High-heeled shoes seem to getting higher and higher, but women who love the look should know their fashion choices may come with a price. A new study shows that wearing high heels can strengthen the ankle initially but leads to weakening and instability over time.

The study’s conclusion, published by Korean researchers in the International Journal of Clinical Practice, makes sense to Tricia Turner, associate professor of kinesiology and athletic training coordinator in the College of Health and Human Services at the University of North Carolina, Charlotte, who was not involved in the study.

“Initially when wearing heels the muscles that surround the ankles have to continuously contract to keep you upright and walking,” she says. “Over time you need less muscle contraction as the lower leg muscles adapt to the changes in footwear. Once that occurs, less muscle contraction occurs. With prolonged use you get muscle shortening in the back of the leg and muscle lengthening in the front of the leg. These changes in muscle length then can change muscle strength.”

The report looked at ankle strength and balance in women training to be flight attendants, collecting data for each class year (freshman through senior) to consider the effects of high heels over time.

Turner said the unstable position high heels require is to blame for many of the problems associated with them.

“In sneakers or flat shoes, the foot is positioned in neutral where the bones of the ankle are under the bones of the lower leg, creating a more stable joint and a decreased likelihood of injury,” she says. “High-heeled shoes also change the normal walking or gait cycle, with the ultimate result being a less fluent gait cycle.”

Your feet aren’t the only thing that high heels may be affecting. Turner said damage to the ligaments or nerves of the ankle could cause problems throughout the legs and back.

“Changes at the ankle cause the muscles higher in the leg and back to lose efficiency and strength. It also changes the load the bones in and around the knee have to absorb which can ultimately lead to injury.”

Plenty of women suffer the ill effects for their fashion choices. Another study, published recently in the journal Foot and Ankle Surgery, found high heel-related injuries nearly doubled during the 11-year period from 2002 to 2012. Most injuries were sprains and strains to the foot and ankle.

Devoted wearers of high heels have options to minimize these ill effects. Turner advised the following tips to keep you safe and fashionable:

  • Use a towel or belt to flex your foot up toward you for 30 seconds and stretch the muscles in your lower leg.
  • Use a Thera-Band to build strength in ankle and leg muscles. Use the Thera-Band to give the ankle resistance as you stretch up, out, and in.
  • Raise your toes off the ground, leaving your heel on the floor. Start the exercise while sitting, then move to a standing position on a flat surface, finally increasing to an incline that puts your toes lower than your heels.
  • Practice using your toes to pick up small objects from the floor to exercise the small muscles in your legs and build foot strength.
  • Stand on one leg at a time for 30 seconds, remaining as still as possible. As your balance improves, you can make the exercise more challenging by closing your eyes or choosing an unstable surface.



Kim, M.H., Choi, Y.T., Jee, Y.S., Eun, D., Ko, I.G., Kim, S.E. . . . Yoo, J. (2015, Jun 1). Reducing the frequency of wearing high-heeled shoes and increasing ankle strength can prevent ankle injury in women. International Journal of Clinical Practice, 69, 909-910. doi:10.1111/ijcp.12684
Retrieved from: https://onlinelibrary.wiley.com/doi/10.1111/ijcp.12684/full

Citty, Wills. (2015, July 6). High heels and ankle issues: A trainer’s advice on how to stay on your feet. UNC Charlotte Department of Kinesiology.
Retrieved from: https://kinesiology.uncc.edu/news/2015-07-06/high-heels-and-ankle-issues-trainers-advice-how-stay-your-feet

Moore, J.X., Lambert, B., Jenkins, G.P, & McGwin, G. (2015, May 12). Epidemiology of high heel shoe injuries in U.S. women: 2002 to 2012. Journal of Foot and Ankle Surgery, 54, 615-619. doi:10.1053/j.jfas.2015.04.008
Retrieved from: https://www.jfas.org/article/S1067-2516(15)00122-2/abstract

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