The 2016 HIGh Heels: Health effects And psychosexual BenefITS (HIGH HABITS) study: systematic review of reviews and additional primary studies

Abstract

BackgroundHigh-heeled shoes (high heels) are frequently worn by many women and form an important part of female gender identity. Issues of explicit and implicit compulsion to wear high heels have been noted. Previous studies and reviews have provided evidence that high heels are detrimental to health. However, the evidence base remains fragmented and no review has covered both the epidemiological and biomechanical literature. In addition, no review has considered the psychosexual benefits that offer essential context in understanding the public health challenge of high heels.MethodsWe searched seven major bibliographic databases up to November 2016, in addition to supplementary searches. We initially identified all review articles of any design that assessed either the psychosexual benefits or negative musculoskeletal health effects of high heels, the latter looking at both the epidemiological and biomechanical perspectives. We additionally considered additional primary studies on areas that had not been reviewed before or in which a marked lack of evidence had been noted. Data were extracted onto standardised forms. Proportionate second review was conducted.ResultsA total of 506 unique records were identified, 27 full-text publications were screened and 20 publications (7 reviews and 13 additional studies) were included in our evidence synthesis. The most up-to-date epidemiological review provides clear evidence of an association between high heel wear and hallux valgus, musculoskeletal pain and first-party injury. The body of biomechanical reviews provides clear evidence of changes indicative of increased risk of these outcomes, as well as osteoarthritis, which is not yet evidenced by epidemiological studies. There were no reviews on psychosexual benefits, but all five identified original studies provided evidence of increased attractiveness and/or an impact on men’s behaviour associated with high heel wear. With regard to second-party injury, evidence is limited to one descriptive study and eight case reports.ConclusionsOur evidence synthesis clearly shows that high heels bring psychosexual benefits to women but are detrimental to their health. In light of this dilemma, it is important that women’s freedom of choice is respected and that any remaining issues of explicit or implicit compulsion are addressed.

Cultural and Aesthetic Analysis of Some of the Most Daring Celebrity Fashion Trends

“…This sex appeal is supported by scientific evidence (Barnish, Morgan, & Barnish, 2017;Guéguen, 2015). Of course, high heels are bad for our health (Barnish et al, 2017;Barnish & Barnish, 2016;Cronin, 2014), but surely that is a choice we can make as adults. Most female celebrities wear high heels for every, or almost every, red carpet appearance or similar.…”

“…Depending on the dress style, and in particular whether it is sheer or has splits, the wearer's shoes may not be seen. However, high heels can have a dramatic effect on women's posture and perceived attractiveness even if they are invisible (Barnish et al, 2017). If the shoes cannot be seen, this can favour the decision towards achieving a dramatic 6 inch height increase through a more moderate heel-to-toe drop of around 4 inches plus a platform.…”

An investigation of the association between body appreciation, need for self‐expression, and interest in cosmetic enhancing procedures

“…First, body appreciation is positively associated with health‐protective behaviors positioned to protect the health and well‐being of the body . Second, some cosmetic enhancing procedures have been shown to pose substantial and detrimental effects to the user's physical health (eg, wearing high‐heeled shoes, use of some cosmetic skincare products). Thus, individuals high in body appreciation may be more inclined to avoid these enhancing procedures.…”

Where Do We Stand on High Heels in 2018? An Audit

“…An umbrella systematic review published in the summer of 2017 [1] brought together evidence for the first time about the psychosexual benefits and health consequences of wearing high heels. It included data from two systematic reviews [2] [3], five non-systematic reviews [4] [5] [6] [7] [8], eight injury case reports [9]- [16], and five psychosexual studies [17] [18] [19] [20] [21].…”

“…It included data from two systematic reviews [2] [3], five non-systematic reviews [4] [5] [6] [7] [8], eight injury case reports [9]- [16], and five psychosexual studies [17] [18] [19] [20] [21]. We have also identified one further psychosexual study [22] and one further review on gait changes [23] that were submitted prior to the publication of Barnish et al Journal of Applied Mathematics and Physics [1] review, but not published in time to be included in it. The body of evidence as it stands demonstrates that, while high heels increase women's attractiveness, it is clear that they substantially increase risk of chronic musculoskeletal (MSK) problems.…”