Original Research| Volume 54, ISSUE 4, P615-619, July 2015

Download started.


Epidemiology of High-Heel Shoe Injuries in U.S. Women: 2002 to 2012

  • Justin Xavier Moore
    Address correspondence to: Justin Xavier Moore, MPH, Department of General Surgery, Division of Trauma and Burns, University of Alabama at Birmingham, 1665 University Boulevard, Ryals School for Public Health Building, 230P, Birmingham, AL 35294-0022.
    Research Assistant, Department of General Surgery, Division of Trauma and Burns, and Departments of Epidemiology and Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL
    Search for articles by this author
  • Brice Lambert
    Research Assistant, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
    Search for articles by this author
  • Gabrielle P. Jenkins
    Research Assistant, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
    Search for articles by this author
  • Gerald McGwin Jr.
    Professor and Vice Chairman, Department of General Surgery, Division of Trauma and Burns, Department of Epidemiology, and Center of Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL
    Search for articles by this author


      The purpose of the present study was to investigate the epidemiology of high-heel–related injuries among a nationally representative population of women in the United States and to analyze the demographic differences within this group. The data used in the present study were collected from the Consumer Product Safety Commission's National Electronic Injury Surveillance System. A total of 3294 injuries, representing an estimated 123,355 high-heel–related injuries, were treated in emergency departments within the United States from 2002 to 2012. The overall rate of high-heel–related injuries for the study was 7.32 per 100,000 females (95% confidence interval 7.08 to 7.56). The injury rate was greatest for young adult females, with the greatest rates observed for those aged 20 to 29 years (18.38 per 100,000 females) and those aged 30 to 39 years (11.07 per 100,000 females). The results from the present study suggest that high-heel–related injuries have nearly doubled during the 11-year period from 2002 to 2012. Injuries from high heels are differential by body region, with most injuries occurring as sprains and strains to the foot and ankle. Although high heels might be stylish, from a health standpoint, it could be worthwhile for females and those interested in wearing high heels to understand the risks of wearing high-heeled shoes and the potential harm that precarious activities in high-heeled shoes can cause. The results of the present study can be used in the development of a prospective cohort study to investigate the risk of injury from high-heeled shoes, accounting for the exposure time and studying differences in demographics (e.g., age and race).

      Level of Clinical Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Linder M.
        • Saltzman C.L.
        A history of medical scientists on high-heels.
        Int J Health Services. 1998; 28: 201-225
        • Treves F.
        The Influence of Clothing on Health.
        Cassell, London1886
        • American Podiatric Medical Association
        A.P.M.A. High-Heel Survey, 2003.
        November 23, 2006 (Available at:) (Accessed January 15, 2014)
        • Frey C.
        • Thompson F.
        • Smith J.
        • Sanders M.
        • Horstman H.
        American Orthopaedic Foot and Ankle Society women's shoe survey.
        Foot Ankle. 1993; 14: 78-81
        • Esenyel M.
        • Walsh K.
        • Walden J.G.
        • Gitter A.
        Kinetics of high-heeled gait.
        J Am Podiatr Med Assoc. 2003; 93: 27-32
        • Hong W.
        • Lee Y.
        • Chen H.
        • Pei C.
        • Wu C.
        Influence of heel height and shoe insert on comfort and perception and biomechanical performance of young female adults during walking.
        Foot Ankle Int. 2005; 26: 1042-1048
        • Ko D.Y.
        • Lee H.S.
        The changes of COP and foot pressure after one hour's walking wearing high-heeled and flat shoes.
        J Phys Ther Sci. 2013; 25: 1309-1312
        • Cronin N.J.
        • Barrett R.S.
        • Carty C.P.
        Long-term use of high-heeled shoes alters the neuromechanics of human walking.
        J Appl Physiol. 2012; 112: 1054-1058
        • Dunn J.E.
        • Link C.L.
        • Felson D.T.
        • Crincoli M.G.
        • Keysor J.J.
        • McKinlay J.B.
        Prevalence of foot and ankle conditions in a multiethnic community sample of older adults.
        Am J Epidemiol. 2004; 159: 491-498
        • Adrian M.J.
        • Karpovich P.V.
        Foot instability during walking in shoes with high-heels.
        Res Q Exerc Sport. 1966; 37: 168-175
        • Chein H.L.
        • Hu T.W.
        • Liu M.W.
        Effects of long-term wearing of high-heeled shoes on the control of the body's center of mass motion in relation to the center of pressure during walking.
        Gait Posture. 2014; 39: 1045-1050
        • Csapo R.
        • Maganaris C.N.
        • Seynnes O.R.
        • Narici M.V.
        On muscle, tendon and high-heels.
        J Exp Biol. 2010; 213: 2582-2588
        • Hsue B.J.
        • Su F.C.
        Kinematics and kinetics of the lower extremities of young and elder women during stairs ascent while wearing low and high-heeled shoes.
        J Electromyogr Kinesiol. 2009; 19: 1071-1078
        • Opila-Correia K.A.
        Kinematics of high-heeled gait with consideration for age and experience of wearers.
        Arch Phys Med Rehabil. 1990; 71: 905-909
        • Simonsen E.B.
        • Svendsen M.B.
        • Norreslet A.
        • Baldvinsson H.K.
        • Heilskov-Hansen T.
        • Larsen P.K.
        • Alkjær T.
        • Henriksen M.
        Walking on high heels changes muscle activity and the dynamics of human walking significantly.
        J Appl Biomech. 2012; 28: 20-28
        • Cronin N.J.
        The effects of high-heeled shoes on female gait: a review.
        J Electromyogr Kinesiol. 2014; 24: 258-263
        • Ebbeling C.J.
        • Hamill J.
        • Crussemeyer J.A.
        Lower extremity mechanics and energy cost of walking in high-heeled shoes.
        J Orthop Sports Phys Ther. 1994; 19: 190-196
        • Mika A.
        • Olesky L.
        • Mika P.
        • Marchewka A.
        • Clark B.C.
        The effect of walking in high- and low-heeled shoes on erector spinae activity and pelvis kinematics during gait.
        Am J Phys Med Rehabil. 2012; 91: 425-434
        • Snow R.E.
        • Williams K.R.
        High-heeled shoes: their effect on center of mass position, posture, three-dimensional kinematics, rearfoot motion, and ground reaction forces.
        Arch Phys Med Rehabil. 1994; 75: 568-576
        • Williams C.M.
        • Haines T.P.
        An exploration of emergency department presentations related to high-heel footwear in Victoria, Australia, 2006–2010.
        J Foot Ankle Res. 2014; 23: 6
        • U.S. Consumer Product Safety Commission
        National Electronic Injury Surveillance System (NEISS) Coding Manual.
        2013 (Available at:) (Accessed January 1, 2014)
        • U.S. Census Bureau
        National Intercensal Estimates (2000–2010).
        2011 (Available at:) (Accessed January 1, 2014)
        • Shehab R.
        • Mirabelli M.H.
        Evaluation and diagnosis of wrist pain: a case-based approach.
        Am Fam Physician. 2013; 87: 568-576