They may be in fashion, but research is increasingly indicating high heels cause long-term physical damage. In July MASSAGE Magazine reported on research that showed regular high-heel wearing leads to shortened calf muscles; now, a new study shows wearing high heels may lead to joint degeneration and knee osteoarthritis

The research was conducted by Iowa State University kinesiology professor and chair Phil Martin and kinesiology master’s student Danielle Barkema.

Barkema selected three different heel heights, flat, two inches, and 3.5 inches, and had each of the 15 women in her study complete walking trials. She measured the forces acting about the knee joint and the heelstrike-induced shock wave that travels up the body when walking in heels. Using sensors, accelerometers and lab equipment such as a force platform and markers/cameras, she was able to capture motion and force data and translate them into results that could change the way millions of women select their footwear, according to a university press release.

“Obviously with research like this, you can’t say with any certainty that if you wear high heels regularly you will develop osteoarthritis. We don’t know that,” Barkema said. “There are probably people [high heel wearers] who do and those who do not. However, based on this information, wearing high heels puts individuals at greater risk for developing osteoarthritis. And it seems to be that the higher the heel height, the greater the risk.”

The researchers found that heel height changes walking characteristics such as slower speeds and shorter stride lengths. And as the heels got higher, they also saw an increase in the compression on the inside, or medial side, of the knee.

“This means that prolonged wearing and walking in heels could, over time, contribute to joint degeneration and knee osteoarthritis,” Barkema said.

The study will be presented, in part, at the annual meeting of the American Society of Biomechanics Aug. 18-21, at Brown University in Providence, R.I.

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