Wearing high heels puts incredible pressure on the front portion of your feet, including the balls of the of the feet and the toes. Furthermore, most high heels have narrowly pointed toe boxes, scrunching your toes together even more.

As a result, regularly wearing high heels can accelerate the development of bunions (bony bumps on the inside of the big toe joint) and hammertoes (toes that remain stuck in a curled position). This is especially true if bunions or hammertoes run in your family, since these conditions also often have a genetic component.

Of course, if you already have bunions or hammertoes, high heels can irritate them even more and be severely painful to wear.

Metatarsalgia simply means pain in the metatarsals, five long bones in each foot located in the balls of the feet. When you wear high heels, all of your body weight is concentrated squarely on the balls of your feet.

This, understandably, can make this part of your foot very swollen and sore. Many people even develop thick calluses, swollen nerve tissue (neuromas), or stress fractures in the metatarsal bones.

Under normal circumstances, calf and leg muscles need to contract to help “pump” blood from your foot back up to your heart. This is critically important for circulation, since blood in the feet has to work against gravity.

When you wear heels, your leg muscles remain in a constantly contracted state. Since they can’t relax, this inhibits their natural ability to “pull” blood away from the feet. As a result, the blood may pool in the legs, and blood vessels may become swollen.

In addition to being a cosmetic eyesore, varicose veins can be painful and increase the risk of restless leg syndrome or ulcers.

If the toe box is too tight, the shoe may be putting direct pressure on your toenails. This greatly increases the likelihood that the nail will become ingrown and start digging into the soft skin of the toe. Ingrown toenails can be very painful, and even lead to an infection if not treated promptly.

Most high heels offer no ankle support whatsoever. In addition, simply wearing them forces you to shift your weight forward and alter your standing and walking mechanics in ways that decrease your stability and make it more difficult to balance.

The result is that wearing high heels can significantly increase your risk of stumbling, falling, and twisting an ankle—enough to sprain or sometimes even break it. The risk is even higher if you’re tired, in a crowded location, or walking on uneven surfaces.

Because your whole body weight is shifted forward and your biomechanics change when wearing high heels, painful problems don’t just stay in your feet. Every part of your body, from legs to back to shoulders, has to adjust in order to keep your balance. And that means the pain can occur almost anywhere.

For example, regular high heel use has been linked to chronic knee pain, hip problems, hamstring and calf injuries, and back pain. All because you have to carry yourself differently when wearing heels.

Is There a “Safe” Way to Wear High Heels?