High-heeled shoes have been worn since the Middle Ages. In the Middle Ages, men wore high-heeled shoes to elevate themselves from the dirt of medieval streets. In the modern world, high-heeled shoes have become a fashion symbol of female sexuality. Scientific studies have confirmed that women who wear high-heeled shoes are deemed more attractive by men. Guéguen’s research showed a linear correlation between heel height and the likelihood of men’s helping behavior. Namely, the higher the heel the higher the likelihood of men offering and providing assistance.
Studies provide evidence of the harmfulness of high-heeled shoes to health. An association between wearing high-heeled shoes and musculoskeletal pain and hallux valgus has also been observed, and there is also an increased risk of osteoarthritis and ankle injuries due to falls. Wearing high-heeled shoes causes significant changes in how the body moves in the space (kinematics) and the power involved in performing the movement (kinetics), and these changes are felt throughout the musculoskeletal system, from the spine to the toes. Those changes are the reason for the development of hallux valgus, osteoarthritis, and ankle injuries.
High-heeled shoes are made in a way that keeps the heel at a higher level than the toes. Thus, while wearing high-heeled shoes, the foot stands permanently in a downhill slope. The only parts of the foot that are in contact with the floor are the tips of the toes and the heel. The arch of the foot is not in contact with the floor. In this position, the ligament extending from the heel to the toes is stretched, which leads to pain and injury because the body is bent forward and 90% of the body weight is on the front of the foot, instead of being distributed throughout the foot. Also, the ankle joint is unstable in that position, and this leads to instability and injury. The body adapts to this change of position with posture changes. The lumbar part of the spine is ejected outward, and the chest is ejected forward which prevents the person from disbalance and falling. These spinal modifications are responsible for back pain during prolonged periods of high heel wearing.
Wearing high-heeled shoes also changes the gait cycle. The gait cycle is the interval between two consecutive contacts of one foot with the ground and it is divided into two phases. The stance phase when the foot is in contact with the ground and the swing phase when the foot is in the air. These stages are necessary because they enable the foot to absorb shock. Wearing high-heeled shoes prevents the foot from going through all the stages of the gait cycle which leads to instability and pain. When walking, a person has to make more steps to maintain its balance. Venous problems that occur after frequent wearing of high-heeled shoes should also be considered. Tedeschi et al associate venous hypertension in the lower limbs with regular and prolonged high-heel wear. Also, this paper reveals that the higher the heel the adverse effects on venous function of the lower extremities are stronger.
How to wear high heels comfortably?
High-heeled shoe comfort studies consider heel height, various insoles, and heel thickness. The following conclusions were drawn. The appropriate heel height range is from 3 to 5 cm. Compared to a thinner heel, a thicker heel increases gait stability, reduces the risk of ankle injury, and increases shoe comfort while walking. The use of a total contact insert significantly reduces the pressure on the foot, which also improves comfort.
Since human feet naturally show a moderate imbalance in body weight distribution when walking barefoot (43% of body weight is on the front of the foot and 57% on the back), orthopedists recommend wearing shoes with a small heel, up to 2 cm.
Inappropriate footwear is linked to many health issues such as circulatory problems and chronic back pain. The International Society of Foot Surgery claims that 80% of the world’s population suffers from ailments caused by inappropriate footwear. In any case, while choosing footwear quality should be imperative, preferably shoes with a heel of 2 cm to combat the natural imbalance of the human foot. When it comes to high-heeled shoes, it is advisable to opt for lower and thicker heels to prevent various locomotor ailments and improve comfort while walking.
Translated by Patricia Štriga
2. Wiedemeijer MM, Otten E. Effects of high heeled shoes on gait. A review. Gait Posture. 2018 Mar; 61: 423 – 430.
3. Barnish M, Morgan HM, Barnish J. The 2016 HIGh Heels: Health effects And psychosexual BenefITS (HIGH HABITS) study: systematic review of reviews and additional primary studies. BMC Public Health. 2017 Aug 1; 18(1): 37
4. Barnish MS, Barnish J. High-heeled shoes and musculoskeletal injuries: a narrative systematic review. BMJ Open. 2016 Jan 13; 6(1): e010053.
5. Wang M et al. Health View to Decrease Negative Effect of High Heels Wearing: A Systemic Review. Appl Bionics Biomech. 2021 Mar 12; 2021:6618581.
6. Pino-Ortega J et al. Impact of high-heeled and sport shoes on multi-joint external load profile during walking. J Back Musculoskelet Rehabil. 2021; 34(3): 389 – 398.
7. Tedeschi Filho W, Dezzotti NR, Joviliano EE, Moriya T, Piccinato CE. Influence of high-heeled shoes on venous function in young women. J Vasc Surg. 2012 Oct; 56(4): 1039 – 44.