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High heels do not increase risk of knee osteoarthritis, but overweight in youth does

September 25, 2003

Wearing high heels does not increase the risk of osteoarthritis in women, indicates research in the Journal of Epidemiology and Community Health. But excessive weight gain before the age of 40 does.

More than 2% of the population over the age of 55 suffers crippling pain as a result of knee osteoarthritis. But by the age of 65, the condition is twice as common among women, leading some researchers to speculate that high-heeled shoes may be partly to blame.

The researchers interviewed 111 women between the ages of 50 and 70, 29 of whom experienced varying degrees of knee pain and were awaiting knee replacement surgery. The remainder, who were recruited from general practitioner lists, had no knee problems.

All participants were asked for details of their weight and height when they left school, between the ages of 36 and 40, and between the ages of 51 and 55. They were also asked about previous injuries, occupational activity, if they [had ever] smoked and use of contraceptive or replacement therapy hormones.

And they were asked about when they first started wearing high heels, how high these were, and how regularly they wore these type of shoes.

Most of the women has spent several years doing physically demanding work, and several activities seemed to be associated with osteoarthritis of the knee, particularly lifting and bending, but there was no clear evidence of a cumulative risk over time.

Several factors were significantly associated with osteoarthritis of the knee, including previous knee injury, osteoarthritis of the feet, heavy smoking, and being overweight. But wearing high heels was not one of them. If anything, wearing high heels seemed to be associated with a reduced risk of developing knee osteoarthritis.

But being overweight (body mass index of 25 or above) between the ages of 36 and 40 increased the risk of developing osteoarthritis of the knee by a factor of 36 within this group sampled.

The authors conclude: “It is very unlikely that prolonged wearing of high heeled shoes represents a risk factor for symptomatic osteoarthritis of the knee in women.” But they suggest that the age at which people first gain excess weight, especially if they fail to shed it, might be a crucial factor in the development of the condition.

British Medical Journal (BMJ)