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<p>High-heeled shoes (HHS) are widely worn for aesthetic, social, and professional reasons, but they are increasingly recognized for their adverse impact on postural alignment and balance. The elevation of the heel alters the body’s natural biomechanics, shifting the center of mass forward and reducing the base of support. These changes challenge the body’s ability to maintain stability, particularly during dynamic tasks and sensory-compromised conditions. This review aims to investigate the effects of high-heeled footwear on human balance, focusing on how heel height influences static and dynamic stability, muscle activation, proprioceptive control, and fall risk. It also explores the role of habitual use and neuromuscular adaptation in mitigating or worsening these effects. A narrative review was conducted using electronic databases including PubMed, Scopus, and DOAJ. Studies included were peer-reviewed, published up to March 2025, and involved healthy female participants. Thirteen studies were selected based on their assessment of balance dysfunction, using tests such as the Sensory Organization Test (SOT), Limits of Stability (LOS), Functional Reach Test (FRT), and Timed Up and Go (TUG). Findings consistently show that heel heights ≥ 7&#xa0;cm significantly impair static balance, increase postural sway, and reduce the effectiveness of ankle strategy, often replaced by less efficient hip control. Dynamic balance is similarly compromised, with higher sway indices, reduced functional reach, and increased Timed Up and Go (TUG) durations. Habitual wearers exhibit partial neuromuscular adaptation, including increased gastrocnemius activity and proprioceptive desensitization, but these adjustments do not restore normal balance function. Kinetic disruptions such as elevated ground reaction forces (GRFs) and decreased coefficient of friction further elevate fall risk. Thresholds for dysfunction were identified at 3.9&#xa0;cm (early impairment), 7&#xa0;cm (functional compromise), and 10&#xa0;cm (high instability). High-heeled footwear poses a significant risk to balance and postural control, particularly at elevations above 7&#xa0;cm. While habitual use may induce compensatory adaptations, these are insufficient to prevent balance dysfunction. Clinicians, physiotherapists, and footwear designers should emphasize ergonomic footwear, user education, and fall prevention strategies. Future research should prioritize long-term biomechanical monitoring and the development of safer high-heel alternatives to minimize adverse health outcomes.</p>

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Effect of High Heel Shoes on Balance—A Narrative Review

  • 期刊论文

  • 发表日期：

    2026年5月19日

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  • Arunachalam Arunagiri Subramanian,
  • Lekha Mysore Devanath,
  • Nirupama Siddaraju

摘要

High-heeled shoes (HHS) are widely worn for aesthetic, social, and professional reasons, but they are increasingly recognized for their adverse impact on postural alignment and balance. The elevation of the heel alters the body’s natural biomechanics, shifting the center of mass forward and reducing the base of support. These changes challenge the body’s ability to maintain stability, particularly during dynamic tasks and sensory-compromised conditions. This review aims to investigate the effects of high-heeled footwear on human balance, focusing on how heel height influences static and dynamic stability, muscle activation, proprioceptive control, and fall risk. It also explores the role of habitual use and neuromuscular adaptation in mitigating or worsening these effects. A narrative review was conducted using electronic databases including PubMed, Scopus, and DOAJ. Studies included were peer-reviewed, published up to March 2025, and involved healthy female participants. Thirteen studies were selected based on their assessment of balance dysfunction, using tests such as the Sensory Organization Test (SOT), Limits of Stability (LOS), Functional Reach Test (FRT), and Timed Up and Go (TUG). Findings consistently show that heel heights ≥ 7 cm significantly impair static balance, increase postural sway, and reduce the effectiveness of ankle strategy, often replaced by less efficient hip control. Dynamic balance is similarly compromised, with higher sway indices, reduced functional reach, and increased Timed Up and Go (TUG) durations. Habitual wearers exhibit partial neuromuscular adaptation, including increased gastrocnemius activity and proprioceptive desensitization, but these adjustments do not restore normal balance function. Kinetic disruptions such as elevated ground reaction forces (GRFs) and decreased coefficient of friction further elevate fall risk. Thresholds for dysfunction were identified at 3.9 cm (early impairment), 7 cm (functional compromise), and 10 cm (high instability). High-heeled footwear poses a significant risk to balance and postural control, particularly at elevations above 7 cm. While habitual use may induce compensatory adaptations, these are insufficient to prevent balance dysfunction. Clinicians, physiotherapists, and footwear designers should emphasize ergonomic footwear, user education, and fall prevention strategies. Future research should prioritize long-term biomechanical monitoring and the development of safer high-heel alternatives to minimize adverse health outcomes.