According to the Spine Health Institute, 72 percent of women wear high heels “at some time.”

Considering this information comes from the Spine Health Institute, you can probably see where we’re going with this.

Yes, high heels can be gorgeous and sexy (see the image above, for example), but they can also be a problem for your posture, spine, and back. And did you know those beautiful, pointy-toed, three-inch wonderpumps you just bought could also contribute to urinary incontinence? Yep.

As ever, our amazing physical therapists, Brianna and Meagan, brought us up to speed on what we need to know about high heels, incontinence, and how to wear those brand-new wonderpumps properly.

How do high heels affect the pelvic floor?

The problem, Bri says, is the change to our posture and everything we have to do to accommodate it. Ideally, we should have a very neutral alignment, with everything stacked appropriately – ribs over hips – to keep us upright.

However, high heels put us in a constant state of falling forward. In order to compensate for that, our normal, gentle “S” curve from the base of our skull down to our tailbone is exaggerated, says Meagan. We have to keep our knees and hips slightly bent to achieve our normal straight up-and-down alignment, which makes our butt stick out. We also have to stick out our chest and pull our shoulders back. All this might sound ideal for accentuating sexy curves, but it could be causing damage to your pelvic floor.

In order to compensate for the falling-forward position of high heels, we do what Bri refers to as “gripping”: we tighten our abdominal muscles and our glutes (butt muscles) to help stabilize us in this forward-leaning posture.

Plus, says Bri, the posture of high heels tends to make our bellies stick out, so we suck those in and hoooooooold. And as we discussed in a previous blog, when our abdominal muscles are held too tightly for too long, we’re actually overtraining our pelvic floor. And that can contribute to incontinence.

What can you do if you’ve been wearing heels for years?

Depending on how much you’ve worn your heels, your calf muscles may be a bit short and tight, says Meagan. Hip flexors – the big muscles surrounding the hip joint – probably also need some attention. The key to regaining your normal posture is gentle stretching.

“You need to regain the flexibility and mobility in your pelvis and lower back in order to restore normal spine and posture,” Bri says, “so we slowly integrate different core exercises to get you back to a neutral, stable position. Then you can relax those abdominals instead of holding them in 24/7 to maintain this idealized posture.”

“We have the false belief that our pelvic floor or our abdominal or back muscles work like ‘isolated pieces,’ but the reality is that they all work in conjunction and are closely related to one another. If your calves are shortening, and you are tightening your butt and lower abdominals to adjust to the new posture, chances are you are also indirectly adding extra pressure to your pelvic floor, and this posture does not favor its correct functioning,” says Estrella Jaramillo, cofounder of B-wom, a digital coach for women’s intimate and pelvic health.

One client Meagan worked with had been in high heels for so many years that flat shoes became uncomfortable – that’s how foreshortened her calf muscles became. “We met halfway,” Meagan says. “We slowly reduced the heel to 2 inches, then 1 inch, and finally to flats.”

Is there a perfect shoe for humans?

Not really, the PTs agree: there’s just too much variability in human bodies to pick a “perfect” one-kind-fits-all shoe.

“We all have similar skeletal structures deep within us,” Meagan says, “but there’s so much variation in body weight, coordination, strength, and endurance, and they all affect how we use our bodies. Some people’s arches collapse, others have super high arches – both need very different types of shoes to fit their biomechanics.”

The PTs suggest we “shop like Cinderella” and pick only the shoe that truly fits. “I tell them to buy with their eyes shut,” Meagan says. “Don’t look at the color or the price tag. If the shoes feel magical, buy them, whether they’re athletic shoes or work shoes.”

Do we have to throw our high heels away?

No. While high heels will probably never be “good” for us, we can certainly minimize the damage:

1. Limit the height, the PTs tell us: go for 1 inch over 2 or 2 instead of 3.
2. Choose a wedge heel over a stiletto for greater stability.
3. If you’re wearing heels to be taller, find some that are also thicker at the toe, decreasing the difference from heel to toe while still increasing your stature.
4. Wear them only a few hours instead of all day.
5. Stay off your feet as much as you can when wearing them.
6. If you’re walking to work, throw the heels in your bag and wear tennis shoes or stylish flats to cover the distance.

Finally, the PTs tell us, if you can’t do any of those, if you’re truly stuck wearing those dagger-sharp three-inchers, stretch your calf muscles multiple times a day. And stop sucking in your gut. The clumsiness of menopause doesn't help here, so do everything you can to combat it.

Do you have issues from wearing fashionable-but-not-very healthy shoes? How did you solve them? We’d love to hear about your experience, so share with us in the comments or on Gennev's Facebook page or in Midlife & Menopause Solutions, our closed Facebook group.

Want more great advice from Bri and Meagan? Ask and ye shall receive:

If you have scars from surgery or injury, learn how to massage your scars to release adhesions, reduce pain, and free up the tissue again. Think you might be peeing too much or too little? Find out what’s “normal” urination and how to get there. Can a PT improve your sex life? O yes – follow their steps for much better sex.