Wearing high-heeled shoes is strongly associated with injury, including injury requiring hospital care. There is evidence that high-heel-wearers fall more often, especially with heels >2.5cm high, even if they were not wearing high heels at the time of the fall. Wearing high heels is also associated with musculoskeletal pain, specifically pain in the paraspinal muscles (muscles running up the back along the spine) and specifically with heel pain and plantar calluses (only women tested).
Many styles of dance involve the usage of heels. Ballroom dancing shoes are designed for usage based on the style of dance being performed. International Standard Ballroom shoes for women are closed toed shoes with a 2 to 2.5 inch sturdy heel because steps are performed using the heel of the foot. International Latin and American Rhythm shoes are open toed, strapped heels that are an average of 2.5 to 3 inches in height. These shoes have the least sturdiest heel because International Latin and American Rhythm styles are performed on the ball of the foot. Additionally, this style of shoe is designed with a flexible sole to allow for pointed feet. Lastly, American Smooth shoes are closed toed, flexible soled shoes that range in heel height from 2 to 2.5 inches. An additional non-traditional ballroom dance that uses heels is the Argentine Tango. While dancing the Argentine Tango, women often wear pointed heels ranging in 2 to 4 inches in height. The higher the heel height, the more advanced in technique and ability a dancer is. The heels are used to change the overall stance of the woman by tilting the hips forward, making the stomach flatter and pushing the backside out. Additionally, the heels cause unsteadiness which forces women to dance on their toes and lean on their partner which adds to the fluidity of the movements. A relatively modern style of dance called Heels Choreography or Stiletto dance specializes in choreography that blends the styles of jazz, hip-hop and burlesque with the fusion of vogue movements and is performed using stilettos or high heels. Some dancers such as Yanis Marshall specialize in dancing with high-heels.
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In the UK in 2016 temporary receptionist Nicola Thorp was sent home unpaid after she refused to follow the dress code of firm Portico. Thorp launched an online petition calling for the UK government to "make it illegal for a company to require women to wear high heels at work". Two parliamentary committees in January 2017 decided that Portico had broken the law; by this time the company had already changed its terms of employment. The petition was rejected by the government in April 2017 as they stated that existing legislation was "adequate". Existing legislation allows women to be required to wear high heels, but only if it is considered a job requirement and men in the same job are required to dress to an "equivalent level of smartness".