In a 2012 study, researchers examined the risk long time high heel wearers would have in regards to calf Muscle fascicle length and strain. The control group consisted of women who wore heels for less than ten hours weekly and the experimental group consisted of women who wore heels for a minimum of forty hours weekly for at least two years. The experimental group was told to walk down a walkway barefoot and in heels while the control group walked down barefoot as cameras recorded their movements to calculate muscle fascicle lengths. The data showed that wearing heels shortened the length of the medial gastrocnemius (MG) muscle fascicles in the calf significantly as well as increasing stiffness in the Achilles Tendon. The experimental group also demonstrated a larger amount of strain on the muscle fascicles while walking in heels because of the flexed position the foot is forced into. The researchers were able to estimate that when wearing heels, the estimated fascicle strains were approximately three times higher and the fascicle strain rate was approximately six times higher. Additionally, they were able to conclude that the long term usage of high heels can increase the risk of injuries such as strain along with discomfort and muscle fatigue.
High heels are marketed to children, and some schools encourage children to wear them. 18% of injuries from wearing high heels were in children, and 4% in under-tens, in a 2002-2012 US survey. Concern was expressed about children's use of high heels in a 2016 medical review on high-heeled shoes. A nine-year old is about half an adult's height, and a toddler about a quarter; so, relative to body height, a 2-inch (5 cm) heel on an adult would be a one-inch heel on the nine-year-old, and a half-inch heel on the toddler, though whether this translates to comparable health harms is not known.
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Research shows that heels draw attention to long legs and small feet. Some argue that "high-heeled shoes, perhaps more than any other item of clothing, are seen as the ultimate symbol of being a woman." High heels often play a key role in emphasizing a wearer's, most commonly a woman's, arched back and extended buttocks. This "natural courting pose" sexualizes the wearer, and can turn them into objects subjected to the male gaze. This research highlights the emphasis heels place on the appearance of the wearer, instead of their arguably more valuable internal traits such as intelligence, creativity, or strength.
With the 1900s bringing two devastating world wars, many countries set wartime regulations for rationing almost all aspects of life. This included materials previously used for making heels, such as silk, rubber, or leather; these began to be replaced with cork and wooden soles. Another one of the numerous outcomes of these wars was an increase in international relations, and a more proliferate sharing of fashion through photography and films, which helped spread high heel fashion as well. Examples of this were the brown and white pumps with cutouts or ankle straps combined with an open toe. Their practicality yet professional look appealed to the new, fast-paced lifestyle of many women.
In the UK in 2016 temporary receptionist Nicola Thorp was sent home unpaid after she refused to follow the dress code of firm Portico. Thorp launched an online petition calling for the UK government to "make it illegal for a company to require women to wear high heels at work". Two parliamentary committees in January 2017 decided that Portico had broken the law; by this time the company had already changed its terms of employment. The petition was rejected by the government in April 2017 as they stated that existing legislation was "adequate". Existing legislation allows women to be required to wear high heels, but only if it is considered a job requirement and men in the same job are required to dress to an "equivalent level of smartness".