High heels shift the body’s center of mass forward toward the midfoot and forefoot, which cascades into changes in foot loading, joint mechanics, posture, and balance. This makes gait less efficient, increases local tissue stress, and raises the risk of pain and injury in the feet, knees, hips, and spine.[1][2][3][4]
## What happens when the center of mass moves forward?
When the heel is elevated, the whole body tilts forward unless counterbalanced; the center of mass (CoM) moves anteriorly and often slightly superiorly. To keep from falling, the body recruits joint angles and muscle activity (ankle, knee, hip, spine) to pull the CoM back over the narrowed base of support, increasing postural demand.[5][6][1]
- Center of pressure shifts toward the forefoot, with significantly higher peak pressures and forces under the metatarsal heads than in flats.[2][7]
- Vertical and anteroposterior ground-reaction forces change timing and magnitude, with higher braking forces occurring earlier in stance.[8][1]
## Foot and midfoot consequences
The midfoot’s role as a load-sharing, shock-absorbing structure is altered as more body weight migrates distally toward the metatarsal heads. The smaller, high-pressure contact area under the forefoot must now manage propulsion and more of body-weight support.[7][2]
- Increased metatarsal pressure and contact area raise the risk of metatarsalgia, calluses, neuromas, and forefoot deformities such as hallux valgus and hammertoes.[4][2][7]
- Plantar fascia strain may decrease at modest heel lifts but rises again with higher, narrow heels, especially during toe-off when toes are forced into extended “tiptoe” posture.[7]
## Ankle, Achilles, and calf adaptations
Because the CoM is forward, the ankle stays in relative plantarflexion throughout stance, changing muscle recruitment around the ankle complex.[3][2]
- Ankle dorsiflexion excursion and late-stance ankle power decrease, so push-off becomes less ankle-driven and more dependent on proximal joints.[3][8]
- Chronic plantarflexed positioning shortens and stiffens the triceps surae–Achilles unit, predisposing to calf tightness, insertional pain, and discomfort when trying to walk in flat shoes.[9][10]
## Knee, hip, and spine loading
To realign the CoM over the foot, the knees, hips, and spine move into a new pattern that increases joint loading and muscular effort.[4][3]
- Elevated heels and anterior CoM promote increased knee flexion and extensor moments in stance, which can raise contact stresses and are associated with heightened osteoarthritis risk.[11][3][4]
- The pelvis tends to tilt anteriorly and the lumbar spine often shows increased lordosis or altered curvature, with greater erector spinae activation to hold the shifted posture, contributing to low-back and hip discomfort.[12][5][4]
## Balance, stability, and injury risk
A forward-shifted CoM combined with a reduced, elevated base of support lowers the safety margins for balance. The neuromuscular system must work harder to control sway and recover from perturbations.[6][13][2]
- Static and dynamic balance are measurably poorer in high heels, with larger CoM/CoP excursions and increased postural sway amplitudes.[13][2][6]
- Supinated rearfoot at initial contact, higher forefoot loads, and the elevated, narrow heel heighten the risk of inversion ankle sprains and falls, particularly on uneven surfaces or with fatigue.[14][1][9]
## Practical takeaways for wearers
While occasional short-duration wear at modest heel heights may be tolerated by healthy individuals, habitual use amplifies these biomechanical consequences.[15][16][3]
- Choosing lower, wider heels with more forefoot support and cushioning reduces the magnitude of the CoM shift and plantar pressure peaks.[2][15][7]
- Alternating with flat or low-heel shoes, performing calf–Achilles stretching and intrinsic-foot strengthening, and limiting duration of wear can mitigate—but not eliminate—the load and postural changes induced by the anterior CoM displacement.[16][9]
Sources
[1] High heeled shoes: their effect on center of mass position, posture ... https://pubmed.ncbi.nlm.nih.gov/8185452/
[2] Effects of high-heeled shoes on lower extremity biomechanics ... - NIH https://pmc.ncbi.nlm.nih.gov/articles/PMC10120101/
[3] Effects of high heeled shoes on gait. A review - ScienceDirect.com https://www.sciencedirect.com/science/article/abs/pii/S0966636218300687
[4] How High Heels Affect Your Spine | Crossroads Chiropractic https://crossroadschiropracticclinicpa.com/how-high-heels-affect-spinal-health/
[5] High heels and Women's Health - Physiopedia https://www.physio-pedia.com/High_heels_and_Women's_Health
[6] The influence of high heeled shoes on balance ability and walking ... https://pmc.ncbi.nlm.nih.gov/articles/PMC6047962/
[7] The Influence of Heel Height on Strain Variation of Plantar Fascia ... https://www.frontiersin.org/journals/bioengineering-and-biotechnology/articles/10.3389/fbioe.2021.791238/full
[8] Walking in high-heel shoes induces redistribution of joint power and ... https://www.tandfonline.com/doi/full/10.1080/23335432.2023.2228362
[9] The Impact of High Heels on Gait and Foot Health https://www.mycfas.com/blog/the-impact-of-high-heels-on-gait-and-foot-health
[10] High Heels: The Health Risks - United Hospital Center Orthopaedics https://wvorthocenter.com/high-heels-health-risks/
[11] [PDF] The Postural and Biomechanical Effects of High Heel Shoes https://www.logan.edu/mm/files/LRC/Senior-Research/2012-Apr-18.pdf
[12] How High Heels Affect Your Spine - Lincoln - Chiropractic FIRST https://www.mylincolnchiropractor.com/blog/how-high-heels-affect-your-spine/
[13] Effects of Occasional and Habitual Wearing of High-Heeled Shoes ... https://www.frontiersin.org/journals/sports-and-active-living/articles/10.3389/fspor.2022.760991/full
[14] How Wearing High Heels Affects Physique and Gait https://www.madisonfootclinic.com/blog/how-wearing-high-heels-affects-physique-and-gait
[15] Health View to Decrease Negative Effect of High Heels Wearing: A ... https://onlinelibrary.wiley.com/doi/10.1155/2021/6618581
[16] The Real Harm in High Heels | American Osteopathic Association https://osteopathic.org/what-is-osteopathic-medicine/the-real-harm-in-high-heels/
[17] High Heeled Shoes: Their Effect on Center of Mass Position, Posture ... https://www.sciencedirect.com/science/article/pii/S0003999321016221
[18] High Heels Effect on Posture - https://www.newagephysio.in/high-heels-effect-on-posture/
[19] High Heels and Spine Health https://www.neuromicrospine.com/news/high-heels-and-spine-health
[20] Effect of wearing high heels on the biomechanical para... https://jkes.eu/seo/article/538076/en
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