High-heeled shoe

European heeled shoes from c. 1690

Platformed footwear has a long history dating as far back as ancient Egypt, though it is unknown when the platforms made their first appearance. In ancient Egypt, wearing very thick soled sandals was an indication of upper class status. Butchers in ancient Egypt also elevated themselves by wearing platformed sandals to keep blood away from their feet.[9][10]

The Persian cavalry wore Galesh, a kind of boot with heels, in order to ensure their feet stayed in the stirrups. Heeled shoes also kept Persian arrow-shooting riders, who stood up on galloping horses, safely on the horse.[11] This utility of the heel for horseback riders has been preserved in the Western cowboy boot. Before the Industrial age, owning horses was an indicator of wealth, as their maintenance was both expensive and time-consuming. Thus, the wearing of heels traditionally implied the wearer had significant wealth.[12] This practical use of the heel has set the standard for most horseback riding shoes throughout history and into the present day.

After the Great Schism in the 11th century, the Pope notably began wearing red-heeled shoes.[3] In 12th-century India, a statue from the Ramappa Temple depicts an Indian woman's foot clad in a raised shoe. During the Medieval period in Europe, both men and women wore platform shoes (the women's variant being known as chopines) to raise themselves out of the trash and excrement filled streets.[13] These heels reached a height of up to 30 inches (76 cm) in 1430. Venetian law later limited the height to three inches—but this regulation was widely ignored.[14] At the end of the Elizabethan era, cavalier boots were introduced for riding. These originally had relatively low heels, but by the time of the English Civil War stacked heels of up to 2 inches were common. A 17th-century law in Massachusetts announced that women would be subjected to the same treatment as witches if they lured men into marriage via the use of high-heeled shoes.[15]

Portrait of King Louis XIV in high heels

Modern high heels were brought to Europe by Persian emissaries of Abbas the Great in the early 17th century.[11] Men wore them to imply their upper-class status; only someone who did not have to work could afford, both financially and practically, to wear such extravagant shoes. Royalty such as King Louis XIV wore heels, and his predecessor King Louis XIII introduced the red heel to the court of French nobility.[3] As the shoes became a fashion trend, other members of society began donning high heels, and some elite members ordered their heels to be made even higher to distinguish themselves from lower classes.[16] Some authorities began regulating the length of a high heel's point according to social rank: "1⁄2 inch for commoners, 1 inch for the bourgeois, one and 1⁄2 inches for knights, 2 inches for nobles, and two and 1⁄2 inches for princes."[17] As women began to wear heeled shoes in the mid-to-late 17th century, societal trends moved to distinguish men's from women's heels. By the 18th century, men wore thick heels, while women wore thin ones.[3] Over the course of the Enlightenment, men's heels began to concentrate into either practical riding boots or tall leather boots worn for status.[3] In the late 1780s, the societal implications of wearing high and thin heels became fixed: high, thin heels represented femininity and the supposed superficiality and extravagance of women.[12]

Typical 18th-century shoe

The design of the high French heels from the late 1600s to around the 1720s placed the wearer's body weight on the ball of the foot and were decorated with lace or braided fabric. From the 1730s to the 1740s, wide heels with an upturned toe and a buckle fastening became popular. The 1750s and 1760s introduced a skinnier, higher heel. The 1790s continued this trend but saw more experimentation with color. Additionally, in this period, there was no difference between the right and left shoes.[18]

In Britain in 1770, an act was introduced into the parliament which would have applied the same penalties to the use of high heels and other cosmetic devices as would have been applied in the case of witchcraft.[19]

During the Regency era Hessian boots similar in appearance to modern cowboy boots were popular among dandies. After the Battle of Waterloo, high heeled boots declined in popularity and were replaced with the lower heeled Wellington Boots popularized by the famous British general.

1850s sewing machine

Heels went out of fashion starting around 1810, and then in 1860, they surged in popularity, with an average height of about two and a half inches. The Pinet heel and the Cromwell heel were both introduced during this time.[20] Their production was also increased with the invention and eventual mass production of the sewing machine around the 1850s. With sewing machines, yields increased as machines could quickly and cheaply "position the heel, stitc[h] the upper, and attac[h] the upper to the sole."[17]

During the 20th Century, World War I and World War II led many countries to ration materials that were previously used to make shoes. Materials such as silk, rubber, and leather were prioritized for military use. Heels began to be replaced with cork and wooden-soled shoes.[21] Due to the post-war increase in international communication, especially through photography and films, the Western fashion of women's high heels began to spread globally.[17] In the early post-war period, brown and white pumps with cutouts or ankle straps combined with an open toe were some of the most fashionable women's heels.[21] High heeled shoes began to also symbolize professionalism for many women in the West, while leather and rubber thick-heeled boots for men came to be associated with Militarism and masculinity.

The era surrounding World War II saw the popularization of pin-up girl posters, the women in which were almost always pictured wearing high heels. In the minds of many men at war, and later, in American society at large, this led to an increase in the strength of the relationship between high heels and female sexuality.[12] The tall, skinny stiletto heel was invented in 1950, and quickly became an emblem of female sexuality.[18] There was a weakening of the stiletto style during the late 1960s through the early 1970s and 1990s when block heels were more prominent, followed by a revival in the 2000s.

For men, high heeled boots made a comeback in the 1950s as the cowboy boot, associated with Western movies. During the 1960s and 70s, Beatle boots, Chelsea boots and Winkle-pickers with Cuban heels became popular among Teddy boys, the mod subculture and the early garage punk scene.

• 
  1920 US Marine Corps shoe, with high heel, showing position of foot bones (vertical black marks on the x-ray are nails used to hold the sole and heel on)
• 
  Same shoe from above, showing pointed toe box too narrow for the toes, and hallux valgus deformity. The high heel shifts weight forwards, putting additional pressure on the sides of the toes
• 
  World War II poster of pin-up girl (Betty Grable) in high heels

In the Western world, high-heeled shoes exist in two highly gendered and parallel tracks: highly fashionable and variable women's shoes with thin long heels, and practical, relatively uniform men's shoes in a riding boot style, with thick, relatively short heels.[13] Heels are often described as a sex symbol for women, and magazines like Playboy, as well as other media sources that primarily portray women in a sexual way, often do so using high heels. Paul Morris, a psychology researcher at the University of Portsmouth, argues that high heels accentuate "sex-specific aspects of female gait," artificially increasing a woman's femininity.[13] Likewise, many see the arching of a woman's back facilitated by wearing high heels as an imitation of a signal of a woman's willingness to be courted by a man.[22][23] Despite the sexual connotations, heels are considered both fashionable and professional dress for women in most cases, the latter especially if accompanied by a pants suit. Some researchers argue that high heels have become part of the female workplace uniform and operate in a much larger and complex set of display rules.[13] High heels are considered to pose a dilemma to women as they bring them psychosexual benefits but are detrimental to their health.[24] The 21st century has introduced a broad spectrum and variety of styles, ranging from height and width of heel, to design and color of the shoe.

Women's high-heeled shoes with dyed black harp seal fur, by Inuk designer Nicole Camphaug

High heels have been made from a wide variety of materials throughout history. In the early years, leather and cowhide were preferred. Later, silk and patent leather were introduced. At the same time, cork and wood were utilized as cheap resources in times of war.[21] After the World Wars, and the increase in production of steel, the actual heel was often a piece of steel wrapped in some material. This enabled designers to make heels taller and skinnier without them snapping.[27] The soles below the ball of the foot of Ballroom shoes can also be made of materials like smooth leather, suede, or plastic.[28]

Wearing high-heeled shoes is strongly associated with injury, including injury requiring hospital care. There is evidence that high-heel-wearers fall more often, especially with heels higher than 2.5 cm,[7] even if they were not wearing high heels at the time of the fall.[6] Wearing high heels is also associated with musculoskeletal pain,[6] specifically pain in the paraspinal muscles (muscles running up the back along the spine) and specifically with heel pain and plantar calluses (only women tested).[7]

A 2001 survey conducted by 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.[29] The same study argues that as heel height increases, the body is forced to take on an increasingly unnatural posture to maintain its center of gravity. This changed position places more pressure and tension on the lower lumbar spine, which may explain why some of the women complained of severe back pain at a higher heel length.

In a 1992 study, researchers from the University of California, Davis, and Thomas Jefferson University conducted an investigation on the effects of increased heel height on foot pressure using forty-five female participants walking across a pressure plate in various heel heights.[30] A Biokinetics software was used to analyze the exact pressure locations on and along each participants' foot. The researchers concluded that an increase in heel height leads 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.

In a 2012 study, Kai-Yu Ho, Mark Blanchette, and Christopher Powers investigated the impact of heel height on patellofemoral joint stress during walking.[31] The study consisted of eleven participants wearing tracking and reflective markers as they walked across a 10-meter force-plated walkway in low, medium, and high heels. The study argued 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 may lead to repetitive overstress of the joint, which may result in an increase in pain and, eventually, patellofemoral joint osteoarthritis and Patellofemoral pain syndrome.

In a 2012 study, researchers examined the long risk time high heel wearers would have in regards to calf Muscle fascicle length and strain.[32] 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. In contrast, the control group walked barefoot as cameras recorded their movements to calculate muscle fascicle lengths. The data showed that wearing heels shortened the size of the medial gastrocnemius (MG) muscle bundles in the calf significantly as well as increasing stiffness in the Achilles Tendon. The experimental group also demonstrated a more significant strain on the muscle fascicles while walking in heels because of the flexed position the foot is forced into. The researchers estimated that when wearing heels, the estimated fascicle strains were approximately three times higher, and the fascicle strain rate was about six times higher. Additionally, they concluded that the long-term usage of high heels could increase the risk of injuries such as strain and discomfort, and muscle fatigue.

• 
  Diagram of an Achilles tendon
• 
  Plantar flexion of the foot in high heels

High-heeled shoes almost always have pointed toe boxes[33] which do not fit around the toes, but displace them from their natural position.

Wearing high-heeled shoes is associated with developing bunions, a deformity of the foot.[6][7]

In 2016, scientists from the Department of Physical Therapy in the Sahmyook University in Korea conducted a study to examine increased heel height and gait velocity on balance control.[34] In this study, the participants were told to wear either a low or high heel and walk on a treadmill at a low and high speed. As a result of this experiment, the researchers argued that as heel height increased, the sway velocity of the bodies increased, which also modified the position of the knee joint, requiring the muscles of the leg to realign the entire body, especially the hips, along the line of gravity. As the body's weight shifted forward, the hips were taken out of alignment, and the knee joints experienced stress to adjust to the shift.

Spinal column curvature

In a 2016 study from the Sahmyook University in Korea, researchers investigated the effects of high heels on the activation of muscles in the cervical and lumbar portions of the spine.[35] 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 and their feet to measure the electrical activity of muscles at different points of movement. The study results 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 requires the spine to adjust itself to maintain balance. The researchers mentioned that these results would increase local muscle fatigue over time, which could lead to muscle swelling, decreased muscle movement, and, in extreme cases of overuse, tissue deformation.

Some research indicates that a possible consequence of wearing high heels is increasing pressure in one's veins. Experiments suggest 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.[8] Other research supports that claim that wearing high heels can lead to numerous long-term effects, including accidental trauma to multiple areas of the body.[13]

Some dress codes require women to wear high heels, and some medical organizations have called for a ban on such dress codes.[6] There have been many protests by women workers against such policies. Laws regarding dress codes that require women to wear high heels in the workplace vary.

A Mile in Her Shoes: men walk a mile in high heels to support domestic violence victims

A Mile in Her Shoes is an annual march in which men wear red high heels and walk a mile to protest domestic violence. Some academics have suggested that by wearing high heels for such a brief period and making a point of acting like they do not know how to walk properly, these men reinforce the stereotype that only women can or should wear high heels.[54]

Standard ballroom tango shoes

Many styles of dance are performed in heels. Ballroom dancing shoes are specific to the dance style being performed. International Standard ballroom shoes for women are closed-toed shoes with a sturdy 2-to-2.5-inch heel because steps are performed using the foot's heel.[55] 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 sturdy heel because International Latin and American Rhythm styles are performed on the ball of the foot. This style of shoe is designed with a flexible sole to allow pointed feet. Lastly, American Smooth shoes are closed-toed, flexible-soled shoes that range in heel height from 2 to 2.5 inches.

A non-traditional ballroom dance that uses heels is the Argentine tango. While dancing the Argentine tango, women often wear pointed heels ranging in height from 2 to 4 inches.[28] More advanced dancers typically choose higher heels. The heels can have a significant impact on the posture of a dancer by tilting the pelvis and making the buttocks more prominent, forcing the abdomen in and pushing the breasts out.[56] They can also cause instability as they force women to dance on their toes and lean on their partner, which adds to the fluidity of the movements.

A 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.[57] Dancers such as Yanis Marshall specialize in dancing with high heels.[58]

Some dance-related injuries are attributable to the use of heels. In particular, shoes with a narrow space for the toes can squeeze tightly enough to cause foot deformity.[59] Dancers can add cushioning to the soles of their dancing shoes or inserts to ease the pain during dancing.[28]