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I really don’t need to say that high heeled shoes are a staple and one of our main customs for women today. We all know that prolonged high heel usage can be uncomfortable and even painful for some (especially for those who are new to a type of shoe). Has anyone ever sprained their ankles wearing high-heeled shoes? I embarrassingly admit that I have, but I know that this has happened to many (hint: we look at some statistics in this post). We all know how popular these types of shoes are for women. High heeled shoes are a huge part of our everyday lives. Next time you are in an office try counting the number of women who are wearing flats and those who wear heels. If your workplace is anything like some of those I have visited for ergonomic assessments, I would imagine that flats would be in the minority and heels the majority. Note: This is supported by the American Podiatric Medical Association that found that 72% of women wear high-heeled shoes and 39% wear high-heeled shoes on a daily basis. Pros (2)

Considering how common these types of shoes are, many are unaware of the musculoskeletal risks that are associated with wearing them. These risks can be compounded since many workplaces are shifting towards standing desks. In my experience, it is surprisingly common that I would see high heeled shoes being used with standing desks; many are just unaware of the musculoskeletal risks associated with high heeled shoes and prolonged standing. A common complaint of wearing high heeled shoes is frequent leg and lower back pain. This may be related to the fact that high heeled shoes causes lumbar flattening (decreased lower back curve). Having a neutral or natural lumbar curve has been linked with comfort and optimal posture for users.

The facts speak for themselves. According the American Podiatric Medical Association here are some of the musculoskeletal risks associated with wearing high-heeled shoes are:

  • Ten percent of women had to receive medical attention (or even hospitalized) because of their shoes
  • Nearly 50% of women have twisted their ankles
  • The top injuries are: broken ankles, twisted knees, infected blisters, bunions and torn tendons
  • More than 60% of women were ready to continue wearing these shoes despite suffering pain and injuries (they say fashion hurts, right?!)

Two key factors when considering high heeled shoes in standing workstations is the impact of high heeled shoes on standing balance and functional mobility. There is much more strain (or more effort required) in the lower extremities when standing with heels. Looking at the BIG PICTURE, this may impact a worker’s compliance with using a standing desk; if they are feeling uncomfortable in the lower extremities as a direct result of standing, they may be less likely to use these desks. At the same time, much research has identified that blood pooling can start to accumulate in the lower extremities after only 30 minutes of standing. So, it may be argued that standing in high heeled shoes may activate the lower extremities’ venous pump to help to reduce blood pooling. This is a working hypothesis of mine!

In addition to the strain, wearing high heeled shoes results in worse standing balance and functional mobility (for example: reaching for items when standing). This result is especially relevant as heel height reaches 10cm (4 inches). With all this in mind, there is considerable evidence that longterm standing in high heeled shoes presents significant musculoskeletal risks.

Pros (2)

Let’s look at some practical advice for those who enjoy wearing high heeled shoes in the office environment:

  • Standing for long periods of time? Consider switching to a lower heel or (even better) a flat to reduce lower extremity strain/discomfort, lower back discomfort, and improve balance and functional mobility.
  • There seems to be a correlation between heel height and reduced balance/functional mobility for shoes 7cm (2.75 inches) and higher. And, this effect increases proportionally with heel size.
  • If high heeled shoes must be worn, research indicates that shoes with 4cm (1.5 inch) heel or less is recommended as the risk is reduced at this height. However, research also indicates that for prolonged standing, high heeled shoes are not recommended at all to really reduce the musculoskeletal risk!


Hapsari, V. & Xiong, S. (2016) Effects of high heeled shoes wearing experience and heel height on human standing balance and functional mobility, Ergonomics, 59:2, 249-264.

One thought on “The Ergonomics of High-Heeled Shoes

  1. I find that wearers of high heels at PC workstations also have problems in getting a good posture when seated. I usually advise they try a footrest, to give them the same leg positions as when driving (which few seem to have a problem with). When driving, the legs are slightly outstretched and the heels (for anyone) on the floor with the foot at a 90 degree angle (ish) to the shin, this is comfortable. I suggest this is what the footrest can offer (if they are drivers especially) they can relate to this. It’s not just about being too short to reach the floor, we can all get a better posture this way (although I am standing as I type this!).


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