High heels have been made from all kinds of materials throughout history. In the early years, leather and cowhide was preferred. As civilizations progressed, silk and patent leather were introduced, while cork and wood were utilized as cheap resources in times of war. After the World Wars and the increase in production of steel, the actual heel was a piece of steel wrapped in some kind of material. This has enabled designers to make heels taller and skinnier without them snapping. The soles below the ball of the foot of Ballroom shoes can also be made of materials like smooth leather, suede, or plastic. 
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In a 2016 study from the Sahmyook University in Korea, researchers wanted to investigate the effects of high heels on the activation of muscles in the cervical and lumbar portions of the spine which refers to the neck and lower back. Thirteen women were recruited to walk down a walkway in three different testing conditions: barefoot, in 4 cm heels and in 10 cm heels. Surface electrodes were placed on the muscle mass of the women’s spines as well as their feet to measure the electrical activity of muscles at different points of movement. The results of the study indicated an increase in both cervical and lumbar muscle activation as heel height increased. The cervical spine, the neck, assists in maintaining head stability and postural control in the body. The usage of high heels shifts the body’s center of mass which forces the spine to adjust itself in order to maintain balance. The researchers mentioned that over time these results would increase local muscle fatigue that could lead to muscle swelling, decreased muscle movement and even tissue deformation.
An analysis of the dance-related injuries in 113,084 adolescents in US emergency rooms from 1991–2007 was conducted using data from the National Electronic Injury Surveillance System. The most common injury found among the data were sprains and strains which accounted for 52.4% of the data. Additional injuries include back and leg pain, loss of joint mobility in the wearer's knees and blisters. In particular, shoes with a narrow space for the toes can squeeze tightly enough to cause foot deformity. Dancers can add cushioning to the soles of their dancing shoes or inserts to ease the pain during dancing.
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