The Footwear-Back Pain Connection

Back pain is common among adults, with up to 80% of people experiencing back pain at least once in their lifetime. and according to the Centers for Disease Control and Prevention (CDC), 39% of American adults report living with back pain.1 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. While the causes of back pain can vary, one often overlooked factor is the type of footwear we wear. Believe it or not, the shoes we put on our feet can significantly impact our spinal health.

We will explore the connection between footwear and back pain and provide insights into choosing shoes to support a healthy back.

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!

Our feet are the foundation of our body’s alignment, and our shoes play a crucial role in maintaining proper alignment from the ground up. When we wear shoes with inadequate support or that don’t fit properly, it can throw off the alignment of our feet, leading to a chain reaction of misalignment throughout the body, including the spine. This misalignment can cause strain on the muscles and ligaments of the back, leading to discomfort and pain.

“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.

“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.” 

High heels

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. One of the most well-known culprits of back pain is 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. The elevated heel alters the spine’s natural curvature, increasing pressure on the lower back and making the muscles to work harder to maintain balance. Over time, this can lead to muscle imbalances, postural issues, and chronic back pain.

“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

Conversely, flat shoes with inadequate support can also contribute to back pain. Shoes that lack proper arch support don’t provide necessary shock absorption and stability, leading to increased stress on the spine. 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.” Additionally, shoes with worn-out soles or insufficient cushioning can exacerbate back pain by failing to provide adequate protection against impact forces.

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. For example, walking shoes for flat feet offer extra cushioned support in the midsole to help prevent your foot from rolling inward as you stride.

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.

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. Rehabilitating back muscles after an injury may require targeted exercises, such as working out on a back extension machine, as opposed to getting new shoes.

Choosing the right footwear. The 5 Top Tips

So, what can we do to prevent back pain and promote spinal health through our footwear choices?

Here are 5 top tips for selecting the right shoes:

1. Opt for shoes with adequate arch support to maintain the spine’s natural curvature.

2. Look for cushioned soles that provide shock absorption to reduce impact on the spine.

3. Choose shoes with a supportive heel counter to stabilize the foot and ankle.

4. Ensure proper fit by wearing shoes and walking around to assess comfort and support.

5. Consider orthotic inserts or custom-made orthotics to address specific foot issues and improve overall alignment.

   
   

When it comes to back pain, every step counts. By paying attention to our shoes and choosing footwear that supports spinal health, we can take proactive steps to prevent discomfort and promote overall well-being.  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!

I grabbed all this information from a variety of sources. The biggest thing I recommend is to make sure the shoes work for you. There are no magic shoes. Sadly - because everyone has different needs and issues your footwear choices will also be different than your partner, your parents, etc. In all of the options listed above - the key to remember is having the right support. You can have heels - just have to watch the pitch of the shoe and the support in the arch. Wedges can be much more supportive and stable. Flat shoes - so many to choose from - just make sure they work for your support needs. Same with sneakers. There are a TON of brands out there. Many are very well made but have a purpose with the construction that doesn't always necessarily offer an arch.

Hope this gave you a little to think about and maybe some insight into why your back could be suffering.