High Heels May Hurt Calf And Tendon Study Finds

This study investigates the effects of prolonged use of high heels by women. Wearing high heels imposes a shortened position on the unit of muscle and tendon or connective tissue between the muscles and the bones of the calf region in legs. Muscles and tendons in the calf area are delicate tissues and might change structurally and functionally in response to prolonged use of high heels. This study tested this hypothesis on women wearing high heels, in comparison with a control group of women who did not wear high heels. Special tests were done on calf muscles. High heels were found to shorten the length and increase the stiffness of specific calf muscles.

Skeletal muscles are known to undergo changes in structure and function upon continuous exposure to mechanical pressure. It has been tested in animal models where muscles acquire a shortened position if immobility is imposed. In women wearing high heels, the length of the calf muscle and connective tissue unit reduces forcibly because of the angular lift on the heel. Previous studies have shown that in human beings, different leg muscles adapt to continuous functions like running or cycling. Moreover, the calf muscles and the connective tissues are sensitive to prolonged mechanical stress. The study, therefore, hypothesizes that calf muscles and tendons can undergo permanent changes due to long-term use of high heels.


  • Through advertisements, 11 women volunteers, who had worn high heels of 5 cm, five days a week for at least two years, were selected. A control group of nine women wearing flat shoes were selected for comparison.
  • Magnetic resonance imaging scans on specific calf muscles and ankle joints were done.
  • Aspects of muscle architecture of a specific calf muscle named gastrocnemius medialis were measured, including its length and angles upon movement. The study focused only on the dominant leg, which helped to regain balance after a sudden stumble.
  • Structural stiffness, length, cross-sectional area of the connective tissues or specifically of the Achilles’ tendon in relation to the wearing of high heels for a prolonged duration were tested. Movements of muscles that move the ankle, foot and toes were also studied.


  • Women wearing high heels for a long time were found to have shortened gastrocnemius muscle bundles.
  • An increase in size and stiffness of the connective tissue in the Achilles’ tendon was observed.
  • It was observed that the tendon to muscle bundle length ratio was 14% larger in the group wearing high heels.
  • No difference in the physiological cross sectional area of the gastrocnemius medialis muscle and Achilles’ tendon was observed.

Next steps/Shortcomings
The researchers were unable to measure physical activity or other habits of the participants due to time constraints.

Two specific changes are observed among women wearing high heels compared to women always wearing flat shoes vis-a-vis the hypothesis: shortened length of the gastrocnemius muscle and increased stiffness of Achilles’ tendon. These effects also seem to act in opposition to and compensate for each other as no significant difference is observed in the force required to rotate the ankle and feet. These alterations in muscular structures resulting in a lower range of ankle motion among women wearing high heels might cause the discomfort they feel while walking in flat shoes. This research proves that human muscular and tendon structures adapt to continuous and prolonged functional demands.

For More Information:
Effect Of High Heels On Leg Muscles And Tendons
Publication Journal: The Journal of Experimental Biology, 2010
By R Csapo; C N Maganaris
From the University of Vienna, Vienna, Austria and Manchester Metropolitan University, Manchester, UK

*FYI Living Lab Reports Are Summaries of the Original Research.

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