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.[13] 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.[19] The soles below the ball of the foot of Ballroom shoes can also be made of materials like smooth leather, suede, or plastic. [20]

Alternatively, World War II led to the popularization of pin-up girl posters, which men would often hang in their bunks while at war. Almost all of these girls were pictured wearing high heels, leading to an increase in the relationship between high heels and female sexuality.[3] The tall, skinny stiletto heel was invented in 1950, strengthening the relationship between women, sexuality, and appearance.[10] There was a weakening of the stiletto style during both the late 1960s / early 1970s and also 1990s when block heels were more prominent, followed by a revival in the 2000s.
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The intricate and complex history of high heels has led to a variety of cultural thoughts and lens through which people view them today. Firstly, it is very exclusively gendered in the sense that few men wear high heels in present times.[4] Secondly, magazines like Playboy, as well as other media sources portraying women in a sexual way, often do so using high heels. Paul Morris, a psychology researcher at the University of Portsmouth, argues that high heels accentuate "sex specific aspects of female gait", artificially increasing a woman's femininity.[4] Respectively, the arching of a woman's back facilitated by wearing high heels signals a woman's willingness to be courted by a man.[14][15] Keeping this sexual undercurrent in mind, heels are considered fashionable for women in most cases. It could be semi-formal with a "button down silk blouse…jeans and high heels."[16] Or, it could be formal with a dress or pants suit. Finally, 20th and 21st century cultural values have dictated that high heels are the norm in professional settings for a woman. Some researchers argue that high heels have even become part of the female workplace uniform, and operate in a much larger and complex set of display rules.[4] High heels are considered to pose a dilemma to women as they bring them psychosexual benefits but are detrimental to their health.[17] The 21st century has introduced a broad spectrum and variety of styles, ranging from height and width of heel, to design and color of the shoe.
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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.[29] 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.[52] 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.[53] Dancers can add cushioning to the soles of their dancing shoes or inserts to ease the pain during dancing.[20]
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Heels went out of fashion starting around 1810, and then in 1860 they returned at about two and a half inches. The Pinet heel and the Cromwell heel were both introduced during this time.[12] Their production was also increased with the invention and eventual mass production of the sewing machine around the 1850s. With sewing machines, yields increased as machines could quickly and cheaply "position[n] the heel, stitc[h] the upper, and attac[h] the upper to the sole."[9] This is also a prime example of how the popularity of heels interacts with the culture and technology of the time.
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