As 30-year-old New Yorker Carrie Donnelly began her bachelorette party in her new black open-toe five-inch heels, she fell, her foot going one way and her ankle the other.

“When I woke up the next day, my ankle was throbbing and had become extremely swollen,” she said. It was a month before her wedding—the last thing she wanted to do was to walk down the aisle in a cast.

Super-high heels like Carrie’s are all the rage. Fashion magazines tout them. Stars like Lady Gaga and Victoria Beckham wear them. The surgeon who treated Carrie’s injuries (fractures to the 4^th and 5^th metatarsals), Judith F. Baumhauer, M.D., incoming president of the American Orthopedic Foot and Ankle Society, has seen plenty of ankle sprains and a variety of fractures in women who fall off their heels. She likens it to stepping off the curb; high heels cause you to lead on your forefoot, where bone has the least contact. And the higher the heel, the more dangerous the shoe.

Joel S. Buchalter, M.D., a clinical assistant professor of Orthopaedic Surgery at the Hospital for Joint Diseases, and co-director of the Orthopaedic Institute at Putnam Hospital Center in New York, says that alcohol seems to be often involved in high-heel injuries. “Because drinking impairs balance and coordination, stepping out to a club or a party in super high heels is just asking for trouble,” he points out. He’s seen quite a few severe ankle fractures and dislocations in which surgery, although helpful, did not make the ankle normal, and he’s witnessed increased injuries to the face and wrists from such falls.

With stilettos, the narrowness of the heel magnifies the risks. “It creates the perfect storm and a recipe for disaster,” Baumhauer says—especially when you walk across uneven ground. She points out that high-heel shoes often lack padding, so there’s not much to cushion the blow when your foot hits the floor. As a result, she sees a variety of fractures (most commonly ankle and fifth metatarsal breaks), as well as ligament tears and dislocated ankle tendons (peroneals), that require surgery.

Still, some fashionistas think their heels aren’t high enough. There are plans afoot for nine-inch Sky Heel, to be released next year. That leaves plenty of time for you to consider these You Tube wipe-outs, if you’re still tempted to hit the stores.

Tips to keep your heel walking fracture-free:

1. If you’re shopping and can’t decide between the 3 and 5 inch heels, choose the lower heel.
2. If you simply must wear super high heels, don’t drink.
3. Kick your shoes off under the table when seated.
4. Take your shoes off to dance.
5. Change into flats for your trip home.
6. When you work out, don’t forget to strengthen and stretch your ankle muscles.
7. If you’ve had a prior ankle injury, think twice before you leave the house in heels.

Orly Avitzur is medical adviser at Consumer Reports and blogs at the Consumer Reports Health Blog.

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