Correlation Between High Heel and Flat Footwear With Balance, Foot Pain and Posture in Healthy Individuals

Abstract

Background: Footwear plays a critical role in influencing human biomechanics, especially concerning balance, foot pain, and posture. High heels and flat footwear are two commonly worn shoe types that impact the body differently. High heels shift the center of gravity forward, increasing muscle strain and reducing balance, whereas flat footwear may offer stability but can lack arch support. The understanding of how these footwear types correlate with musculoskeletal parameters in healthy individuals is crucial for preventing discomfort, deformities, and postural issues in the general population.

Materials and method: An observational analytical study was conducted among 120 healthy individuals (aged 20–35 years) at Krishna College of Physiotherapy, Karad. Participants were grouped based on habitual use of high heels and flat footwear. Data were collected using standardized tools: the Star Excursion Balance Test (SEBT) for balance, Craniovertebral Angle (CVA) for posture, Foot Posture Index (FPI-6), and the Foot Function Index (FFI) for foot pain and disability. Participants met inclusion criteria of one-year footwear use history and no prior postural or balance disorders. Data analysis was performed to determine correlation strength between footwear type and the measured variables.

Result: The study found statistically significant correlations across all variables. The correlation between SEBT (balance) in flat vs. high heel users was very strong (r = 0.8918), indicating that both types influence balance performance. Postural alignment (CVA) showed strong correlation (r = 0.8061), while FPI (foot posture) showed very strong correlation (r = 0.9970), and FFI (foot pain) demonstrated a moderate to strong correlation (r = 0.7386), all with p-values < 0.0001.

Conclusion: The study concluded that there is a significant correlation between type of footwear and musculoskeletal health in healthy individuals. High heels were associated with increased foot pain, altered posture, and reduced balance. Even flat footwear, if lacking support, may negatively impact postural alignment and comfort. Therefore, proper footwear selection is essential to prevent long-term biomechanical complications and promote musculoskeletal wellbeing.