The biomechanics of our body affect everything from how we sit to how we walk, and everything in between. As infants, the biomechanics of our bodies adapt as we learn to lift our heads, crawl, pull ourselves up and eventually teeter into someone’s arms before starting the process all over again. We get more stable on our feet as we grow, but our biomechanics are constantly changing. As adults, long hours in traffic, sitting at a desk and even the shoes we wear on a daily basis can influence our body position and even our perception of muscular and skeletal pain. But few other shoes affect the same and functioning of the foot as dramatically as high heels do.

In fact, walking in heels can alter the natural position of the foot-ankle complex, changing the positioning of the entire chain of the lower limb (ankles, knees and hips) to the spine. We’ve known for a while that the feet and ankles of women (or men) who wear heels over a long period of time are different from the feet and ankles of those who wear flats on a daily basis, but I got curious if there was a difference in the length of time that someone wears heels for.

I lucked out. Aka I found an answer in the research.

In 2015, a letter to the editor of the International Journal of Clinical Practice described the outcomes of a study in which women who were required to wear heels for their eventual jobs as airline attendants had their ankle strength measured and compared to women in different years of schooling. The four year program required these women to wear 10cm heels at least 3 times per week over 4 years as it was a requirement of their jobs. Point aside that airline attendants (or anyone in general) shouldn’t be required to wear high heels as part of their job, this was an interesting comparison in ankle strength related to length of time wearing heels.

The results were fascinating! Over the course of the research, the students strength in legs and ankles increased in their second and third years of study compared to their first year, especially in the joint area of the ankle. However, students in their final year of study showed a weakening of their ankles and poorer balance when compared to students in their first year.

So what’s this mean overall? While, first things first this is a small study, so we have to take it in context with the rest of the research out there. The literature strongly supports the fact that heels make ankles weaker, this particular study gives us insight into the mechanism and the timeline.

BUT – we can do something about it! A love (or requirement) of wearing heels shouldn’t have to impact good biomechanics, but major accidents such as falls and serious ankle sprains can result without proper maintenance and conditioning. So I strength my ankles through a few simple exercises such as towel scrunches, heel lifts (like a relevé) and heel drops. I would also recommend that you walk to work in sneakers or flats and then change into heels when at work, as well as remove your heels if safe to do so when sitting at your desk.

Additionally, for those of you who may need extra support in the ankle strengthening department, I use a technique called prolotherapy in my clinic to strengthen the ligaments on the outside and inside of your ankles. Curious if this could help strengthen your ankles, improve your balance and stop that wobbling? Give me a call at the clinic (902.820.3443) or send me an email to learn more!

-Dr. Ashley

Research:

Abdel-aziem AA, Draz AH. Chronic ankle instability alters eccentric eversion/inversion and dorsiflexion/ plantarflexion ratio. J Back Musculoskelet Rehabil 2014; 27: 47–53.
Csapo R, Maganaris CN, Seynnes OR, Narici MV. On muscle, tendon and high heels. J Exp Biol 2010; 213: 2582–8.
Cronin NJ, Barrett RS, Carty CP. Long-term use of high-heeled shoes alters the neuromechanics of human walking. J Appl Physiol 1985; 2012: 1054–8.
Kim, MH., Choi YT., Jee YS., et al. (2015).Reducing the frequency of wearing high-heeled shoes and increasing ankle strength can prevent ankle injury in women. International Journal of Clinical Practice.
Lee KY, Lee HJ, Kim SE, Choi PB, Song SH, Jee YS. Short term rehabilitation and ankle instability. Int J Sports Med 2012; 33: 485–96
Silva AM, de Siqueira GR, da Silva GA. Implications of high-heeled shoes on body posture of adolescents. Rev Paul Pediatr 2013; 31: 265–71.
Tedeschi Filho W, Dezzotti NR, Joviliano EE, Moriya T, Piccinato CE. Influence of high-heeled shoes on venous function in young women. J Vasc Surg 2012; 56: 1039–44.
Yung-Hui L, Wei-Hsien H. Effects of shoe inserts and heel height on foot pressure, impact force, and perceived comfort during walking. Appl Ergon 2005; 36: 355–62.

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