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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.[25] 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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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.[13] 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.[9] Examples of this were the brown and white pumps with cutouts or ankle straps combined with an open toe.[13] Their practicality yet professional look appealed to the new, fast-paced lifestyle of many women.
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The design of the high French heels from the late 1600s to around the 1720s placed body weight on the ball of the foot, and were decorated with lace or braided fabric (pictured). From the 1730s-1740s, wide heels with an upturned toe and a buckle fastening became popular. The 1750s and 1760s introduced a skinnier, higher heel. The 1790s continued this trend, but added combinations of color. Additionally, throughout all of these decades, there was no difference between the right and left shoe.[10]

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]
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]
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.[28] 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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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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