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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.
In 2016, scientists from the Department of Physical Therapy in the Sahmyook University in Korea conducted a study to examine the effects of increased heel height and gait velocity on balance control. Balance control refers to the ability of the body to maintain itself along the line of the center of gravity within a base of support. This must be achieved with minimal postural sway velocity which is the horizontal movement of a body trying to maintain balance when standing still. Wearing high heels narrows the base of support that the body has in order to avoid falling and also restricts the area within which the body must sway. In this study, the participants were told to wear either a low or high heel and walk at a low and high speed on a treadmill. As a result of this experiment, the researchers were able to conclude that as heel height increased, the sway velocity of the bodies increased which also modified the position of the knee joint. Muscles have to realign the entire body especially the hips along the line of gravity. As the weight of the body shifted forward, the hips were taken out of alignment and the knee joints experienced stress in order to adjust to the shift.
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In a 2012 study, Kai-Yu Ho, Mark Blanchette and Christopher Powers, wanted to determine if heel height increased patellofemoral joint stress during walking. The patellofemoral joint refers to junction where the femur and patella meet. The study consisted of eleven participants wearing tracking and reflective markers as they walked across a 10 meter force plated walkway in low, medium and high heels. The study showed that as the height of the heel increased, the ball of the foot experienced an increase in pressure resulting in increased discomfort levels and peak patellofemoral joint stress. The researchers also mentioned that the long term usage of high heels would lead to repetitive overstress of the joint which would result in an increase in pain and eventually, patellofemoral joint osteoarthritis and Patellofemoral pain syndrome.
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