Heels vs flats: Which is better for your knees? Orthopaedic surgeon explains what matters when choosing everyday shoes

Know what kind of shoes you should wear in order to protect your knee health! Expert also reveals whether flats or heels hurt your knees more.

Your choice of footwear may affect your knee health. Everyday footwear should not only be limited to aesthetics; it also needs to support your feet and joints. Choosing the right pair goes beyond what matches your outfit or is easy to slip on.

Dr Ameet Pispati, director of orthopaedics and robotic knee surgery at Jaslok Hospital and Research Centre, Mumbai, shared with HT Lifestyle, in an interview, which types of footwear may put stress on your feet and joints. Are flats better than heels? What prevails over the other?

“With every step, your feet absorb and transmit forces through your ankles, knees, hips and spine. Your footwear influences how those forces are distributed,” he said. So, the angle of your footwear directly affects your knees.

Can high heels cause knee problems?

If you are wearing high heels all day, your knee joint bears the pressure. (Picture credit: Freepik)

High heels are a major fashion statement; they make you feel confident and bold. But the expert flagged this footwear, calling it an ‘obvious example’ of footwear that exerts stress on your knee joint.

How do heels affect your knee joints? Dr Pispati described, “Heels push the body’s weight forward, change the natural position of the ankle and increase the load around the knee. They can also alter posture and place additional stress on the lower back.”

But there is no need for a blanket ban on high heels, as Dr Pispati believed occasional wear is tolerable, but when you spend long hours, you may experience foot, knee, or back pain,

Are flat shoes better?

Flats are not the naturally better choice either. (Picture credit: Freepik)

The natural assumption might be that flat shoes are better for your knee health than heels. But the doctor showed a more nuanced perspective, saying that flat shoes are not automatically a better choice either.

Dr Pispati shared, “Thin, completely flat shoes and flip-flops often provide little cushioning, stability or support. They may be perfectly fine for a short trip, but prolonged walking or standing in them can make the feet work harder and may aggravate existing foot, knee or back problems.”

What should a comfortable pair of shoes look like?

Rather than focusing solely on heels versus flats, you should prioritise comfort, according to the doctor. But what makes a shoe comfortable? Dr Pispati shared the following features to look for:

• Adequate cushioning
• Stable sole
• Sufficient room for the toes
• Secure fit around heel
• Toes not squeezed together
• Foot should not slide inside the shoe

When should you see a doctor?

Here are some signs that mean you should go see a doctor:

• New or persistent knee, hip, foot or back pain
• Pain worsens after walking or standing

If you experience the above-mentioned signs, consider changing the footwear.

The doctor, however, advised not to blame shoes only, as sometimes pain can continue despite changing footwear."Pain that continues despite changing footwear, is associated with swelling, locking or giving way, or interferes with walking or daily activities deserves a proper medical assessment. The underlying problem may be arthritis, a foot abnormality, a tendon problem or another joint condition that needs treatment," Dr Pispati said.

In the end, the expert's parting advice involves reminding us that there is no universally perfect shoe. Someone with arthritis, flat feet, a previous knee injury or a foot deformity may require different footwear from someone with completely healthy feet. Even expensive ‘orthopaedic’ shoes are not automatically better if they are uncomfortable or unsuitable for your particular foot.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.