Habitual High Heel Use Could Have Long-term Effects on Walking

Previous studies exploring the effects of wearing high heels have found that it causes shortening of the medial gastrocnemius muscles and increases Achilles tendon stiffness, resulting in chronic adaptations in the muscle-tendon units in the foot. However, few studies have looked at the effect of these changes on the locomotor and neuromechanical function of muscle-tendon units, especially in habitual high heel wearers.

In response, researchers from Griffith University in Queensland, Australia decided to examine the effects of habitual high heel wearing on the neural and mechanical behavior of the triceps surae muscles during walking.

“No study before ours had looked at length changes of the muscle fibers,” lead author Neil J. Cronin, PhD, who is a senior researcher at the University of Jyväskylä in Finland, told O&P Business News. “This was a major gap in our knowledge because movement can only happen when muscles contract, so we need to understand this process in order to fully comprehend the effects of wearing high heels for a long time.”

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The researchers recruited two groups of participants. The first group consisted of nine women who habitually wore heels with a minimum height of 5 cm for at least 40 hours per week and at least 2 years. The 10 women in the control group wore heels for fewer than 10 hours per week. The average age of the participants was 25 years.

Both groups walked at a self-selected speed over a level walkway approximately 8 m long while barefoot 10 times. The test group performed the task an additional 10 times while wearing heels of their own choice. The researchers used electromyography to measure the muscle activation, and an ultrasound probe was used to measure fascicle strains.

The results of the study, which were published in the Journal of Applied Physiology, showed that while walking in heels, the test group had shorter muscle fascicles during standing than the controls, suggesting that they had already experienced chronic adaptations in muscle-tendon architecture. The researchers also found that the heel group demonstrated significantly larger strains in the muscle fascicles when walking in heels compared with barefoot walking. The heel group also demonstrated higher muscle activation in the medial gastrocnemius than the control group.

“The high heel group activated their muscles relatively more when walking overground compared to the control group. There are two implications of this,” Cronin said. “First, the muscles are likely to fatigue sooner, because they are being used to a greater extent. Second, using more energy to achieve a given distance, which seems to be the case in the high heel group, is less efficient.”

Barefoot results

The researchers also found that the heel group demonstrated higher muscle activation while walking barefoot compared with the controls, but they had similar fascicle strains and joint kinematics to the control group. This partially refuted the researchers’ hypothesis that the heel group would demonstrate larger fascicle strains than the control group while walking barefoot.

“We were originally surprised by this finding. Our working hypothesis, which is currently untested, is that when the high heel group walks barefoot, it somehow represents a ‘novel’ task as far as the brain is concerned, since the muscles and tendons, as well as the brain itself, have adapted to the conditions that are imposed by wearing heels,” Cronin said. “In response to this, it seems that the high heel group subconsciously activates their muscles more strongly. We hope to test this idea in the future.”

This adaptation when walking barefoot poses potentially harmful effects when women switch from heels to flat shoes.

“We know that the muscles and tendons get used to the position they are forced into when in heels,” Cronin said. “Therefore, if somebody switches to only wearing flat shoes, this would represent a change in the way the muscles and tendons are loaded. Whenever this happens, there is always a potential for injury.”

The most significant aspect of the study, however, was the young age of the participants. The participants had already developed chronic adaptations, suggesting that adaptations can occur more quickly than previously thought. How these adaptations could affect muscle and tendon structure later in life remains unknown.

“Unfortunately I only have anecdotal evidence at the moment,” Cronin said. “I have been told by numerous women that they are unable to walk in flat shoes anymore because it is too painful. This is probably the same effect we have seen in the younger women; the tendon becomes very stiff, and perhaps beyond a certain point, which may be several decades, this is irreversible.” — by Megan Gilbride

For more information:
  • Cronin NJ, Barrett RS, Carty CP. Long-term use of high heeled shoes alters the neuromechanics of human walking. J Appl Physiol. 2012 Jan 12. Epub ahead of print.