (Levine & Whittle, 1996).
One explanation offered by the authors is that the study focused only on short-term changes. As we know, the body is adept at compensating for brief periods. Thus, it’s reasonable to infer that while the body might maintain a relatively similar spinal shape for a short duration, long-term use of heels likely leads to inevitable spinal alterations (Betsch et al, 2011).
Changes in spinal angle are problematic because they can increase the loading on the intervertebral discs—the "gummy bears" between your vertebrae—and on the facet joints that enable spinal segments to glide. Both of these can contribute significantly to chronic lower back pain (Legaye et al, 1998; Betsch et al, 2011).
Even Changes at Your Neck!
The spine and pelvis are intrinsically linked by strong fibrous tissues, meaning changes in the pelvis are closely associated with changes throughout the spine (Betsch et al, 2011; Levine & Whittle, 1996).
However, these effects aren't limited to your lower back! Studies have shown that women, both with and without chronic neck pain, exhibited increased muscular tension in their lower back AND neck muscles (cervical paraspinals) when walking in heels (Park et al, 2016; Mika et al 2011).
This chronic muscle constriction is linked to persistent overload, leading to strains, reduced oxygen transport, fatigue, headaches, and dysfunction in the cervical spine (Mika et al 2011).
So, now you decide. Do you want your entire body, from your feet to your neck, to conform to your shoes, or do you prefer shoes that allow your whole body to move optimally?
Our zero-drop, wide-toe box shoes are undoubtedly appreciated by our ankles, knees, and spine, and yours will be too.
