DULUTH - Serina Popoe never wears high heels.

"They hurt, and I'll trip," said the South Range woman.

During a walk around sunny downtown Duluth, Popoe, 42, wore flats, and Dana Bourdage wore 2-inch heels. Bourdage, 47, said she used to wear heels every day for work, but today, she's usually in flats because wearing them hurts her hips.

While there are claims that heels can improve posture and balance, local experts say that's not necessarily true.

"If you're talking about the aesthetics of posture, by being higher off the ground, it can actually improve your posture," said Dr. Curt Kristensen of Northern Foot & Ankle Associates. "In terms of biomechanical posture ... that is not enhanced with heels. ... From a functional standpoint, you're more at risk with injuries," he added.

There aren't really benefits to wearing heels, said Ryan Reinking, board-certified foot and ankle surgeon of Orthopaedic Associates of Duluth.

"Our feet have adapted, they were not built to pound the pavement and concrete surfaces, which is what we're on most of the day," he said. That's why a supportive shoe yields more benefits in general.

Many consider anything above an inch and a half a high heel, but any raise off the ground counts. A high heel is a shoe with an arch over 2-2½ inches, Reinking said.

And the shorter the shoe, the better, he said.

That's because high heels put the heel of the foot above the shelf of the toes. Short-term effects are increased pressure; rubbing; ingrown toenails; calluses; or neuroma, an enlarged nerve. More outcomes can be the development of hammertoes or bunions.

Prolonged wear can cause a shortening of the tendon or calf muscle. It can leave the wearer more prone to ankle sprains due to lack of support or Achilles tendonitis.

Wearing heels also affects areas outside the feet and ankles.

The paraspinal muscles in the neck, and girdles around your trunk and hips are working harder when the wearer is in heels on a regular basis, Kristensen said.

This also puts pressure on the kneecaps, which can lead, over time, to the early onset of osteoarthritis, according to Time magazine.

Longer-term effects may appear after long-term wear - five days a week for six months or longer, Reinking said.

Issues affect male clients through the use of western or steel-toe boots or Cuban heels. These tends to be supportive, Kristensen said, but there's often friction with a narrower toe box.

Heels come in child sizes today, but Kristensen said he tries to discourage children from wearing shoes that don't have a lot of support. Reinking recommends kids not wear heels until at least after the 11-15 age range.

Kristensen has recommended to some clients to retire their heels, and there has been reluctance. It's a habit for many, he said.

If heels are worn, he recommends a wider and deeper toe box. Lean against a wall, take your heels off at your desk, stretch. Consider metatarsal gel pads, girthier heels or taping the third and fourth toes together. Cleaning the inside of the heel can help reduce slips or injury, and using petroleum jelly on the feet to keep the skin supple and smooth can help, he said.

Avoid barefoot walking or flip-flops; some soreness can be avoided by avoiding flimsy shoes, Kristensen added. Also, loose summer shoes may cause you to grip the sole with your toes, which shortens your gait, leading to other foot and ankle issues, according to Time.

Get the right size heels, or it's going to hurt worse, said Popoe.

Added Bourdage: "Take them off as soon as possible."

"Avoid them as much as you can, and wear them in special occasions," Reinking said.

That's what Shawna Charles of Duluth does.

The 27-year-old has a go-to pair of 4-inch heeled booties reserved only for nights out. "I'm not that graceful," she said.

She has been wearing high heels for only two years, and she's more comfortable walking in them than she used to be.

Most people wearing heels have been doing it for a long time, she said, but: "Heels aren't for everybody, and that's OK. I don't think they're supposed to be."