Higher-heeled shoes increase the risk of joint degeneration and knee OA

The risk of developing joint degeneration and knee osteoarthritis is increased by prolonged wearing of and walking in high heels, according to the results of an Iowa State University study.

Danielle Barkema, a kinesiology master’s student at Iowa State University, completed her thesis research studying the effects of high-heeled walking on forces acting on lower extremity joints. Phil Martin, head of the kinesiology department, assisted her with the study.

“Wearing high heels regularly puts a person at risk and the higher the heel, the greater the risk,” Martin stated in a press release. “The loading that is being produced in the joint with every step that they take is higher — or at least, these data suggest that. These are not direct measures of loading within the joint, but they’re an alternative way of looking at that kind of loading.”

Effects of heel height

Barkema’s study included 15 women who completed walking trials wearing three different heel heights: flat, 2 inches and 3.5 inches. She measured the forces acting about the knee joint and the heel strike-induced shock wave that travels up the body when walking in heels, according to the release.

Barkema found that heel height affected walking speeds and stride lengths, the release noted. An increase in the compression on the medial side of the knee was also observed as heel height increased.

“This means that prolonged wearing and walking in heels could, over time, contribute to joint degeneration and knee osteoarthritis,” Barkema stated in the release.

Changes in posture

The study also found that wearing heels, especially those 2 inches or higher, alters body posture by changing joint positions at the ankle, knee, hip and trunk, which can create strain on the lower back, the release noted.

“Visually, it is quite apparent that somebody’s posture is altered when wearing high heels,” Barkema notede. “We noted those changes in posture [in the study], as well as various joint angles, such as the knee and ankle angle. The most dramatic change occurs at the ankle.”

Barkema’s study will be presented, in part, at the annual meeting of the American Society of Biomechanics, August 18 through 21, at Brown University in Providence, R.I.

Our study, which was previously featured on the ORTHOSuperSite, focused on the long-term use of high-heeled shoes and the adaptive responses of that may be triggered in muscles and tendons. Our data demonstrate that a particular lifestyle condition (regular use of high heels) may induce morphological changes in muscles and tendons, which seem to functionally compensate each other. We think that this is an interesting notion. Yet, Danielle Barkema's results seem to be in line with previously reported data suggesting that, by putting on high heels, the body's center of mass is raised and shifted forward, which affects the entire gait cycle and may result in increased pressure on the forefoot and non-physiological forces acting on ankles, knees and hips. Also, increased tonic activity of the lower back muscles may be required to compensate for the forward shift of the body's center of mass. Thus, in the long run, wearing high heels may well lead to a number of orthopedic ailments, including osteoarthritis. I'm not sure whether this study is going to have a significant impact on orthopedists' working life. In the end, the acute and long-term risks associated with high-heeled shoes have been known for decades. Women will continue wearing them nevertheless. And orthopedists will continue fixing osteoarthritis, bunions and ankle sprains.

- Robert Csapo
Center of Sports Sciences
University of Vienna
Vienna, Austria

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