Effect of wearing high-heeled shoes on postural control and foot loading symmetry

Purpose: This study aimed to evaluate the effects of high-heeled shoes (HHS) and experience with such footwear on foot loading and standing balance using linear and nonlinear methods. Methods: Sixteen young female experts in wearing high-heeled shoes (HHE) and sixteen young females who occasionally wore high-heeled shoes (HHO) completed a Fall Risk Test (FRT) on the Biodex Balance System platform. They also underwent a both-leg standing test on the Zebris pressure mapping platform, both barefoot and while wearing 11 cm HHS. The study analyzed several parameters, including the FRT index, foot loading parameters, linear measures of postural stability (Center of Pressure (CoP) path length and velocity), and nonlinear postural control measures (sample entropy - SampEn, fractal dimension - FD, and the largest Lyapunov exponent - LyE). Results: HHS caused a significant increase the fall risk of more than 44%, but only in the HHE group. The presence of HHS caused a significant increase in CoP path length and CoP velocity by almost 78%. The values of these parameters increased by more than 67% in the HHO group and by more than 92% in the HHE group. HHS caused a significant increase in the values of nonlinear measures (FD and LyE) in the mediolateral direction. Higher FD and LyE values suggest the ability to react faster to destabilizing stimuli and better balance control related to plasticity and adaptability to new conditions. HHS also led to up to 70% loading on the supporting limb. Conclusions: High heels in the population of young women significantly worsen static balance.