High heels and Women's Health

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Original Editor - Kapil Narale

Top Contributors - Kapil Narale and Kim Jackson  

Introduction

Its a popular notion that high heels can increase a Woman's physical attractiveness, thus enhancing her health and fertility.

Many Women (59% of Women) are seen to be wearing high heels for social or professional reasons, anywhere from 1 to 8 hours a day.

Legs in high heels are seen to be more attractive than legs without high heels. Legs that are in heels are perceived to be longer than those not in heels. The longer leg length is seen to be more sexually attractive to the opposite sex. the use of high heels give the perception that Women are being safeguarded by their partners. Women feel more sexually attractive as well.

High heels are seen to superficially increase Women's attractiveness to Men through altering their gait, reducing their stride length, and increasing their pelvic tilt and hip rotation. in addition, the curve in Women's lumbar spine is increased, which also increases attractiveness.

High heels do have psychosexual benefits which make their use more preferred, however there are many detrimental effects associated with high heels, making their use a public health challenge.

There is an association between psychosexual benefits and the negative effects on musculoskeletal health, which makes high heels a social and controversial issue. These effects and aspects will be discussed.

Musculoskeletal Health

A biomechanical review has found that there are incorrect variations to the neuromechanics of walking gait, and kinematics and kinetics of structures within the body from the spine to the toes, which can create a risk for various conditions such as musculoskeletal pain, hallux valgus, ankle inversion injuries, and osteoarthritis. There can also be deviations in foot and ankle kinematics, kinetics, knee and hip flexion, gait, posture, and balance. Increased lumbar lordosis due to an increased pelvic tilt can be associated with the risk of low back pain.

It is seen that the use of high heels in adolescents, individuals ranging from 10-19 years old, can lead to postural impairments, which affect head positioning, the back, pelvis, and the knee. Heel height and width are primary contributors to postural changes, and boy imbalance.

High heels are also seen to increase lumbar lordosis. They also increase the height of the body's Center of Mass, therefore decreasing postural stability. Due to these changes, there is an adjusted increase in erector spinae activity, to maintain the deviated posture. The increased muscle activity can lead to increased discomfort and muscle fatigue. This would help explain the onset of low back pain in individuals who use high-heels for an extended period.

Erector Spinae Activity and Pelvis Kinematics

The increased heel height produces an altered activation timing of the erector spinae muscles. A study showed that there was an early activation of the erector spinae muscle. This goes to show that foot wedging can produce distinctive changes in the timing of muscle activation in the low back and pelvis, during gait. This may be clinically significant since an even short increase in EMG activity of the back muscles can lead to chronic overload and fatigue.

A study measured the EMG of the erector spinae and pelvis kinematics, in normal walking speeds, of younger Women and middle-aged Women, in three conditions: without shoes, in low-heeled shoes (4cm), and high heeled shoes (10cm). It is seen that as heel height increases, erector spinae EMG activity increases.

As can be seen throughout various studies, there are biomechanical differences according to the age range of individuals.

In younger women, within the three conditions of increasing heel height, there was an increased EMG activity recorded during gait at initial ground contact (heel strike), and at toe off. However, EMG activity did not differ much between wearing high heels and low heels. In addition, with high heels, there was a greater pelvic range of motion in the sagittal plane, compared to low heels and no heels. It is seen that younger individuals have a pronounced anterior pelvic tilt, and an increased spine lordosis.

In middle aged Women, there was a significantly higher lumbar erector spinae EMG activity between wearing high heels and with no heels. There was no significant difference between wearing low heels and no heels. They are seen to have a pronounced posterior pelvic tilt, and a reduced spine lordosis.

Its interesting to note these differences since these changes in middle-aged Women can increase soft tissue mechanical loading, which can facilitate degenerative changes. This can be noticed in those individuals with low back and knee concerns. The increased lumbar erector spinae EMG activity has the potential to cause muscle overuse, which could to low back problems.

The lower pelvic range of motion in middle aged Women, compared to younger Women, can signify that tissues in the lumbopelvic region become more rigid as one ages. Thus, the harmful effects of high heels on posture and spinal tissues may be more apparent with age.

Pelvic range of motion did not display a significant difference with heel height in the frontal or transverse planes, in both the young women and middle-aged women groups. However, the values were significantly lower in the middle-aged women group. In addition, heel height showed no significant effect on pelvic alignment angle, in both young and middle-aged women, in the sagittal, frontal, or transverse planes, during the initial contact and toe off phases of gait. Pelvic tilt angle, between young and middle-aged women, had no significant difference.

It is interesting to note that gait velocity were not significantly different between young women and middle-aged women, and between the conditions of wearing no heels, low heels, and high heels.

Gait Disturbances

Studies have shown that gait with high heels is less energy efficient, which can increase fatigue, reducing reflex and voluntary movement responses, in addition to change in rate of muscle activation and strength.

The use of high heel shoes aligns the foot in plantarflexion, which produces increased ground reaction forces that have an effect on the spine. Initial ground contact at the beginning of the gait cycle, induces a force caused by an increased ground reaction force, which is transmitted up the spine. This can pose as a danger of low back pain, as related to heel height. It is possible that loads absorbed by tissues during gait may further aggravate low back pain symptoms. However, the increased loads can in fact be dampened by alterations in the kinematics of the body, or through direct absorption by the soft tissues.

Increased lumbar lordosis which occurs with the use of high heeled shoes has a purpose of absorbing the vertical loads. Thus, repetitive strain injuries can be caused by tissue overload that is not accommodated for in high heeled gait.

Local muscle fatigue can be triggered by ...

Osteoarthritis

Various biomechanical reviews show evidence that there is a risk of osteoarthritis, though there isn't evidence of epidemiological studies.

Second-party Injury

An injury, caused by another person, due to the mechanism of a stiletto (heels that are higher than 1 inch) is very possible, and can lead to temporary or more long-term impairments or damages, especially when involved in stepping on anothe rindividual or used in a fight.

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