The answer to the question: “Are high heels bad for your health?” may seem obvious to some. There is copious research into the manifold ways that high heels affect their wearers’ well-being, but it is highly fragmented, often focusing on specific health issues. Plus, there is also research that shows benefits to wearing high heels. We decided to take the many factors involved in high heel health into account and conduct the first systematic review of research into both the benefits and harms of high heel wear.
We identified 506 individual studies on the issue of high heels and health, screened 27 of them and included 20 publications in our evidence synthesis. Our findings, published in the journal BMC Public Health, showed consistent evidence linking high heel wear to an increased risk of bunions, musculoskeletal pain and injuries to the wearer. Some of these injuries, such as ankle fractures, were serious and required hospital attention.
It is important to note, however, that the overall risk of injury is moderate. In some cases, people suffered serious injuries from wearing high heels, but these were not particularly common and the current evidence does not suggest serious cause for alarm. Some studies have suggested a link between high heel wear and osteoarthritis but our review found that the link is inconclusive. It is clear though that frequent wear tends to be more detrimental for long-term health, while the highest and narrowest heels are those that are most linked to serious injuries, such as ankle fractures.
One element of high heel wearing that is often ignored in the high heels public health debate, but which we took into account in our study, is the psychological benefits they bring to wearers. Like it or not, high heels are a symbol of modern (heteronormative) female sexuality.
We found consistent evidence that high heel wear offers benefits to women in terms of how they perceive their own beauty, how attractive they were to men and also men’s willingness to help them, for example completing a questionnaire or retrieving a dropped glove. So there is a potential dilemma that women face: wearing high heels may increase their attractiveness but it may also be detrimental to their health.
Freedom to choose
It is important that women make their own, well-informed choices regarding whether and how often to wear high heels. Our hope is that, by increasing public awareness about both the positive and negative aspects of wearing high heels, people can make an informed choice.
To do so, they will have to navigate pervasive elements of culture that promote high heel wearing as fashionable or an expected part of a dress code. People’s freedom to choose is always affected by social expectations. But, informed by research and advocacy, there has been progress in moving away from the idea that high heels are the only choice for women in smart professional or social situations.
Given the evidence that more frequent wear is worse for women’s health, it is especially important that women are not required to wear high heels at work. They, of course, may choose to do so if they wish to (unless there are specific occupational reasons not to allow them, such as in a factory).
There has been clear progress regarding companies no longer requiring high heels, and indeed changes of policy by major firms have been reported in the media. Nevertheless, whether or not companies can legally require women to wear high heels as part of a dress code remains a point of confusion. The jurisdiction of British Columbia in Canada brought in legislation to specifically prohibit employers from requiring staff to wear heels.
In the UK, the government rejected a similar proposal. But this does not make it legal for companies to require that women wear high heels to work. In fact, the statement released by the government at the time clearly stated that it opposed compulsory high heel wear at work, but felt that the existing Equality Act 2010 precludes this practice in most circumstances. It made clear that it is against the law to discriminate on the grounds of gender – which would generally include requirements that women wear something that is bad for their health if men do not have to.
Many people do not know this, however. We’d therefore benefit from further clarification on how the Equality Act specifically relates to high heel wearing or the introduction of specific legislation to prevent compulsory high heel wear in workplaces. Clarity on this matter is important to safeguard the health of women – and indeed any wearers of high heels.
Max Barnish is a postdoctoral research associate in health technology assessment at the University of Exeter.
Heather May Morgan is a lecturer at the University of Aberdeen.