How High-heeled Shoes Create Musculoskeletal Disorders

The popularity of high-heeled shoes continues to soar in the market despite the obvious negative alterations in gait and posture.

Creating the illusion of long, slender legs, the increase in heel height induces significant biomechanical changes – reduction in ankle range of motion, improper distribution of weight in the metatarsals, increased pressure on the ball of the foot and diminished balance control.

In a recent research published in the Journal of Foot and Ankle Injuries by the University of Alabama at Birmingham, it was found that foot-related injuries associated with wearing high heels doubled between the years 2002 and 2012, and more than 80 per cent of the reported injuries were to the ankle and foot.

There is excessive pressure placed on the calf, hip and back musculature due to the abnormal stance undertaken by the body – the pelvis tilts anteriorly, the lordotic curve of the lumbar spine increases, the ankles and knees are thrust forward to compensate for the overall loss in balance and stability in high-heeled shoes.

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These neuromuscular adjustments raise the centre of gravity and shift the weight forward towards the metatarsals. The base of support, as a result of this, becomes narrow in the front with a lack of sufficient posterior support from the heels. This increases instability in the ankles, making it difficult to walk and increasing the incidences of sprains and fractures.

In an effort to maintain the upright posture of the body, the upper back and shoulders attempt to reposition the centre of gravity within the base of support by pushing it posteriorly towards the heel, but with minimal success.

A narrative systematic review of international peer-reviewed scientific literature by Maxwell and Jean for the British Medical Journal established a significant association of high-heeled shoes with hallux valgus and musculoskeletal pain.

Being the first systematic review conducted from an epidemiological perspective, the authors screened 56 full-text articles and included 18 studies in seven languages before determining the gradual impact of high heels on musculoskeletal health.

The development of foot conditions such as hammertoes, Morton’s neuroma and metatarsalgia can also be attributed to the frequent use of high-heeled footwear; the narrow toe box leads to compression of the metatarsals in the front, which increases stress on the forefoot and can cause damaging changes to the foot structure.

The American Podiatric Medical Association recommends the use of shoes which provide adequate cushioning at the front of the shoe.

A heel height of two inches or less should help in avoiding many of the injuries associated with increased pressure on the ball of the feet and toes.

It would also be helpful to alternate between different shoe types during the day, to lessen some of the stress placed on the lower limbs.

An orthotic intervention would be prescribed only to correct any underlying biomechanical issues that could get further exacerbated upon wearing high heels or to treat any existing pathologies of the lower extremity caused by the frequent use of high-heeled footwear.

A thorough gait analysis should be performed on an individual who wears high heels often to identify postural discrepancies such as a compromised medial longitudinal arch or a weakened foot structure, for the purpose of implementing an early intervention.

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References:

1. Barnish M., Barnish J. (2016) High-heeled shoes and musculoskeletal injuries: A narrative systematic review. British Medical Journal: January 2016, Vol. 6, doi:10.1136/bmjopen-2015-010053
2. Moore J.X., Lambert B., Jenkins G.P., McGwin G. Jr. (2015) Epidemiology of High-Heel Shoe Injuries in U.S. Women: 2002 to 2012. Journal of Foot and Ankle Surgery: July/August 2015, Vol. 54, No. 4, pp. 615-619, doi: 10.1053/j.jfas.2015.04.008.
3. Greene P.D., Roberts L.S. (2005) Kinesiology: Movement in the Context of Activity, Volume 1. Elsevier Health Sciences.

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