The ankle, leg, and back damage that awaits women who frequently wear high heels is not enough to dissuade most. Even when they feel the effects after around an hour of walking around. A recent study conducted at the University of North Carolina at Charlotte has found that although wearing high heels initially strengthens a woman’s ankle muscles, it eventually leads to instability and weakening of those same muscles.

"Initially, when wearing heels, the muscles that surround the ankles have to continuously contract to keep you upright and walking,” Tricia Turner, associate professor of kinesiology and athletic training coordinator in the College of Health and Human Services at UNC Charlotte, said in a statement. “Over time you need less muscle contraction as the lower leg muscles adapt to the changes in footwear. Once that occurs, less muscle contraction occurs.”

Turner and her colleagues gathered data from women training to be flight attendants to determine ankle strength and balance at the start of their freshman all the way to the end of their senior year. They found that ankle damage associated with high heel use was caused by forcing the foot into a naturally unstable position. With sneakers and flat shoes, on the other hand, the bones of the ankle are below the bones of the lower leg, creating stability. Over time, ligament and nerve damage in the ankle leads to complications in the legs and back.

So what’s the extent of the damage caused by wearing high heels? While Turner’s research team decided to focus on ankle damage caused by high heel use, other studies have found that wearing too many stilettos can lead to around a dozen injuries from a woman’s toes to her lower back, including shortened calves, muscle fatigue, osteoarthritis, and altered posture. Unfortunately, most women in their 20s decide to play through the pain.

"With prolonged use you get muscle shortening in the back of the leg and muscle lengthening in the front of the leg. These changes in muscle length then can change muscle strength,” Turner added. "High-heeled shoes also change the normal walking or gait cycle, with the ultimate result being a less fluent gait cycle. Changes at the ankle cause the muscles higher in the leg and back to lose efficiency and strength. It also changes the load the bones in and around the knee have to absorb, which can ultimately lead to injury."

If you’re not so dead set on ditching the pumps just yet, Turner has provided some tips for minimizing your risk for injury with a combination of stretching, strength training, and balancing drills. Stretch your lower leg muscles by using a towel to pull your foot to your body for 30 seconds. Strengthen big lower leg and ankle muscles by using a theraband to resist ankles as they push up, out, and in, or strengthen small lower leg and ankle muscles by picking up objects off the floor. Balance by standing on one leg for 30 seconds at a time.

Source: Reducing the frequency of wearing high-heeled shoes and increasing ankle strength can prevent ankle injury in women. International Journal of Clinical Practice. 2015.