The Connection Between Footwear and Back Pain

According to the Centers for Disease Control and Prevention (CDC), 39% of American adults report living with back pain. That’s a lot of folks dealing with an issue that profoundly affects daily life. After all, the back is the source of strength for many common activities. Walking, twisting, turning, bending down—innumerable actions can become uncomfortable when your back hurts.

If you’re one of the many who experience an aching back, you may want to explore options other than your spinal column for the source of your pain. It’s entirely possible that bad shoes could be causing your back pain. What you wear on your feet has a surprising reach upward, impacting your gait, posture, spinal alignment, and more.

So how do you find shoes that’ll keep your back going strong? Here’s what you need to know about the connection between footwear and back problems.

Understanding the Back Pain-Footwear Connection

The old “Dem Bones” song about “the foot bone’s connected to the leg bone” was onto something. What impacts bones at the bottom of your skeleton radiates upward to affect the bones of the spine. It’s all connected!

“When back problems originate from your feet, we call it a biomechanical issue,” explains Pamela Mehta, MD, an orthopedics and sports medicine physician with Resilience Orthopedics. “Biomechanics essentially means how our bones, joints, and muscles work together and how changes in external forces impact the rest of our body.”

Shoes and Movement

As you walk, your feet strike the ground, acting as shock absorbers for the rest of the body. Wearing shoes with improper support can result in greater wear and tear on your muscles and joints, as well as giving us unnatural movement.

As cute as those high heels might be, for example, consider the difference between standing on tiptoes and the body’s natural, flat-footed state. Well-cushioned shoes, on the other hand, help absorb impact and lessen systemic pain.

“If you have a problem or change in your feet, you will start to walk differently," says Dr. Mehta. "The pressures on each of your joints shift, putting less pressure on some and more on others. This creates an imbalance and can cause pain and joint conditions.” 

Shoes and Posture

Correct posture is another key to preventing or alleviating a painful back. With the right footwear, you maintain a healthier stance, keeping the right curvature in your cervical, lumbar, and thoracic spine and helping distribute your weight evenly across your frame. The result: Less stress on ligaments, muscles, and joints—and, therefore, less pain.

Of course, not every case of back pain can be solved with a visit to the shoe store. It’s always best to see an orthopedist to get to the root of your particular condition. For some people, a herniated disc, sciatica, automobile accident, fall, poor ergonomics, or other underlying causes may be at play.

Types of Footwear and Their Impact on Back Pain

Here’s a look at how various types of shoes impact posture, potentially causing or relieving back pain.

High Heels

You probably know you're choosing fashion over function when you slip on a pair of stilettos—but how bad are high heels for back pain, really? High heels change your posture, says Dr. Mehta, causing ripple effects for the spine.

“Our weight is shifted to increase pressure on the balls of our feet, and the alignment of our spine changes," she says. “High heels affect the way your ankles, knees, and hips move when you walk, as well as affect your balance and how you use the muscles of your back. All of this can have a knock-on effect and worsen back pain.”

Flat Shoes

A pair of ballet flats or flat dress shoes typically aren't the best choice for spinal health either since a lack of arch support can lead to a rolling inward of the foot, known as pronation. This can create a misalignment that translates to strain on the knees, hips, and, ultimately, lower back. Still, Dr. Mehta says flats can be a decent choice if they have good support.

“When wearing flat shoes with good support, your weight is distributed evenly across your feet, and your spine is fairly straight,” she says. “This helps us to have good posture, which can help prevent or reduce back pain.”

Sneakers and Athletic Shoes

With appropriate cushioning and support, sneakers and athletic shoes can relieve back pain. Choosing the right ones usually involves determining the activity you’ll be doing in them. Shoes exist for tennis, running, basketball, pickleball, and more.

Before purchasing, research what features you need for your sport or activity. Heel cups, insole cushioning, a wide base, and other features can meet your needs. One cardinal rule to remember no matter what you choose—don’t hang on to athletic shoes for too long.

Worn-out soles and degraded materials can increase your risk of back pain and even injury. The American Academy of Podiatric Sports Medicine recommends changing athletic shoes every 300 to 500 miles of walking or running or with any signs of unevenness when placed on a flat surface.

Choosing the Right Shoes for a Pain-Free Step

When looking for the right shoes for back pain, Dr. Mehta says the best choices may be tailored to each individual. “The ideal solution for choosing your shoewear is to get a gait analysis; this is a review of how you run and/or walk. Ideally, this is from a healthcare professional, but...you [also] could head to a running shop and see if they offer this service.”

In a gait analysis, you’ll typically be asked to run and walk on a treadmill, sometimes on camera, while a professional notes your physical tendencies, such as how your foot hits the ground and whether it rolls inward or outward.

“This tells us a lot about how much arch support you need in your shoes, which will help in your decisions on what type of shoes to wear to help prevent back pain,” Dr. Mehta says.

Once your analysis is complete, it can offer guidance on what to look for in shoes, such as what level of arch support, heel height, or material is best for you. If you’re unable to get a gait analysis immediately, simply consider how your shoes affect your posture, movement, and pain levels. If you can tell a certain pair puts your legs, hips, or ankles into an unnatural position or impedes your regular movement, it may be time to replace them.

Bottom Line

Don’t underestimate the power of your footwear to create or alleviate back pain. By shielding your feet from blunt impact and choosing shoes that maintain spinal alignment, you may be able to live a far more pain-free life.

That said, back pain can have a wide variety of causes, so it’s always best to check in with your healthcare provider if you’re experiencing pain. But even if you receive a medical diagnosis, selecting your footwear carefully is not only good for your health, it can be fun!