Sport Sciences for Health

, Volume 15, Issue 1, pp 237–248 | Cite as

Effects of different heel heights on lower extremity joint loading in experienced and in-experienced users: a musculoskeletal simulation analysis

  • Jonathan SinclairEmail author
  • Darrell Brooks
  • Bobbie Butters
Original Article



This study examined the effects of different high-heeled footwear heights on lower extremity compressive joint loading and triceps-surae muscle–tendon kinematics during walking, using a musculoskeletal simulation-based approach, in both experienced and in-experienced high heel users.


The current investigation examined 12 experienced and 12 in-experienced high-heel wearers, walking in four different footwear (high heel, medium heel, low heel, and trainer). Walking kinematics were collected using an eight-camera motion capture system and kinetics via an embedded force plate. Lower extremity joint loading and triceps-surae muscle kinematics were explored using a musculoskeletal simulation approach.


Irrespective of experience, when wearing high heels of increasing height, compressive loading parameters at the medial tibiofemoral compartment and patellofemoral joint were significantly greater and exceeded the minimum clinically important difference (MCID). Furthermore, irrespective of wearers’ experience, the triceps-surae muscle–tendon units were placed in a shortened position when wearing high heels of increasing height, with the differences exceeding the MCID.


It can be concluded that heeled footwear increases the mechanical factors linked to the aetiology of degenerative joint osteoarthritis and chronic shortening of the triceps-surae muscle–tendon units. Therefore, the current investigation provides evidence that irrespective of experience, heeled footwear of increasing height may negatively influence female’s lower extremity musculoskeletal health.


Biomechanics High heels Osteoarthritis Musculoskeletal 


Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All participants provided written informed consent.

Supplementary material

11332_2019_534_MOESM1_ESM.jpg (227 kb)
Supplementary material 1 Supplemental data: Appendix Figure 1: (a knee flexion angle during the stance phase, b soleus muscle force, c lateral gastrocnemius muscle force, and d medial gastrocnemius muscle force) (black: high heel, light grey: medium heel, black dot: low heel, dark grey: trainer, black dash: high heel experienced, black outline: medium heel experienced, grey dot: low heel experienced and dark grey outline: trainer experienced) (JPG 226 KB)


  1. 1.
    Linder M, Saltzman CL (1998) A history of medical scientists on high heels. Int J Health Serv 28:201–225. CrossRefGoogle Scholar
  2. 2.
    Hong WH, Lee YH, Chen HC, Pei YC, Wu CY (2005) Influence of heel height and shoe insert on comfort perception and biomechanical performance of young female adults during walking. Foot Ankle Int 26:1042–1048. CrossRefGoogle Scholar
  3. 3.
    Cronin NJ (2014) The effects of high heeled shoes on female gait: a review. J Electromyogr Kinesiol 24:258–263. CrossRefGoogle Scholar
  4. 4.
    Stefanyshyn DJ, Nigg BM, Fisher V, O’Flynn B, Liu W (2000) The influence of high heeled shoes on kinematics, kinetics, and muscle EMG of normal female gait. J Appl Biomech 16:309–319. CrossRefGoogle Scholar
  5. 5.
    Naik GR, Al-Ani A, Gobbo M, Nguyen HT (2017) Does heel height cause imbalance during sit-to-stand task: surface EMG perspective. Front Physiol 8:626–634CrossRefGoogle Scholar
  6. 6.
    Simonsen EB, Svendsen MB, Nørreslet A, Baldvinsson HK, Heilskov-Hansen T, Larsen PK, Henriksen M (2012) Walking on high heels changes muscle activity and the dynamics of human walking significantly. J Appl Biomech 28:20–28. CrossRefGoogle Scholar
  7. 7.
    Esenyel M, Walsh K, Walden JG, Gitter A (2003) Kinetics of high-heeled gait. J Am Podiatr Med Assoc 93:27–32. CrossRefGoogle Scholar
  8. 8.
    Kerrigan DC, Lelas JL, Karvosky ME (2001) Women’s shoes and knee osteoarthritis. Lancet 357:1097–1098. CrossRefGoogle Scholar
  9. 9.
    Barkema DD, Derrick TR, Martin PE (2012) Heel height affects lower extremity frontal plane joint moments during walking. Gait Posture 35:483–488. CrossRefGoogle Scholar
  10. 10.
    Kerrigan DC, Todd MK, Riley PO (1998) Knee osteoarthritis and high-heeled shoes. Lancet 351:1399–1401. CrossRefGoogle Scholar
  11. 11.
    Hame SL, Alexander RA (2013) Knee osteoarthritis in women. Curr Rev Musculoskelet Med 6:182–187CrossRefGoogle Scholar
  12. 12.
    Hapsari VD, Xiong S (2016) Effects of high heeled shoes wearing experience and heel height on human standing balance and functional mobility. Ergonomics 59:249–264. CrossRefGoogle Scholar
  13. 13.
    Csapo R, Maganaris CN, Seynnes OR, Narici MV (2010) On muscle, tendon and high heels. J Exp Biol 213:2582–2588. CrossRefGoogle Scholar
  14. 14.
    Herzog W, Longino D, Clark A (2003) The role of muscles in joint adaptation and degeneration. Langenbecks Arch Surg 388:305–315CrossRefGoogle Scholar
  15. 15.
    Herzog W, Clark A, Wu J (2003) Resultant and local loading in models of joint disease. Arthritis Care Res 49:239–247. CrossRefGoogle Scholar
  16. 16.
    Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, Thelen DG (2007) OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng 54:1940–1950. CrossRefGoogle Scholar
  17. 17.
    Lerner ZF, Haight DJ, DeMers MS, Board WJ, Browning RC (2014) The effects of walking speed on tibiofemoral loading estimated via musculoskeletal modeling. J Appl Biomech 30:197–205. CrossRefGoogle Scholar
  18. 18.
    Lerner ZF, DeMers MS, Delp SL, Browning RC (2015) How tibiofemoral alignment and contact locations affect predictions of medial and lateral tibiofemoral contact forces. J Biomech 48:644–650. CrossRefGoogle Scholar
  19. 19.
    Steele KM, DeMers MS, Schwartz MH, Delp SL (2012) Compressive tibiofemoral force during crouch gait. Gait Posture 35:556–560. CrossRefGoogle Scholar
  20. 20.
    Van Eijden TMGJ, Kouwenhoven E, Verburg J, Weijs WA (1986) A mathematical model of the patellofemoral joint. J Biomech 19:219–229. CrossRefGoogle Scholar
  21. 21.
    Willson JD, Ratcliff OM, Meardon SA, Willy RW (2015) Influence of step length and landing pattern on patellofemoral joint kinetics during running. Scand J Med Sci 25:736–743. CrossRefGoogle Scholar
  22. 22.
    Spoor CW, Van Leeuwen JL (1992) Knee muscle moment arms from MRI and from tendon travel. J Biomech 25:201–206CrossRefGoogle Scholar
  23. 23.
    Besier TF, Draper CE, Gold GE, Beaupré GS, Delp SL (2005) Patellofemoral joint contact area increases with knee flexion and weight-bearing. J Orthop Res 23:345–350. CrossRefGoogle Scholar
  24. 24.
    Almonroeder T, Willson JD, Kernozek TW (2013) The effect of foot strike pattern on Achilles tendon load during running. Ann Biomed Eng 41:1758–1766. CrossRefGoogle Scholar
  25. 25.
    Sinclair J (2016) Side to side differences in hamstring muscle kinematics during maximal instep soccer kicking. Mov Sport Sci 91:85–92. CrossRefGoogle Scholar
  26. 26.
    Sinclair J, Taylor PJ, Hobbs SJ (2013) Alpha level adjustments for multiple dependent variable analyses and their applicability—a review. Int J Sports Sci Eng 7:17–20Google Scholar
  27. 27.
    Sinclair J, Janssen J, Richards JD, Butters B, Taylor PJ, Hobbs SJ (2018) Effects of a 4-week intervention using semi-custom insoles on perceived pain and patellofemoral loading in targeted subgroups of recreational runners with patellofemoral pain. Phys Ther Sport 34:21–27. CrossRefGoogle Scholar
  28. 28.
    Felson DT (2004) Risk factors for osteoarthritis: understanding joint vulnerability. Clin Orthop Relat Res 427:16–21. CrossRefGoogle Scholar
  29. 29.
    Vincent KR, Conrad BP, Fregly BJ, Vincent HK (2012) The pathophysiology of osteoarthritis: a mechanical perspective on the knee joint. PM&R 4:3–9. CrossRefGoogle Scholar
  30. 30.
    Fulkerson JP, Arendt EA (2000) Anterior knee pain in females. Clin Orthop Relat Res 372:69–73CrossRefGoogle Scholar
  31. 31.
    Heino JB, Powers CM (2002) Patellofemoral stress during walking in persons with and without patellofemoral pain. Med Sci Sports Exerc 34:1582–1593. CrossRefGoogle Scholar
  32. 32.
    Thomas MJ, Wood L, Selfe J, Peat G (2010) Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review. BMC Musculoskelet Disord 11:201–205. CrossRefGoogle Scholar
  33. 33.
    Almonroeder TG, Benson LC, O’Connor KM (2015) Changes in patellofemoral joint stress during running with the application of a prefabricated foot orthotic. Int J Sports Phys Ther 10:967–972Google Scholar
  34. 34.
    Ebbeling CJ, Hamill J, Crussemeyer JA (1994) Lower extremity mechanics and energy cost of walking in high-heeled shoes. JOSPT 19:190–196. CrossRefGoogle Scholar
  35. 35.
    Zöllner AM, Pok JM, McWalter EJ, Gold GE, Kuhl E (2015) On high heels and short muscles: a multiscale model for sarcomere loss in the gastrocnemius muscle. J Theor Biol 365:301–310. CrossRefGoogle Scholar
  36. 36.
    Barton CJ, Coyle JA, Tinley P (2009) The effect of heel lifts on trunk muscle activation during gait: a study of young healthy females. J Electromyogr Kinesiol 19:598–606. CrossRefGoogle Scholar
  37. 37.
    de Oliveira Pezzan PA, João SMA, Ribeiro AP, Manfio EF (2011) Postural assessment of lumbar lordosis and pelvic alignment angles in adolescent users and nonusers of high-heeled shoes. J Manip Physiol Ther 34:614–621. CrossRefGoogle Scholar
  38. 38.
    Gefen A, Megido-Ravid M, Itzchak Y, Arcan M (2002) Analysis of muscular fatigue and foot stability during high-heeled gait. Gait Posture 15:56–63. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Centre for Applied Sport and Exercise Sciences, Faculty of Health and WellbeingUniversity of Central LancashirePrestonUK
  2. 2.School of Medicine, Faculty of Clinical and Biomedical SciencesUniversity of Central LancashireLancashireUK

Personalised recommendations