High heels are a common fashion choice, but they fundamentally alter the body’s natural posture and walking mechanics by elevating the heel significantly higher than the toes. Scientific biomechanical studies demonstrate that wearing high heels introduces significant changes to the way forces are transmitted up the leg, placing measurable and chronic stress on the knee joint. Understanding these mechanical alterations is the initial step in assessing the potential for long-term wear and tear.
How Heels Alter Knee Biomechanics
The elevation of the heel shifts the body’s center of gravity forward, forcing the leg to compensate for this new alignment. This shift shortens the natural stride length and alters the normal walking pattern, increasing the mechanical load on the knee joint. Specifically, high heels cause the knee to maintain a slightly flexed, or bent, position for a longer duration during the stance phase of walking.
This sustained flexion causes an increase in the force that compresses the kneecap against the thigh bone—the patellofemoral joint. Studies have shown a significant increase in peak patellofemoral joint stress as heel height increases, with one study noting an increase of nearly 90% when comparing a high heel to a low heel. This greater stress is a direct result of higher knee extensor moments and larger knee flexion angles.
The altered gait also increases the external adduction moment at the knee, a rotational force that pushes the knee inward. This moment places increased compressive pressure on the medial (inner) compartment of the knee. The changes in knee mechanics, including the increased flexion and adduction moments, are similar to patterns observed in people progressing toward knee degeneration.
Specific Long-Term Knee Conditions
The chronic and repetitive mechanical stress placed on the joint by high-heeled walking is strongly implicated in the development of degenerative conditions. The primary long-term concern is an increased risk of developing knee Osteoarthritis (OA), a progressive disease characterized by the breakdown of joint cartilage. Women already have a higher incidence of knee OA compared to men, and the chronic biomechanical changes induced by high heels may be a contributing factor to this disparity.
The sustained, increased pressure on the patellofemoral joint and the increased adduction moment accelerate wear and tear. This chronic, uneven loading can erode the smooth, protective articular cartilage that covers the ends of the bones in the knee joint. Once this cartilage degrades, the bones begin to rub together, leading to the pain, stiffness, and reduced mobility characteristic of OA. While a direct, causal link has not been established, the consistent presence of these OA-associated mechanical changes in high-heel wearers points to a higher lifetime risk of joint damage.
Practical Strategies for Reducing Joint Strain
For individuals who choose to wear high heels, several strategies can be employed to actively minimize the resulting strain on the knee joints. One of the most effective methods is to limit the maximum heel height, as joint stress increases significantly with every centimeter of elevation. Choosing heels that are two inches (approximately 5 cm) or lower can substantially reduce the pressure exerted on the forefoot and the knee.
Limiting the frequency of wear is also a helpful measure, avoiding the use of high heels every day and instead rotating them with supportive flats or lower-heeled shoes. When selecting heels, a thicker heel, such as a wedge or block heel, is preferable to a narrow stiletto, as it allows for better stability and more even distribution of the body’s weight.
Incorporating regular stretching and strengthening exercises can help counteract some of the negative effects of high heel use. Stretching the calf muscles and Achilles tendon is beneficial, as high heels cause these tissues to shorten and tighten. Strengthening the muscles that support the knee, such as the quadriceps and hamstrings, can also improve joint stability and help manage the altered biomechanics.