There have been a good amount of useful articles lately about shoes and how they impact our posture and our spine. Why should you care?

Question 1: Do you have back pain? What about knee pain?

Question 2: Do you have bunions or baby bunions?

Question 3: Do you have plantar fascitis?

Yes? Then you should care. One of the tricky aspects of a performance based career is the performance attire, which for women, often translates to tall high heels with a small toe box. Men aren't off the hook either though! A small toe box (like these guys) can translate to gait issues and bunions. Add that to wearing crazy dress shoes a few days a week, coupled with high heel boots, flats with small toe boxes, and turned out feet, and it's a disaster waiting to happen. Not only that, your feet are the root of your standing position, whether it's in performance or in life, and can be the source of a whole chain of postural and muscular imbalances.

Even doctors 70 years ago knew that small toe boxes hurt the feet-yet we still have so many uncomfortable shoe options!  This is from my 1940's book "The New Modern Home Physician." — **Even doctors 70 years ago knew that small toe boxes hurt the feet-yet we still have so many uncomfortable shoe options! This is from my 1940's book "The New Modern Home Physician."**

First thing-what's a bunion? Basically, the muscles and bones around the big toe start to create a bulge on the medial side of the foot and the big toe turns laterally. Huh? Not only is it uncomfortable, but it's not pretty. Both men AND women get them, and it's not just from high heels. Notice how in the first image, there's space for the toes to spread a little. Then in the second, the toe box (i.e. the space in the shoe for the toes) gets smaller and the toes start to cramp. And then the third, the pointy shoe, is just a full out bunion fiasco. Basically, you just want to have more space in your shoes for your toes!

**I've seen this image in a few places, name Katy Says and a bunch of other foot related blogs which I think borrow it from her.**

Second- how do high heels affect things? First of all, smarter foot people than I have written TONS about this, so if you're curious, there's lots more to read. When you wear an elevated heel, you increase the posterior tilt of the pelvis which is a causation of the slumping of the upper spine. In addition, heels flatten the natural curves of the spine, the weight distribution between ball of foot and heel is disrupted, and you start to reduce your joint range of motion. Not only that, but you start to walk weirdly, taking little teeny steps and overarching your thoracic spine. Remember, this includes all heels, which includes running shoes, boots, dress shoes, etc, not just fancy high heels for the ladies!

Notice how in the first picture, the woman has a natural curve to her spine? The second image shoes how our gravity is pitched forward in heels (any heel here, folks), and the third shows the repercussions. This woman bends her knees more, and the curves in her spine are exaggerated. Some folks do the opposite, and hyperextend their knees and flatten their spine.