Can Shoes Affect Your Spondylolisthesis?

spondylolisthesis and high heels

We frequently receive great questions from readers in our comment sections or email inbox. We often feel that the answers to many of these questions can help others, and the following is a perfect example.

We received the comment below regarding the influence of shoe heel height on spondylolisthesis or spondylolysis-related pain. After the question you can read our answer that helps to clarify the question: “Can shoes affect your spondylolisthesis or spondylolysis?”

Reader’s Question:

“I have one more question for you. This is regarding shoe heel height and and its effect if any on spondylolisthesis.

I have read that people with spondylolisthesis (I have grade 1, not always symptomatic) should avoid high heels and perhaps that they should wear low heeled shoes. The reason given is because it is said that high heels cause the lower back to become more lordotic, arching in, putting pressure on the low back and maybe adding shear force on the lower vertabrae.

I’ve also read that really “high heels” are bad for everyone, because they deform the foot and also can lead to back strain due to increased lumbar lordosis.

I’ve also read to the contrary that high heels do not cause lumbar lordosis (they do the opposite) nor do they cause pain:

I’ve also read of a case study that showed a woman had pain from her spondy when she wore low heeled shoes.

So I am a little confused. Being a guy, I’m not going to wear very high heeled shoes. I usually wear running shoes for walking. But they do come in different heel heights… or more accurately, different heel toe differentials. Many running shoes for example use a 12mm-14mm differential (difference between height of heel and forefoot). Lately though, with the minimalist/barefoot running trend, shoes have been dropping their heel heights and advertising their heel to toe drops as a selling point. It is said that a lower heel/heel toe drop makes it easier to land on the mid foot when running which is thought by some to be better than heel striking, which supposedly higher heels encourage.

Anyway, do you think heel height (heel toe differential), in a moderate range of say 14mm to totally flat, has any impact on spondylolisthesis one way or the other?

I’m asking because I have generally have found that low heeled shoes do seem to cause a little back aching (though barefoot feels fine). I have also found the same with shoes that have higher heels than I am used to.

Just wondering if it is just an issue of getting used to a shoe height or if there is a spondy interaction and if there is any real evidence for the suggestion to wear low heeled shoes for spondy.

Thanks again for your time and patience!”

Our Answer:

That’s a great question and I’ll have to agree that there is no concrete answer. In my experience, and based on what other evidence I have read, there is no guarantee that the height of the shoe’s heel will create pain.

The structure and design of the human body leads to an ideal posture, which of course varies a bit from person to person.  There are different ways in which our nervous system makes use of sensory information such as the length of muscles and positions of joints. And this information is used to help us adjust our posture or move fluidly so that we can interact with the world around us.  Our bodies are constantly making adjustments based on this information.

So your nervous system will have to make adjustments in your posture or your movement patterns if you drastically change your joint position away from this “ideal” by wearing shoes that raise your heels higher than you are used to (or drop them lower, like with the emergence of “barefoot” shoes).

When you wear shoes that raise your heels above your toes, your body’s center of mass is slightly shifted upward.  Your nervous system adjusts by making your calf muscles more active in order to keep you on your feet.  Stay in those shoes long enough and you’re going to have tight calf muscles – overworked from trying to keep you upright.

spondylolisthesis and high heels

The higher the heel is above the feet, the higher the center of mass goes. This can lead to multiple compensations in the body.

Another problem of spending a lot of time in shoes that raise your heel level is that your normal ankle joint mobility is restricted.  This is important because in many cases of normal activities, your joints generally alternate between preferring a role of either stability or mobility.  Starting with the feet and moving up….feet (stability), ankles (mobility), knees (stability), hips (mobility), low back (stability), upper back (mobility), shoulder blades (stability), and shoulders (mobility).  This is the Joint-by-Joint Approach popularized by physical therapist Gray Cook and strength coach Mike Boyle.

So shoes with a heel raise effectively reduce the potential mobility at the ankle. This change has to be accounted for in other joints, especially above and below the ankle.  So the foot or the knee give up some of their inherent stability in order to gain a little more mobility.  This may set the stage for even more changes up the kinetic chain, which may have a big influence on your spondy.

This makes a good case for why ladies shouldn’t wear high heels, right? And it might even scare you from wearing running shoes, since traditional running shoes raise the heel “significantly” when compared to standing barefoot.

So “barefoot” shoes or going barefoot must be the ticket! 

Kozzi-bare-foot-woman-walk-outdoor--293 X 442

The answer to your spondylolisthesis pain is a little more complicated that just going barefoot.

But of course, that would be too easy.  Structural changes to the foot may mean a quick change to barefoot/minimalist shoes is met by new aches and pains that stress the body’s tissues.  Barefoot or minimalist shoes require the foot to provide adequate stability and the ankle to provide adequate mobility.  If you have calf muscles that are tight from overcompensating from day after day in running shoes, then an abrupt switch to barefoot/minimalist shoes will overly stress the calves by requiring flexibility that the muscle isn’t ready to provide.  Again, something else will have to compensate and now you’ve got potential problems elsewhere or at your low back.

However, if your muscles and connective tissues have adequate mobility, your foot structure is adequate, and your nervous system can make the needed adjustments to provide stability, then there won’t be much of an issue transitioning to barefoot shoes.

The theory that the type of shoe creates increased lordosis at the low back, or any other postural change, is really just a function of whatever compensatory mechanisms are already present.  The shoe is just exaggerating a problem that already exists.

So there you have it.

There is no simple answer to what type of shoe or level of heel raise is best for everyone.  If someone has restricted mobility and altered movement patterns, then the main focus should be on correcting the restrictions and improving the movement – no matter what type of shoe they wear.

In this particular case, since you say both low-heeled and higher-heeled shoes cause discomfort, then one possibility is that you may have restrictions in flexibility or joint mobility that are being exposed by either type of shoe you wear, so you would need to address those movement issues.

Another possibility, since you say you feel fine when actually barefoot, is that your shoes are robbing your feet of something feet love to do – provide feedback.  Your feet, along with the fingertips, are densely packed with nerve endings. When you are barefoot, your body is getting all kinds of information that it uses to maintain posture or provide movement.

Again, your shoes may be robbing you of valuable sensory information.

This is a long-winded answer, but the truth to many of these common questions is more complicated than a simple “yes” or “no.” Taking the extra effort to provide a quality explanation leads to opening a new train of thought for the patient. Hopefully this leads to a better rehabilitation and long-term improvement!

We thank this reader for the question and wish them the best with their recovery! Let us know if you have any other questions, comments or experiences with certain shoes and your spondylolisthesis or spondylolysis pain.

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Leave A Reply (12 comments so far)

  1. salo
    3 years ago

    hi, like always, very informative article.
    The other day I realize something interesting related to your article. I used for training minimalist shoes, and I found them very comfortable. But the other day I realized that they are providing me with added external support. I try to do some reverse longues and Bulgarian splits barefoot,(using the same weight as with the shoes ) and I wasn’t able to keep the balance. Im trying now to do those exercises barefoot, but I found it much easier when I wear the shoes. Does that mean that I have some heel weakness that the shoe covers for?
    Again, thanks.

    • SpondyInfo
      3 years ago

      Hello Salo. Great to hear from you.

      I like your question. Shoes can be a tricky thing — sometimes better balance with them and sometimes better balance without them. A “weakness” in the heel is unlikely. More likely to have “weakness” in the small muscles in the arch of your foot that attach to your toes — specifically the big toe. I keep putting the term weakness in quotation marks because it really has nothing to do with strength. It’s more of the timing of when muscles turn on. But using the term “weakness” is so common, probably because a disruption in the timing of muscle activation can make you feel like you have weakness.

      But back to the foot….The smaller muscles in the arch of the foot are really interesting. First, they are stimulated best when barefoot. Second, they trigger a reflex that helps stimulate stabilization of your hip and core. But if their timing is delayed and your body has fallen into a compensation involving calf and shin muscles then your balance will suffer — whether barefoot or in shoes. The shoes may just be providing a wider platform which creates a fabricated sense of stability. I would feel pretty safe betting that shoes (minimalist or otherwise) will take foot function farther from natural function as compared to being barefoot.

      Here’s something you can do about it. Start barefoot. Stand on the right foot (the left foot can be behind you and helping with balance). Bend your knee slightly — picture a runner at the starting line of a race. Firmly press your big toe into the floor. You should feel the ball of the big toe lift slightly from the floor or you may feel a muscle tightness in the arch. Hold the toe squeeze for 10 seconds. Relax completely then repeat. Six total repetitions.

      Then try your reverse lunges again on the right foot. Drop back into the lunge as normal, but as you return to stance do two things: 1) push the big toe into the ground as you stand up from the lunge, and 2) finish the movement balancing on the right leg with the knee slightly bent. Repeat this 10 times or so.

      Repeat the whole process on the left.

      Then put your shoes on and repeat the whole process again on both feet. You can use the toe press with just about any leg exercise. Always pressing the big toe into the floor on the way back to a single leg stance posture. This activity will help “wake up” the stabilizing muscles in your feet. Performing the activity barefoot will provide the most sensation. But repeating the activity in shoes will help your foot muscles stay active in the shoe, too. And if you’re like most of us then you’re spending more time in a shoe than out of it.

      Best of luck!

    3 years ago

    Hi, maybe a stupid question but have to try my luck anyways. …I am malec39 and have to wear business suits to work with regular dress shoes with heals which are becoming uncomfortable with my grade 1 , isthmic, stable, two year old spondylolisthesis. Could you suggest a reasonable alternative?

    • SpondyInfo
      3 years ago

      Hi Shehryar Ali. There are no stupid questions on our website, so do not worry about that. You actually ask a great question. And I am sure there are others who have a similar question and will find our conversation helpful. I am by no means the guy to ask fashion questions too, but I do have a nice resource that may help you out. It is important to understand that I do not personally know this person, but his site comes as a recommendation. The following link is for a podiatrist that has a solid understanding of the role that the feet play in movement. He created an excellent post about various shoes that are flat, wide at the toes and are flexible. Give it a look and I think it may provide you with a great resource for your question. Best of luck!

  3. Manal
    2 years ago

    what sports good for the spondylothesis. Can biking real biking is ok

  4. Ann
    2 years ago

    I have a dual problem. I have grade2spondo and also two mild buldging disks. The exercises I can do for spondolo I will hurt the disks and vice versa……what am I to do??????

    • SpondyInfo
      2 years ago

      Hi Ann. It is not uncommon for someone to have multiple issues present in the back. A spondy and bulging discs is one of the most common.

      My recommendation is to seek out a board certified therapist who can observe your exercise habits and methods. Perhaps you are doing exercises wrong and this is leading to stress and strain on your back ultimately affecting both the discs and vertebrae. It is much more common for someone to incorrectly perform an exercise and then experience pain than it is to perform it correctly and experience pain. Having a professional eye to guide you could be very helpful.

      I would also recommend seeking out a movement screen by a professional. I discuss that more here:

      Best of luck!

  5. csq
    2 years ago

    My back most definitely hurts depending on the shoes I ware from flipflos/vans/heels/tennis shoes…My feet were so numb wearing my ” one of the few famous brand name” sneakers … and I couldn’t ride the stationary recumbent bike for more than 5 mins and than numbness. Idk if it is a problem with ppl with spondy- but I walk on my on my toes. I understand there is no easy answer.. and there is no end all be all.. but at the same time I would have loved if my Pt had told me about minimalist shoes. It only makes sense to me now that but of course I shouldn’t be wearing tennis shoes with more heel. I don’t wear heels anymore. Which is sad.. I have a beautiful pair of 4in…but I digress… we know high heels are pretty much a no-no.. but your shoes to walk?bike?workout in?! Well I did some digging myself… and I found altra zero drop shoes. Just go check them out for yourselves. The heel is lower than the whole foot and helps me stand up which helps obviously with my alignment. I’m still in pain and having a different PT that I’ll be working with this week. And these shoes help me. I can do a bit more than I could before. I also recommend looking into the way you tie your shoes. I do a “high arch” method. So I skip a bit in the middle. If your feet are going numb definitely look into 🙂 I’m not a dr nor am I a scientist nor am I a PT but I know what helps me function. Wish you all well.

    • SpondyInfo
      2 years ago

      Thanks for the info and tips csq.

      I would like to comment on your “toe walking”. Not all spondy sufferers are toe walkers, but often times those that spend their entire life walking on their toes have developed certain tightnesses that have led to compensations over the years. Without getting to technical, those years spent on the toes have forced certain muscles into overtime, thus leading to some very overworked and stress muscles.

      This is even a greater reason to seek out some kind of movement screen by a certified professional to help determine if your compensations are affecting your spondy. I discuss more here:

      Hope it helps!

  6. Alex Hourahine
    2 years ago

    Hi Justin I really appreciate all that you are doing for us out here. I can’t bring my self to refer to my condition as “Spondy” it sounds like I am referring to an old friend and that is far from how I feel about it. 🙂
    I do have a couple of questions I would appreciate your thoughts on.
    In your experience if you have been diagnosed with grade 1, does that infer that things might continually de-grade over time to 2 or 3 or 4.
    My other question,is you have referred to diet as a factor in finding ways to manage things. Can you point to a source that would expand on that.
    Keep up this great work you are offering a very valuable and unique service Very Best regards Alex

    • SpondyInfo
      2 years ago

      Hi Alex. Good questions. Just because you are given a grade 1 diagnosis by your doctor does not mean things will automatically regress to a higher grade over time. Of course, accidents can happen. You could fall, be in a crash, etc and be more susceptible than someone without this injury, but again those instances are rare. There are a few things that determine how likely you are to regress to further slippage.

      First, the type of of spondy that you have can make a difference and put you at higher risk. For example Degenerative spondy is more likely to slip further when compared to an isthmic spondy. Especially in elder women who also suffer from osteoporosis. The individual who would be best suited to give you an definitive answer would be your doctor as they can determine what kind of spondy you most likely have.

      Another factor to consider is past injury history in combination with other current injuries. For example, do you have bulging discs present, stenosis, etc. These factors could also play into your question.

      As far as diet goes I did a lot of research on foods that have anti-inflammatory benefits and properties. I was always hesitant to discuss this into great detail on the site mainly due to the fact I am not a registered dietician and I did not what to give out dieting advice. My suggestion would be to google or search this topic as there are tons of articles and advice by professionals. The main thing I did was to dramatically cut back on my sugar and carb intake. I still have them from time to time, but I made big changes. I also added a wide variety of fruits, vegetables and other “healthy” options.

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