High-heeled-related alterations in the static sagittal profile of the spino-pelvic structure in young women

Women wearing high-heeled shoes have been considered to be more characterizing beauty, self-assurance and elegance. However, while maintaining the body on this type of support base, women with increased heel height often complain that wearing high-heeled shoes causes them to experience low back pain. The aim of the present study was to morphologically assess the effect of high-heel use on the static sagittal profile of the spino-pelvic structure.

A total of 21 Chinese girls were recruited in this study, with informed written consent. For each participant, standing left lateral radiographs, including that of the spine and pelvis, were obtained in a standardized standing position under barefoot and high-heel use conditions. The radiographic assessments were performed to detect the changes in the spino-pelvic profile under barefoot and high-heel use conditions.

The average lumbar lordosis (LL) was 54.3 ± 6.4º under the barefoot condition and increased to 65.2 ± 5.1º after high-heel use (P < 0.001), with a significant increase in the disc L5/S1 and disc L4/L5 tilt angles. Of the 21 participants, 15 (71.43 %) had an increased kyphosis value for thoracic kyphosis, and 6 (28.57 %) had a decreased value after high-heel use, with a significant increased mean kyphosis value of 3.4 ± 1.5º overall (P < 0.001). The sagittal vertical axis (SVA) was always positive and was worse after high-heel use (P = 0.012): 11.5 ± 8.7 mm under the barefoot condition and 29.8 ± 8.5 mm under the high-heel use condition. Bivariate correlation analysis showed that both ΔLL and ΔSVA were positively associated with the heel height of the shoes and were inversely associated with the age of the participants. Receiver operator characteristic analysis showed that a heel height >45.5 mm was strongly predictive of the loss of static sagittal balance of the spine during high-heel use (sensitivity 87.5 %, specificity 62.5 %, area under the curve: 0.773; P = 0.026).

The present study revealed that wearing high-heeled shoes can lead to increased LL and an uneconomic body position. This finding may help explain why some women complain that wearing high-heeled shoes causes them to experience low back pain.