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The average woman owns nine pairs of heels, according to a 2014 survey conducted by the American Podiatric Medical Association of 1,000. But a full 71 percent admitted they hurt, making them the most common cause of female foot pain. Although the right pair can easily elevate an outfit, knowing how to wear them, when not to, and which styles are healthiest for feet remain a mystery to many. Jacqueline Sutera, DPM, a podiatrist based in New York City, cuts through the confusion and shares seven insider secrets about heels.

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1. Height Counts

Feet house more nerve endings per square centimeter than other part of the body, and as heels get higher more body weight is placed on the metatarsal bones within the foot. (One inch carries 22 percent of a person’s body weight, two inches carry 57 percent, and three inches hold 76 percent, according to the Spine Health Institute.) This extra weight can cause tendonitis, in-grown toenails, and pinched nerves in feet and toes. “Over time, high heels shorten Achilles tendons and destroy the protective fat pads in feet,” says Sutera. To keep toes happy, alternate heel heights and styles throughout the week.

2. Size Matters

Shop for shoes at the end of the day and try heels on as you plan to wear them in real life (for example, with stockings or barefoot). And make sure you purchase the correct size. While shoes that are too big cause feet to slip around and can lead to injury, a study from the American Orthopaedic Foot and Ankle Society shows that 88 percent of American women wear shoes that are ½ inch too small—which can cause not only pain and blisters but also corns, bunions, ingrown toenails, and hammer toes, according to the American Academy of Orthopaedic Surgeons. Trying to get a perfect fit? Never break shoes in by wearing them, says Sutera. “Use a shoe stretcher and wear them for 15 to 30 minutes at a time.”

3. Feet Get Tired Too

Four hours should be the maximum length of time for wearing heels nonstop because feet get fatigued. When commuting, Sutera recommends wearing switch-out shoes that are shock-absorbing, rubber- bottomed, and thick-soled. Sneakers are ideal; ballet flats and flip-flops should be avoided because they lack support.

4. It Isn’t Just Your Feet That Suffer

If gaining three inches makes you feel different, it could be because wearing heels misaligns posture. Daily high heel use over a number of years can actually lead to changes in your anatomy, according to the Spine and Health Institute. Walking in a pair of pumps pushes hips and knees forward, hyperextends the back backward, and contorts the entire skeleton.

5. Wedges Work

When choosing shoes with heels, consider a platform no higher than two inches. “Styles such as wedges, chunky heels, and platforms are preferable because they transfer body weight across a greater surface area,” Sutera says. If you opt for high-heeled sandals, choose a pair with straps, which provide support by anchoring the foot to the shoe.

6. Podiatrists Have Tricks That Can Help

For those times when you decide you simply have to wear heels, insoles that are shock absorbent, cushioned, and supportive of arches can alleviate foot pain and protect feet’s paddings. (Sutera is a spokesperson for Vionic, and recommends their orthotics.) A caveat: They shouldn’t be placed in stilettos because they’ll force toes into an even narrower area. You can also consider a fairly new treatment performed by some podiatrists called “foot cushioning,” in which facial fillers, such as hyaluronic acid, Sculptra, or Juvéderm, are injected into the balls of the feet to provide extra padding on this high-pressure area to relieve pain and make shoes more comfortable. The procedure is pricey at about $500 per foot, and results last three to six months. If this is of interest, it’s important to find a podiatrist with training in the technique.

7. Stretching is Smart

Each time you wear heels, Sutera suggests exercising feet before and after to re-elongate tendons and counteract the contracting and shortening that occur. Four to try: The Downward Dog yoga pose (hold for 15 seconds), runners' stretches (place outstretched hands on a wall in front of you at shoulder height and with back straight, keeping right foot straight behind a bent left leg), heel drops (while standing on a step, slowly lower a heel and use calf muscles to return to starting position), and massaging feet with a golf ball (15 seconds per foot for each). Finish up by icing calves, Achilles tendons, and the balls of feet for 15 minutes each, on and off.