Prolonged wearing of high-heeled shoes has been linked to injuries related to the plantarflexor (PF) and dorsiflexor (DF), but a new study in the International Journal of Clinical Practice has also found that it may initially strengthen ankle muscles but eventually can lead to a muscular imbalance, a predictor of ankle injury.

The study by Dr. Yong-Seok Jee of Hanseo University in Seosan, Korea, and colleagues followed 40 healthy collegiate women from the Department of Air Tourism and Service who were required to wear high-heeled shoes for their classes (10cm heels) more than three times per week. Participants were categorized according to their class year, from freshman to senior, and ankle strength was isokinetically measured by a HUMAC NORM System. Dynamic balance was assessed using a HUMAC Balance System.

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Researchers discovered that prolonged wearing of these shoes negatively impacted the ankle strength of not only the PF and DF, but also the invertor (IV) and evertor (EV). Surprisingly, the ankle strength of the IV and EV in the dominant and non-dominant sides had a tendency to increase until the junior year and significantly decrease in the senior year.

The authors conclude that while wearing high heels could strengthen ankle muscles at first (1–3 years), prolonged use (about 4 years) may cause a muscular imbalance that is a predictor of ankle injury. It is important for wearers of high-heeled shoes to regularly perform ankle strengthening exercises such as towel scrunches, heel walking, toe tappers, and heel raises, and to limit the frequency of wearing high-heeled shoes as preventative measures.

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