Low Advice (High heeled shoes)

Low Advice (High heeled shoes)

Low Advice (High heeled shoes)


“Conflict-of-interest” is a term commonly heard these days, what with the “Whitewater” affair/scandal/nonsense (you choose) in the news almost every day. While I’m not running for elective office, I would like to start by stating unequivocally that I have absolutely no personal stake or interest, none whatsoever, in dispensing the following advice:

Women should not wear high-heeled shoes!

Now, of course I’m speaking from a strictly biomechanical, not esthetic, point of view. And the most recent study of the effects of high-heeled shoes on biomechanics of gait and energy expenditure confirms what many had always suspected and had been suggested by previous studies: use of such footwear comes with a cost.

Investigators at the University of Massachusetts Amherst looked at changes in lower limb joint angles, ground reaction forces and oxygen consumption parameters (heart rate, VO2, CO2, volume) in subjects walking with shoes of varying heel heights, from “flat” (0.5 in.) to “spike” (3.0 in.). The data clearly show that all three functions are significantly affected by heel height of 2 inches or greater.

Common sense should tell us that these results are no big surprise. High-heels obviously place the foot and ankle in an unnatural position, with the foot pointed downward and with a limitation to the upward movement of the foot. From this starting point, compensations must take place at joints and muscles further up. As this study confirmed, the knee seems to be most affected, with the flexion angle values and timing of movement altered. Timing of muscle contractions, especially the quads, is also changed. Heel and knee rotation movements take on an “adversarial” rather than complementary relationship which adds to the risk of injury.

Ground reaction forces during stance phase were also found to rise as heel height increased, which will affect the amount of shock transmitted to the lower extremities. Finally, oxygen consumption increased significantly, particularly with the highest-heels, indicating there is an energy cost associated with use of these shoes.

Obviously, no one is likely to use high-heeled shoes for running, so the potential for the occurrence of the above adverse effects from wearing these shoes during daily walking activities is most likely proportional to the amount of use. There are other risks involved, however, with even simple wearing of high-heels, regardless of walking distance, which can ultimately have an effect on running performance and injury development. These involve contraction and tightening of the calf muscles and heel cord, which increases the likelihood of Achilles tendinitis if not actual rupture. Also, there is good evidence that high-heeled shoes, which are generally narrow in shape and are generally not well-cushioned, promote the formation of bunions and other forefoot problems.

These are the facts. The choice is yours. And remember, I’m only looking out for your running health!

Gabe Yankowitz

Gabe is a long-time runner and physical therapist currently practicing in Manlius. Gabe is a physical therapist in Central New York for the past 35 years, specializing in orthopedic treatment and rehabilitation. His website is www.gaberun.com

  • Physical therapy degree from Upstate Medical Center (1983)
  • Doctor of Physical Therapy degree from the Massachusetts General Hospital Institute of Health Professions  (2007)
  • Board-Certification as Clinical Specialist in Orthopedic Physical Therapy (2009).