A pair of 5-inch stilettos can add the finishing touch to any outfit. After all, aren’t Louboutins and Manolos a girl’s best friend? But strutters beware: The "mile-long legs" effect from high heels could cause long-term back, ankle, and knee damage (not to mention that aching feet thing).

Hell on Heels — Why It Matters

high heelsPhoto by Aleksandra Flora

According to Carrie Bradshaw, all women have the right to shoes. Carrie is also ignoring about 250 years of scientific inquiry into heels A History of medical scientists on high heels. Linder, M., Saltzman, C.L. College of Law, University of Iowa. International Journal of Health Services: Planning, Administration, Evaluation, 1998;28(2):201-25. Before getting into a brawl over a pair of Jimmy Choos, take note that wearing heels (even ones less than an inch high) can cause muscle strain and possibly even permanent damage among frequent wearers Moderate-Heeled Shoes and Knee Joint Torques Relevant to the Development and Progression of Knee Osteoarthritis. Kerrigan, D.C., Johansson, J.L., Bryant M.G., et al. Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA. Archives of Physical Medicine and Rehabilitation. 2005 May;86(5):871-5.. Muscles and tendons are malleable tissues that change in response to stress. Wearing high heels every day can shorten calf muscles by up to 13%, causing lower leg stiffness and limiting the ankle’s range of motion On muscle, tendon and high heels. Csapo, R., Maganaris, C.N., Seyennes, O.R., et al. Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University, Faculty of Science and Engineering, John Dalton Building, Chester Street, Manchester, UK. The Journal of Experimental Biology. 2010 Aug 1; 213(Pt 15):2582-8.. Heels may give women a certain swish to their walk but that "je ne sais quoi" could cause some serious "dommage." Heels change a person's walking motion, increasing the amount of bone-on-bone forces in the knee which can lead to osteoarthritis Walking on high heels changes muscle activity and the dynamics of human walking significantly. Simonsen, E.B., Svendsen, M.B., et. al. Department of Neuroscience and Pharmacology, The Panum Institute, University of Copenhagen. Journal of Applied Biomechanics, 2012 Feb;(28)1:20-8.

(Also Check Out: 14 Health Risks You Might Be Wearing)

High-heeled shoes may also damage muscles and tissue around the knee joint, which can potentially result in painful osteoarthritis — ouch! The change in vastus medialis oblique and vastus lateralis electromyographic activity related to shoe heel height during treadmill walking.Park, KM., Chun, SM., Oh, DW., et al. Department of Physiotherapy, College of Health and Sports Science, Daejeon University, Daejeon, Korea. The Journal of Back and Musculoskeletal Rehabilitation. 2010; 23(1):39-44. Moderate-Heeled Shoes and Knee Joint Torques Relevant to the Development and Progression of Knee Osteoarthritis. Kerrigan, D.C., Johansson, J.L., Bryant M.G., et al. Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA. Archives of Physical Medicine and Rehabilitation. 2005 May;86(5):871-5..

Studies also suggest stilettos can cause back problems and exacerbate existing ones. Women who wear high heels on a daily basis are more likely to display poor posture, experience lower back pain, and suffer from prolonged muscle fatigue Effect of positive heel inclination on posture. Franklin, M.E., Chenier, T.C., Brauninger, L., et al. Department of Physical Therapy, School of Allied Health Sciences, East Carolina University, Greenville, NC. The Journal of Orthopaedic and Sports Physical Therapy. 1995 Feb; 21(2):94-9. Changes of bioelectrical activity in cervical paraspinal muscle during gait in low and high heel shoes. Mika, A., Oleksy, L., Mikolajczyk, E., et al. Department of Clinical Rehabilitation, University School of Physical Education in Kraków, Poland. Acta of Bioengineering and Biomechanics. 2011; 13(1):27-33..

To Heel With It — The Answer/Debate

Although it's tempting to slip on those pumps before a night on the town, the achy pain experienced after the first few struts is a tell-tale sign something is wrong. Instead of heels, rheumatologists suggest wearing flat, flexible shoes with good arch support to ease stress on knee joints and lower body muscles. If heels are an absolute must, it's best to wear them sparingly, since many of their biggest harms come via repetitive stress on the calves and knee joint.

Don’t want to sacrifice fashion for health? Try trading heels for a cute pair of flats or non-heeled boots to wear to work or for a night out. Perhaps someone better get Lady Gaga on the telephone about her choice of footwear.

Are high heels really worth the health risks? How do you cut the pain while walking tall? Let us know in the comments.

Originally posted July 2011. Updated June 2012.

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