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Draft Note: Any information that is bolded is information that was already on the High Heel Wikipedia page. Information I have written is non-bolded and I have added a total of 4 images.

Types

• Stacked heel – usually layers of leather 5 mm thick stacked together and trimmed to match the shape of the heel. These are commonly known as block heels.
• Continental heel – 7.5 mm, with the upper part of the chest of the heel spreading towards the center of the shoe.
• Setback heel – similar to the continental heel, but the surface of the back of the heel is straight, forming a right angle.
• Cuban heel – similar to the continental heel, but not curved, generally medium height
• Pantaloon heel – "similar to pantaloon pants: the top lift part of the heel is spread out as it extends to the bottom part of the heel, and the waistline of the heel is curves inward naturally."
• Angle heel – "the surface of the base of the heel is straight until reaching the waistline, and it looks like the shape of the Korean letter ¬"
• Pinet heel – straight and skinny
• Cromwell shoe – based on Oliver Cromwell with heel up to 170 mm (6.5 in).
• Bar Style – had jewelry or other decorative aspects to go along with flapper culture.
• New Look in 1947 – a slim/elegant heel, newly discovered by putting steel in the heel. This enabled the heel to be ultra skinny without snapping.
• Annabelle – 7 cm platform heel
• Stiletto – Tall, skinny heel; first mentioned in a newspaper in September 1953.
• Wedgies - These were popularized by Salvatore Ferragamo, who introduced this in the Italian market in the late 1930s.

Materials

High heels have been made from all kinds of materials throughout history. In the early years, leather and cowhide was preferred. As civilizations progressed, silk and patent leather were introduced, while cork and wood were utilized as cheap resources in times of war. After the World Wars and the increase in production of steel, the actual heel was a piece of steel wrapped in some kind of material. This has enabled designers to make heels taller and skinnier without them snapping. The soles below the ball of the foot of Ballroom shoes can also be made of materials like smooth leather, suede, or plastic.

Research Studies Conducted on the Medical Aspects of Wearing Heels

Back and Joint Pain

A 2001 survey conducted by researchers from Pennsylvania State University using 200 women found that 58% of women complained of lower back pain when wearing heels and 55% of women said they felt the worst overall back pain when wearing the highest heel. The researchers explained that as heel height increases, the body is forced to take on an unnatural posture to maintain its center of gravity. This changed position places more pressure and tension on the lower lumbar spine which explains why the women complained of severe back pain at a higher heel length.

In a 1992 study, researchers from the University of California and Thomas Jefferson University wanted to investigate the effects of increased heel height on foot pressure using forty-five female participants walking across a pressure plate in various heel heights. A Biokinetics software was used to analyze the exact pressure locations on and along each participants' foot. The researchers were able to conclude that an increase in heel height lead to an increase in pressure beneath each of the Metatarsal bones of the foot. Additionally, they found that the highest heel heights caused constant pressure that could not be evenly dispersed across the foot.

Metatarsal bones (shown in green)

In a 2012 study, Kai-Yu Ho, Mark Blanchette and Christopher Powers, wanted to determine if heel height increased patellofemoral joint stress during walking. The patellofemoral joint refers to junction where the femur and and patella meet. The study comprised of eleven participants who wore tracking and reflective markers as they walked across a 10 meter force plated walkway in low, medium and high heels. The study showed that as the height of the heel increased, the ball of the foot experienced an increase in pressure resulting in increased discomfort levels and peak patellofemoral joint stress. The researchers also mentioned that the long term usage of high heels would lead to repetitive overstress of the joint which would result in an increase in pain and eventually, patellofemoral joint osteoarthritis and Patellofemoral pain syndrome.

In a 2012 study, researchers examined the risk long time high heel wearers would have in regards to calf Muscle fascicle length and strain. The control group consisted of women who wore heels for less than ten hours weekly and the experimental group consisted of women who wore heels for a minimum of forty hours weekly for at least two years. The experimental group was told to walk down a walkway barefoot and in heels while the control group walked down barefoot as cameras recorded their movements to calculate muscle fascicle lengths. The data showed that wearing heels shortened the length of the medial gastrocnemius (MG) muscle fascicles in the calf significantly as well as increasing stiffness in the Achilles Tendon. The experimental group also demonstrated a larger amount of strain on the muscle fascicles while walking in heels because of the flexed position the foot is forced into. The researchers were able to estimate that when wearing heels, the estimated fascicle strains were approximately three times higher and the fascicle strain rate was approximately six times higher. Additionally, they were able to conclude that the long term usage of high heels can increase the risk of injuries such as strain along with discomfort and muscle fatigue.

In a 2016 systematic review of all scientific literature regarding high heels across seven major databases, researchers found that the majority of studies and articles stated that the wearing of high-heeled shoes was associated with hallux valgus and musculoskeletal pain specifically the paraspinal muscles (muscles running up the back along the spine).

Balance Control of the Body

In 2016, scientists from the Department of Physical Therapy in the Sahmyook University in Korea conducted a study to examine the effects of increased heel height and gait velocity on balance control. Balance control refers to the ability of the body to maintain itself along the line of the center of gravity within a base of support. This must be achieved with minimal postural sway velocity which is the horizontal movement of a body trying to maintain balance when standing still. Wearing high heels narrows the base of support that the body has in order to avoid falling and also restricts the area within which the body must sway. In this study, the participants were told to wear either a low or high heel and walk at a low and high speed on a treadmill. As a result of this experiment, the researchers were able to conclude that as heel height increased, the sway velocity of the bodies increased which also modified the position of the knee joint. Muscles have to realign the entire body especially the hips along the line of gravity. As the weight of the body shifted forward, the hips were taken out of alignment and the knee joints experienced stress in order to adjust to the shift.

Postural Effects

Spinal Column Curvature

In a 2016 study from the Sahmyook University in Korea, researchers wanted to investigate the effects of high heels on the activation of muscles in the cervical and lumbar portions of the spine which refers to the neck and lower back. Thirteen women were recruited to walk down a walkway in three different testing conditions: barefoot, in 4 cm heels and in 10 cm heels. Surface electrodes were placed on the muscle mass of the women’s spines as well as their feet to measure the electrical activity of muscles at different points of movement. The results of the study indicated an increase in both cervical and lumbar muscle activation as heel height increased. The cervical spine, the neck, assists in maintaining head stability and postural control in the body. The usage of high heels shifts the body’s center of mass which forces the spine to adjust itself in order to maintain balance. The researchers mentioned that over time these results would increase local muscle fatigue that could lead to muscle swelling, decreased muscle movement and even tissue deformation.

A systematic review of 2016 found the wearing of high-heeled shoes to be associated with hallux valgus, musculoskeletal pain and first-party injury. Research has shown correlation between the height of a heel and the amount of injury that results. Specifically, high heels can affect the amount of tension present in the paraspinal muscles, or muscles running up the back along the spine. Because humans typically stand with flat feet, the bodies’ muscular response to the unnatural feeling of wearing high heels is to tense, causing back, leg, and even shoulder muscles to tighten in order to improve balance and stability. Some more specific instances of the numerous negative side effects of wearing heels include ankle sprains, back and leg pain, shortening of the Achilles tendon, and loss of joint mobility in the wearer's knees. In particular, shoes with only a small space for the toes, can sometimes squeeze tightly enough to cause foot deformity. Additionally, heels may affect how the wearer walks by slowing and shortening their normal stride.

Vein swelling

Further research reveals that another possible consequence of wearing high heels is an increase of pressure in one's veins. Experiments have proven that the higher the heel, the "higher [the] venous pressure in the leg." This means that after repeated use of high heels, varicose veins and other undesirable symptoms are much more likely to appear in the legs. Other research supports these two claims when arguing that wearing high heels can lead to numerous long term effects, including accidental trauma to multiple areas of the body.

Dancing

Styles of Dance that use Heels

Standard Ballroom Tango shoes

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.

Injuries

An analysis of the dance-related injuries in 113,084 adolescents in US emergency rooms from 1991-2007 was conducted using data from the National Electronic Injury Surveillance System. The most common injury found among the data were sprains and strains which comprised of 52.4% of the data. Additional injuries include back and leg pain, loss of joint mobility in the wearer's knees and blisters. In particular, shoes with a narrow space for the toes can sometimes squeeze tightly enough to cause foot deformity. Dancers can add cushioning to the soles of their dancing shoes or inserts to ease the pain during dancing.

Main article: Dance and health#Risks of dance

High-heeled shoe#Medical research

What are the negative effects of wearing high heels over a prolonged period of time in terms of a person's gait, posture and overall muscular pain?

This article provides mostly background information and the history behind heels. Although there is some information regarding the medical effects and risks of wearing heels, there is a lot that can be further discussed. Furthermore, there are only two sub topics under medical research: joint and back pain and vein swelling which is a very specific effect. I think joint and back pain can be further split into two separate topics because back pain can relate to spinal curvature, lumbar support and a person's gait. Joint pain can be specifically focused on the toes or the foot or it can be expanded to discuss joint pain in the legs and hips as a result of wearing heels. Additionally, I think the background information regarding the types of heels can be explored further which can also relate back to the medical effects of wearing heels. Taller heels such as stilettos will have a greater effect than a smaller heel.