I used to repeat the common saying “beauty is pain” (and sometimes I still do, for the right pair of shoes).

However, I was rudely awakened last year when I felt an intense, aching pain in my foot that made walking difficult, and I’m a fairly active person in her 20s.

My doctor and I concluded that the issue was probably a particular pair of shoes I like to wear — cute white sneakers that aren’t wide enough for my feet, as much as I try to pretend they are. She also urged me not to wear heels, saying she never did.

This discussion raised a question: Is wearing uncomfortable shoes more harmful than I realized?

“Wearing uncomfortable shoes isn’t as serious as a heart attack,” said Dr. Jodi Schoenhaus, a board-certified podiatrist and owner of Foot, Ankle and Leg Vein Center. “However, it makes for a very painful experience while wearing the shoe and can have lasting effects.”

Yet many people still wear them. According to a narrative review in the Journal of Foot and Ankle Research, 63-72% of people wear incorrectly sized footwear.

“All too often, I see issues in my office arising from poor shoe gear selection,” said Dr. Daniel Geller, chief medical officer at Kane Footwear, a sports podiatrist and foot and ankle surgeon.

When it comes to the specific risks, many factors can play a role, from the type of shoes to how long and how often you wear them. Let’s get down to it.

How long can you wear uncomfortable shoes before having problems?

Unfortunately, you run risks even after one night of wearing uncomfy shoes, especially if you move around a lot in them.

More specifically, Schoenhaus said that even two hours of walking can cause problems, and Geller responded similarly: “I’ve seen patients develop issues after only one wear.”

Two important side notes: One, this isn’t a sign that a person doesn’t exercise enough, and two, the risks are real. Geller recalled patients who developed debilitating shin pain after only a few short runs in the wrong pair of shoes.

But again, the length of time it takes to incur an injury depends on several factors.

“Chronic problems like bunions or hammertoes usually take months or years of repeated stress, while acute injuries like stress fractures can occur after just a few days of overuse in poor footwear,” said Dr. Gregory Alvarez, a podiatrist with Ankle and Foot Centers of America.

When the harm kicks in depends on individual factors, too. “Someone with flat feet that dons a ballet flat may flare up their plantar fascia after one use, while [for] another, it may take a while,” Geller said. “We are all different and prone to different injuries for a variety of reasons.”

Ahead, the podiatrists dive deeper into various foot conditions and when you may experience them.

Long-term conditions that can result from wearing the wrong shoes.

For what it’s worth, you’re less likely to have major problems in the short term (aka, after a couple of hours). But still, it’s important to be aware of what happens most often, namely blisters, sores and swelling. This combination of symptoms probably isn’t too surprising; perhaps you’ve experienced one or all of them several times before. They’re also pretty transient issues, according to Geller.

However, wearing shoes that don’t fit or support your foot, either frequently or for extended periods, can lead to additional risks, some of which are more serious.

“Long-term, wearing the wrong, poorly fitted shoe typically aggravates underlying conditions that can have lasting effects,” Schoenhaus said.

Ahead, she and other podiatrists share examples that typically develop over time.

An irritated bunion

A bunion is a small deformity where your big toe gets out of alignment and sticks out. The bunion may not be painful at first, but wearing uncomfortable shoes long-term can cause the bunion to become irritated, swollen and painful, Schoenhaus said, even when you’re long done with the pair of shoes that contributed to it.

Pain in other parts of your body, like your back and knees

This can also result from a poor foundation in shoe selection, Geller said.

“Placing the foot in an inefficient position for walking puts strain on the skin, tendons, bones and joints,” Schoenhaus explained. “The longer you wear a shoe and the more active you are in that shoe, the more harmful it can be to the foot, knee, hip and lower back.”

Plantar fasciitis

If your shoe lacks support, cushion or proper fit, you risk plantar fasciitis, according to Geller. This is a common condition causing heel pain that usually increases gradually, but it can also be sudden.

Hammertoes

Alvarez and Geller listed this potential side effect. Hammertoes, or toe joints that point up instead of lying flat are one of the most common foot issues. At-home treatments can help, but surgery can be needed in severe cases. Hammertoes can be caused by shoes that are too narrow, small or high heels, as well as other foot and health conditions.

Achilles tendonitis

If you develop Achilles tendonitis, you may feel an ache in the back of your leg or above your heel, as well as tenderness and stiffness.

Geller said that wearing high heels can create tightness and require extensive physical therapy and outer modalities. Shoes that don’t have much support can also contribute to this condition, according to Schoenhaus.

Stress fracture

This can result from walking extensively in shoes that don’t have enough support, Schoenhaus said. Again, that lack of support puts extra pressure on your bones and joints.

Morton’s neuroma

While the word “neuroma” is typically associated with a tumor or cancer, it isn’t in this case.

“This is pain in the ball of your foot, plus irritation to the nerves that go to the toes,” Schoenhaus said, noting it’s often caused by high-heeled shoes.

What is the worst-case scenario?

The concerns above are pretty rough — there’s no doubt about that. Also, what one person considers the “worst-case scenario” may differ from what another person does. With that said, what are podiatrists’ biggest concerns?

For Schoenhaus, it’s a person with diabetic neuropathy getting a skin wound. “The skin can open, allowing bacteria to enter the body,” she said. “This leads to infection and possible amputation.”

Alvarez warns about severe nerve damage and joint deformities that require reconstructive surgery. “For instance, frequent use of high heels can contribute to degenerative arthritis in the midfoot or chronic Achilles tendon pain that severely limits mobility,” he said.

As mentioned earlier, those can happen quickly or over a longer period.

So, to conclude, yes, the shoes you wear — and how comfortable or uncomfortable they are — matter.

“Shoes are the foundation of our day-to-day activities, whether it be exercise and fitness or work-related attire and nightlife,” Geller said. “If your feet hurt, that means your body is telling you something.”