The Biomechanical Consequences of Heel Elevation on Spatiotemporal and Kinematic Gait Parameters

Abstract

Background and aim: High-heeled footwear is commonly linked to fashion, elegance, and professionalism; nonetheless, its biomechanical impact on gait, posture, and musculoskeletal health presents considerable challenges. This study examines the impact of varying heel heights on sagittal plane gait parameters, joint kinematics, and implied postural stability. Material and methods: Ninety healthy female university students, screened for regular footwear habits but naive to the specific experimental shoes, were categorized into three groups based on standardized shoes provided with different heel heights: low (0-3 cm), medium (3-5 cm), and high (>5 cm). Using synchronized high-speed video cameras (sagittal view data analyzed), participants’ gait was recorded as they walked trials down a predetermined 7-meter walkway. Silicon Coach Pro 8 software was utilized to assess gait metrics, including stride length, cadence, joint angles (hip, knee, ankle), and velocity, using anatomical landmarks. Results: Higher heel height was significantly linked to increased maximum ankle plantarflexion (up to 39.0° ± 1.76°), increased maximum knee flexion (up to 26.26° ± 1.85°), and altered ankle dorsiflexion kinematics (peak increased to 8.80° ± 1.68°), as well as shorter strides (by ~13 cm compared to low heels) and slower gait speeds (by ~0.13 m/s compared to low heels). High heels also imply postural changes, inferred from previous literature to include potentially increased lumbar lordosis and anterior pelvic tilt, which are known risk factors. Conclusion: The results quantitatively demonstrate the biomechanical trade-offs associated with increasing heel height, emphasizing the necessity of ergonomic footwear design and usage guidelines to mitigate negative health impacts. This study reinforces and quantifies the dose-dependent effects of heel height on lower limb mechanics and potential postural consequences.