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High-heeled shoes, also known as high heels, are a type of shoe with an upward-angled sole. The heel in such shoes is raised above the ball of the foot. High heels cause the legs to appear longer, make the wearer appear taller and accentuate the calf muscle.[1]
There are many types of heels in varying colors, materials, styles, and heights. High heels have been used in various ways to communicate nationality, professional affiliation, gender, and social status. High heels have been an important statement piece of fashion throughout history in the West.[2] In early 17th-century Europe, high heels were a sign of masculinity and high social status. It was not until the end of the century that this trend spread to women's fashion.[3] By the 18th century, high-heeled shoes had split along gender lines. By this time, heels for men were chunky squares attached to riding boots or tall formal dress boots, while women's high heels were narrow and pointy and often attached to slipper-like dress shoes (similar to modern heels).[3] By the 20th century, high heels with a slim profile represented femininity; however, a thick high heel on a boot or clog was still socially acceptable for men.[2] Until the 1950s, shoe heels were typically made of wood, but in recent years they have been made of a variety of materials including leather, suede, and plastic.[4]
Platformed footwear has a long history dating as far back as ancient Egypt, though it is unknown when the platforms made their first appearance. In ancient Egypt, wearing very thick-soled sandals was an indication of upper-class status. Butchers in ancient Egypt also elevated themselves by wearing platformed sandals to keep blood away from their feet.[9][10] In Manchu China during the Qing dynasty platformed shoes, with the elevation in the center of the sole rather than at the heel, were worn by higher-status women.[11]
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The design of the high French heels from the late 1600s to around the 1720s placed the wearer's body weight on the ball of the foot and was decorated with lace or braided fabric. From the 1730s to the 1740s, wide heels with an upturned toe and a buckle fastening became popular. The 1750s and 1760s introduced a skinnier, higher heel. The 1790s continued this trend but saw more experimentation with color. Additionally, during this period, there was no difference between the right and left shoes.[19]
In Britain in 1770, an act was introduced into parliament that would have applied the same penalties to the use of high heels and other cosmetic devices as would have been applied in the case of witchcraft.[20]
During the 20th century, World War I and World War II led many countries to ration materials that were previously used to make shoes. Materials such as silk, rubber, and leather were prioritized for military use. Heels began to be replaced with cork and wooden-soled shoes.[22] Due to the post-war increase in international communication, especially through photography and films, the Western fashion of women's high heels began to spread globally.[18] In the early post-war period, brown and white pumps with cutouts or ankle straps combined with an open toe were some of the most fashionable women's heels.[22] For many women in the West, high-heeled shoes began to symbolize professionalism, whereas leather and rubber thick-heeled boots for men came to be associated with militarism and masculinity.
The era surrounding World War II saw the popularization of pin-up girl posters, the women in which were almost always pictured wearing high heels. In the minds of many men at war, and later, in American society at large, this led to an increase in the strength of the relationship between high heels and female sexuality.[13] The tall, skinny stiletto heel was invented in 1950, and quickly became an emblem of female sexuality.[19] There was a weakening of the stiletto style during the late 1960s, early 1970s, and 1990s when block heels were more prominent, followed by a revival in the 2000s.
For men, high heeled boots made a comeback in the 1950 as the cowboy boot, associated with Western movies. During the 1960 and 1970, Beatle boost, Chelsea boots and Winkle-pickers with Cuban heels became popular among Teddy boys, the mod subculture and the early garage punk scene.
In the Western world, high-heeled shoes exist in two highly gendered and parallel tracks: highly fashionable and variable women's shoes with thin long heels, and practical, relatively uniform men's shoes in a riding boot style, with thick, relatively short heels.[14] Heels are often described as a sex symbol for women, and magazines like Playboy, as well as other media sources that primarily portray women in a sexual way often do so using high heels. Paul Morris, a psychology researcher at the University of Portsmouth, argues that high heels accentuate "sex-specific aspects of female gait," artificially increasing a woman's femininity.[14] Likewise, many see the arching of a woman's back facilitated by wearing high heels as an imitation of a signal of a woman's willingness to be courted by a man.[23][24] Despite the sexual connotations, heels are considered both fashionable and professional dress for women in most cases, the latter especially if accompanied by a pants suit. Some researchers argue that high heels have become part of the female workplace uniform and operate in a much larger and complex set of display rules.[14] High heels are considered to pose a dilemma to women as they bring them sexual benefits but are detrimental to their health.[original research?][25]
Wearing high-heeled shoes is strongly associated with injury, including injury requiring hospital care. There is evidence that high-heel-wearers fall more often, especially with heels higher than 2.5 cm,[7] even if they were not wearing high heels at the time of the fall.[6] Wearing high heels is also associated with musculoskeletal pain,[6] specifically pain in the Paraspinal muscles (muscles running up the back along the spine)[1] and specifically with heel pain and plantar calluses (only women tested).[7]
A 2001 survey conducted by Pennsylvania State University using 200 women found that 58% of women complained of lower back pain when wearing heels, and 55% of women said they felt the worst overall back pain when wearing the highest heel.[30] The same study argues that as heel height increases, the body is forced to take on an increasingly unnatural posture to maintain its center of gravity. This changed position places more pressure and tension on the lower lumbar spine, which may explain why some of the women complained of severe back pain at a higher heel length.
In a 2012 study, Kai-Yu Ho, Mark Blanchette, and Christopher Powers investigated the impact of heel height on Knee stress during walking.[32] The study consisted of eleven participants wearing tracking and reflective markers as they walked across a 10-meter force-plated walkway in low, medium, and high heels. The study argued that as the height of the heel increased, the ball of the foot experienced an increase in pressure resulting in increased discomfort levels and peak patellofemoral joint stress. The researchers also mentioned that the long-term usage of high heels may lead to repetitive overstress of the joint, which may result in an increase in pain and, eventually, patellofemoral joint osteoarthritis and Patellofemoral pain syndrome.
In a 2012 study, researchers examined the long risk time high heel wearers would have in regards to calf Muscle fascicle length and strain.[33] The control group consisted of women who wore heels for less than ten hours weekly and the experimental group consisted of women who wore heels for a minimum of forty hours weekly for at least two years. The experimental group was told to walk down a walkway barefoot and in heels. In contrast, the control group walked barefoot as cameras recorded their movements to calculate muscle fascicle lengths. The data showed that wearing heels shortened the size of the medial gastrocnemius (MG) muscle bundles in the calf significantly as well as increasing stiffness in the Achilles Tendon. The experimental group also demonstrated a more significant strain on the muscle fascicles while walking in heels because of the flexed position the foot is forced into. The researchers estimated that when wearing heels, the estimated fascicle strains were approximately three times higher, and the fascicle strain rate was about six times higher. Additionally, they concluded that the long-term usage of high heels could increase the risk of injuries such as strain and discomfort, and muscle fatigue.
In a 2016 study from the Sahmyook University in Korea, researchers investigated the effects of high heels on the activation of muscles in the cervical and lumbar portions of the spine.[36] Thirteen women were recruited to walk down a walkway in three different testing conditions: barefoot, in 4 cm heels and in 10 cm heels. Surface electrodes were placed on the muscle mass of the women's spines and their feet to measure the electrical activity of muscles at different points of movement. The study results indicated an increase in both cervical and lumbar muscle activation as heel height increased: the cervical spine, the neck assists in maintaining head stability and postural control in the body. The usage of high heels shifts the body's center of mass, which requires the spine to adjust itself to maintain balance. The researchers mentioned that these results would increase local muscle fatigue over time, which could lead to muscle swelling, decreased muscle movement, and, in extreme cases of overuse, tissue deformation.
Some research indicates that a possible consequence of wearing high heels is increasing pressure in one's veins. Experiments suggest that the higher the heel, the "higher [the] venous pressure in the leg." This means that after repeated use of high heels, varicose veins and other undesirable symptoms are much more likely to appear in the legs.[8] Other research supports that claim that wearing high heels can lead to numerous long-term effects, including accidental trauma to multiple areas of the body.[14]
