Total Health

Can the footwear you choose have an impact on your spine?

February 28th, 2021 by
Category: Dr. Luke Vella Health & Wellbeing Spinal Health

shoes lined up on a doormat

There’s no hiding the fact that back pain can (and is) a debilitating and ongoing issue for many Australians. But have you ever taken a step back and thought about the impact that your choice of shoes are having on your spine?

From a biomechanical and Chiropractic point of view, your footwear choices have a huge impact on your spine and the way it functions. This is because of the lower limb kinetic chain. The kinetic chain relates to the flow of the joints in the lower limb and how they interact with each other, including the ankles, knees, hips and finally up into the spine. As your feet and ankles are at the bottom of the kinetic chain, your choice of footwear has a major influence in terms of the position of the ankles, knees, hips and spine. When we wear the incorrect footwear, we place the above joints at risk of being in a position that is more forward or backward than what it should be normally. This in turn can lead to muscle imbalances, muscle tightness and ultimately joint and back pain. 

What kind of feet do you have?

infographic showing different types of feet - normal, flat and hollow
Source: https://www.aerothotic.com/blog/wp-content/uploads/2020/01/1577780115-3.jpg

The above picture shows us the three main types of feet: ‘normal’, flat and hollow. Not sure what kind of feet you have? Finding out your foot type from home is easy! All you’ll need is:

  • A bucket of water big enough to fit your foot in 
  • A piece of paper or cardboard

To find out what kind of feet you have, follow the below simple steps: 

  •  Fill the bucket with water, just enough to cover the bottom of your foot
  • Step in the bucket, wet the bottom of your foot and then lift it up, allowing any excess water to drip off.
  • Place the wet foot onto the paper or cardboard for approximately three seconds
  • When you take your foot off the paper/cardboard, compare the print to the picture above to determine your foot/arch type. Easy as that!

What shoes should you wear according to your foot type to avoid lower limb or back pain?

Now that you know what kind of foot type you have, it is important to understand what kind of shoes you should be  wearing to help avoid any lower limb or back pain. 

Normal Feet

For those with a normal foot type, look out for a neutral shoe that still offers good cushioning and ankle stability.

Flat Feet/Fallen Arches

For those with a flat foot or fallen arch, ideally you want to be wearing a shoe that offers good arch support that will help hold your arch in its neutral position, helping with the kinetic chain.

Hollow Feet/High Arches

And finally, for those with a high arch/hollow foot type, wearing a shoe with NO arch support is important. We want to be looking for a shoe with a neutral sole and plenty of cushioning in the sole – people with hollow feet tend to be harder on their feet.  

Unfortunately, not all the shoes we like will be suitable for our foot type. Thus, it is important that we look at getting insoles to place in the shoes that do not suit us. For those who have flat feet, you should look at using an innersole that offers arch support. For those who have a high arch, it’s important that: 

  1. You do not add arch support to your shoes – this will only further push your kinetic chain out of alignment
  2. You are adding an innersole that provides extra cushioning

So in saying all this, which shoes are impacting your back the most? The simplest answer to this question is – all of them! Whether you’re wearing a pair of flats to the office, out for the night in high heels or going for your daily jog in your favourite pair of runners, they all have an effect on your lower limb kinetic chain and your back.

High heels and back pain

side profile of woman on seat wearing high heels

It’s not uncommon knowledge that wearing high heels can be painful and lead to back pain. But do you know why this is? When wearing heels, several things happen:

  • Body weight is shifted forward 
  • An increase in pressure on the bones and joints in the feet, ankles, knees and hips
  • Heels restrict the amount of movement that the ankle and feet can engage in, thus leading to poor mobility
  • Heels place extra pressure in the chest and pelvis due to body weight being shifted into an unnatural position

When reviewing all these factors, it’s no wonder poor posture and back pain can accompany wearing heels.

What to look for in heels

When shopping for a new pair of heels (out of need or want), look out for the following features which can help make wearing them easier and less painful:

  • Look for a rounded toed heel instead of a pointed toed heel
  • Look for a heel that isn’t too tall (under two inches is a good place to start)
  • Look for a heel that has a wider stilt
  • And most importantly, make sure the high heels fit properly! 

Better alternatives include:

  • Wedges 
  • Platforms 
  • Low heels (under 2 inches) 

Office flats and back pain

close up of man lacing up office footwear on feet

Is wearing flats to work better than heels? Yes 

Will this mean no more back pain? No

Although men and women’s office/flat dress shoes do not shift your body weight forward like heels do, there’s still a chance that they are causing your ankles, knees and hips to misalign if they are lacking support.

If you have a flat foot and do not have arch support in your flats – this particularly affects you! If you walk in office flats without arch support the plantar part of your foot and ankle rolls inwards, putting the lower limb kinetic chain out of alignment. This in turn leads to back pain.

When shopping for a new pair of flats, keep the following in mind: 

  • Make sure the shoe fits! If the shoe is too small, it will increase pressure and lead to more pain. If the shoe is too big, this will lead to the adoption of an improper walking style, leading to an increase in leg and back pain.
  • Make sure the shoe has good support (especially for people who have flat feet), either inbuilt or through an external innersole that can be added.
  • And lastly make sure there is plenty of cushioning in the sole of the shoe. 

Heavy duty work boots and back pain

image of worn work boots lined up on a shelf

When on a job site, the last thing you want to worry about is back pain. So tomorrow morning when you put on your boots for the day, take a few extra moments and look at the factors below which could be causing you back pain/leading to back pain from wearing heavy duty boots:

  • Do they fit correctly?
  • Are the boots laced up/zipped up properly?
  • Are the boots wearing down in the heel or under the sole?

If your work boots are not fitting correctly, it causes your feet to be compressed (too small) or to be gripped onto the sole of the shoe with your toes (too big). Both can lead to back pain as the body shifts its weight forward to account for the imbalances in the feet.

If your boots are not tied up and zipped up properly, the ankles are not supported as should be. This increases the risk of not only back pain, but also ankle, knee and hip pain as the muscles in the lower limb is constantly in a state of activation.

Lastly, work boots that are worn out do not offer the same support as they once did, thus time to be replaced and tackling back pain from the feet up!

Slides/thongs and back pain

close up image of flip flops on sand

Slides and thongs are an easy piece of footwear to quickly slip on when we are in a rush or on the way out to the beach, however have you ever stopped and though about their impact on your feet, and in turn your back? Not only does this type of footwear often offer no support at all, but they also tend to:

  • Cause the toes to scrunch and clench to hold the foot in place
  • Add extra pressure to the outside of the feet and lower leg
  • Tilt the pelvis forwards and in turn, increase the spinal curve in your lower back

The above factors, combined with generally taking shorter strides while wearing thongs and slides, leads to increased pressure and deceased range of motion in the hips and back muscles, resulting in back pain while wearing this type of footwear.

To still enjoy the convenience of thongs and slides, look out for these features when purchasing your next pair: 

  • Make sure they have a sturdy sole and strap 
  • Look for models with a thick and cushioning sole

A couple of good brands which offer these features include 

Running shoes and back pain

man in red jumper and shorts running at night time

Choosing the right runners is so much more important than we realise. Not only do our runners set the pace for our run, but they also support our feet, ankles, knees, hips and yes, your back!

For those with a neutral foot/arch or a high arch, look out for runners that:

  • Have NO arch support
  • Offer ankle support 
  • Are cushioned well 

For those with a flat foot/low arch, look out for runners that:

  • Have arch and ankle support 
  • Offer good cushioning 
  • Include lace holes up to the top of the tongue of the runner so that the laces  can be tired up correctly to offer more support 

We also need to make sure the runner fits correctly as well, this means that:

  • Runners should not be too small, causing the toes to hit the top of the shoe
  • Runners should not be too big, causing instability in the feet, ankles, knees and hips 
  • Runners should offer ankle support, no matter what foot type you have 
  • Runners should offer good cushioning as running is an activity that is very hard on your lower limb kinetic chain biomechanics 

So, which brands offer this? For those with flat feet and in need of arch support look at:

For those with a neutral foot/arch or a high arch:

  • You can look at any brand, as most brands offer a neutral fitting shoe 
  • For those with a high arch, keep in mind that lots of cushioning is important 

Casual sneakers and back pain

image of a person wearing high top black converse shoes

As nice as casual sneakers look, it’s best that we keep them for casual times! This is for a number of reasons:

  • Casual shoes offer no support
  • Casual shoes are often very stiff and inflexible, therefore decreasing range of motion in the feet and ankles
  • Casual shoes are sometimes constructed in ways that do not match the shape of the natural foot, thus altering the foot’s biomechanics 

We should avoid wearing our casual shoes to places such as the gym, work and on long walks. This will not only help our feet be supported appropriately in different settings, but also help to combat back pain due to wearing improper footwear. Some smart swaps include:

  • Nike Metcons instead of Converse for weight training at the gym
  • Proper work boots to job sites instead of casual shoes such as gumboots 
  • The correct runners for your foot type when going for long walks instead of shoes like Stan Smiths or Vans

Should you change some of your footwear?

After figuring out your foot type, it is important to take a second to evaluate the footwear you own and assess it in terms of its effectiveness for your foot type and if it has been/may start to cause you back pain. If you own shoes that has been causing you pain or has the potential to in future, you should look at making some smart swaps from the options above.

If you have any further questions, or would like to talk about determining your foot type and which footwear is best suited to you, contact us or another health professional for tailored advice.



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