What are the effects of high heels on gait?

Effects of High Heels on Gait

High heels negatively alter gait biomechanics by forcing the foot into increased plantar flexion, which leads to changes throughout the kinetic chain including increased knee flexion, lower back lordosis, reduced balance, and potentially increased risk of falls and injuries. 1

Biomechanical Changes

• High heels force the foot into an increased plantar flexion position, altering the natural foot-ankle complex and producing a chain reaction of effects that travels up the lower limb to the spine 2
• Static and dynamic balance are significantly better in low-heeled rather than high-heeled shoes 3
• Wearing high heels leads to asynchronous timing of subtalar and knee joint action, which increases with heel height 4
• The rollover function of the feet is compromised, affecting normal gait mechanics 1

Specific Gait Alterations

• Step length is reduced when wearing high heels, leading to a less efficient gait pattern 1
• Vertical ground reaction force and maximum anteroposterior braking force increase as a function of heel height 4
• Ankle plantar flexion and knee flexion increase with higher heel heights 4
• When crossing obstacles, individuals wearing high heels maintain toe clearance similar to barefoot conditions but have significantly reduced heel clearance, increasing tripping risk 5

Energy Expenditure and Physiological Impact

• Heart rate and oxygen consumption increase with heel height, indicating higher energy expenditure during walking 4
• The metabolic cost of walking increases significantly as heel height increases, making walking less efficient 4
• These physiological changes can lead to increased fatigue during prolonged walking 2

Fall Risk and Safety Considerations

• The risk of falling increases when wearing high heels, especially when navigating obstacles 5
• Heel clearance is reduced linearly with increasing obstacle height when wearing narrow-heeled shoes, indicating progressively higher risk of tripping 5
• Significant differences in gait parameters occur between 5.08 cm (2 inches) and 7.62 cm (3 inches) heel heights, suggesting heels should not exceed 5.08 cm to maintain comfort and decrease injury risk 4

Clinical Implications

• Both variable and constant height heels (regardless of shoe size) present similar negative effects on walking parameters 6
• The American Geriatrics Society notes that proper footwear is important for maintaining balance and preventing falls, with low-heeled shoes being preferable 3
• When leg length discrepancy occurs (such as when wearing a walking boot or brace on one foot), a contralateral shoe lift should be considered to improve comfort and balance 3

Recommendations

• For everyday use, low-heeled shoes are recommended to maintain proper biomechanical alignment and reduce fall risk 3
• If high heels must be worn, limit heel height to no more than 5.08 cm (2 inches) to minimize negative biomechanical effects 4
• For individuals with existing foot or back problems, properly fitting footwear that accommodates foot structure and provides adequate support is essential 7
• For older adults or those at risk of falls, avoid high heels entirely as they significantly compromise balance and increase fall risk 3