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September 10, 2010

BehindTheMedspeak: Wearing high heels shortens calf muscles, thickens and stiffens the Achilles' tendon, and decreases the ankle's range of motion


So while you might like the way your legs look while you're wearing stilettos, you won't like the changes that result.

Here's Leslie Tamura's August 31, 2010 Washington Post story about recent research on the effects of high heels on the lower leg.


Getting ready to put your summer sandals at the back of closet and break out your high-heeled pumps? Consider the latest study examining the physical costs of adding height to your step.

Compared with wearing flats, wearing heels regularly can lead to shortened calf-muscle fibers and thicker, stiffer Achilles' tendons, according to physiology professor Marco Narici and his colleagues at Britain's Manchester Metropolitan University and at the University of Vienna. This may be why some women feel tightness in their calves when they kick off their heels. The findings are published in the July issue of the Journal of Experimental Biology.

From a group of 80 volunteers ages 20 to 50 who had worn two-inch or higher heels five times a week for at least two years, the researchers selected 11 who felt discomfort in their calves after taking off the shoes. Researchers did not assess physical activity level or heel thickness. A control group included nine women of comparable age, height and mass who wore flats regularly.

With magnetic resonance imaging, researchers noted that those in both groups had calf muscles of similar size but different shape. Assuming this was due to fiber lengths, the researchers used ultrasound to confirm their hypothesis: Individual muscle fibers shortened with high-heel wear.

Then the researchers measured how muscles contracted and performed using a dynamometer, a device that measures force, torque, power and velocity. Shortened fibers would suggest a high-heel wearer's calf muscles would produce less force than a flat-shoe wearer, but muscles performed similarly in both groups.

"We couldn't understand why," Narici said.

Curious, they used MRI and saw that the Achilles' tendon compensated for muscle fiber length. The tendon was significantly thicker and stiffer in high-heel wearers.

If women insist on wearing heels, Narici said, shortened fibers and thick, stiff tendons are inevitable. Narici suspects these adaptations may have an impact on athletic performance, though they do not appear to hinder everyday movements.

"You can't run at the same level as a person who doesn't wear high heels," he said. "If the tendon becomes stiffer and the muscle fibers become shorter, the ability to store and release elastic energy is problematic."

Future research will look at these energy costs. For now, Narici suggests that high-heel wearers stretch their calves at least twice a day.

"Women enjoy wearing high heels," Narici added. "They look good. They feel good . . . we don't want to stop them from wearing high heels."


The abstract of the scientific paper cited above follows.



Wearing high heels (HH) places the calf muscle–tendon unit (MTU) in a shortened position. As muscles and tendons are highly malleable tissues, chronic use of HH might induce structural and functional changes in the calf MTU. To test this hypothesis, 11 women regularly wearing HH and a control group of 9 women were recruited. Gastrocnemius medialis (GM) fascicle length, pennation angle and physiological cross-sectional area (PCSA), the Achilles' tendon (AT) length, cross-sectional area (CSA) and mechanical properties, and the plantarflexion torque–angle and torque–velocity relationships were assessed in both groups. Shorter GM fascicle lengths were observed in the HH group (49.6±5.7 mm vs 56.0±7.7 mm), resulting in greater tendon-to-fascicle length ratios. Also, because of greater AT CSA, AT stiffness was higher in the HH group (136.2±26.5 N mm–1 vs 111.3±20.2 N mm–1). However, no differences in the GM PCSA to AT CSA ratio, torque–angle and torque–velocity relationships were found. We conclude that long-term use of high-heeled shoes induces shortening of the GM muscle fascicles and increases AT stiffness, reducing the ankle's active range of motion. Functionally, these two phenomena seem to counteract each other since no significant differences in static or dynamic torques were observed.

September 10, 2010 at 04:01 PM | Permalink


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though I might end up a thick ankled babushka with contracted calf muscles and rock hard achilles tendons, I have enjoyed my short-term, high-heeled rewards.

Posted by: Milena | Sep 11, 2010 7:43:46 AM

You're cruel, Joe. You write an article about why we shouldn't wear high heels, and then go and illustrate it with drop-dead sexy high heels to die for...

Posted by: Kitten | Sep 10, 2010 8:03:22 PM

"These stilettos are made for walking, and that's just what they'll do, one of these days these stilettos are gonna walk all over you"

Be still my heart!

The original...


Posted by: Joe Peach | Sep 10, 2010 5:01:54 PM

God, I love those shoes. But ya gotta have limo ...

Posted by: Diana McLellan | Sep 10, 2010 4:08:42 PM

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