A 2001 survey conducted by researchers from Pennsylvania State University using 200 women found that 58% of women complained of lower back pain when wearing heels and 55% of women said they felt the worst overall back pain when wearing the highest heel. The researchers explained that as heel height increases, the body is forced to take on an unnatural posture to maintain its center of gravity. This changed position places more pressure and tension on the lower lumbar spine which explains why the women complained of severe back pain at a higher heel length.
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.
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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. 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." This is also a prime example of how the popularity of heels interacts with the culture and technology of the time.
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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