by Erik Dalton, Ph.D.
The biomechanical effect of heels in everything from running shoes to stilettos has puzzled researchers and fired controversy for almost a century. In a highly functioning body, the neuro-myo-skeletal system ‘hangs’ in dynamic equilibrium, each part balancing the other. But when a woman wears high heels, a new dynamic equilibrium occurs (Fig 1) If one body part becomes ‘fixed,’ the whole system must compensate with altered movement patterns resulting in kinetic chain ‘kinks.’ Here’s an interesting experiment that’ll help you get a feel for biomechanical adjustments high-heel wearers deal with every day: • Stand barefoot with the back against a wall. Observe how your ‘upright’ body column forms a perpendicular line (ninety degree angle) with the floor (Fig 2A).
• Slide a two inch wedge of some kind (phone book, etc.) under both heels and notice that by keeping your body column rigid, you’re forced to tilt forward from ninety to about seventy degrees (Fig 2B).

The brain, guided by foot, ankle and visual proprioceptors, must instantaneously make a whole series of myofascial and joint adjustments (ankle, knee, hip, spine, and head) to regain and retain erect stance and equilibrium (Fig 3). But high-heeled posturo-functional faults are not confined to the external milieu; they may also inflict compressional damage on the internal viscera…particularly pelvic bowl contents. According to research conducted by Diane Lee, excessive lumbar lordosis causes the pelvic bowl to dip anteriorly which raises the body’s center of gravity leading to reduced proprioceptive stability.1

Many women love to wear high heels, and I might add many men like women in high heels. However, it’s true that some women suffer for their vanities. In young women, this is accommodated fairly well by ankle and hip mobility and low back stability. But, many high-heel wearing women find that as they age and the hip joints stiffen, shock waves shoot through the lumbar spine causing disc compression, ligamentous laxity and facet joint spurring. Women should be cautious about wearing heels constantly, or over long periods of time.

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