Comparison of Balance in Habitual High Heels Wearers and Flat Shoe Wearers by Star Excursion Balance Test

Abstract

Background: The capacity to maintain a stable and upright posture, or balance, is influenced by footwear type. High heel shoes (HHS) alter foot alignment and weight distribution, potentially impacting balance and increasing fall risk. Despite the popularity of high heels, the balance effects compared to flat shoes remain underexplored.

Objective: To compare the balance between habitual high heel wearers and flat shoe wearers using the Star Excursion Balance Test (SEBT).

Methods: A cross-sectional study was conducted from July 2022 to January 2023, including 70 female participants aged 18-35 years. Participants were habitual wearers of high heels or flat shoes for at least six months. Individuals seeking medical care for lower extremity issues or with a history of lower extremity fractures or surgeries were excluded. Balance was assessed using the SEBT, which involves reaching in eight directions from a central stance. Each participant performed three trials per direction. Leg length was measured to normalize reach distances. Data were analyzed using SPSS version 25.0. The Mann-Whitney U Test was used to compare balance between groups, with a significance threshold of p<0.05.

Results: The mean age of participants was 23.83 years (SD = 3.43). For the anterior reach on the dominant side, flat shoe wearers had a significantly better balance with a mean rank of 38.93 compared to 27.50 for high heel wearers (p=0.031). No significant differences were observed in other directions: anterior reach non-dominant side (p=0.499), anteromedial reach dominant side (p=0.384), anteromedial reach non-dominant side (p=0.887), medial reach dominant side (p=0.174), medial reach non-dominant side (p=0.524), posteromedial reach dominant side (p=0.544), posteromedial reach non-dominant side (p=0.913), posterior reach dominant side (p=0.704), posterior reach non-dominant side (p=0.350), posterolateral reach dominant side (p=0.177), and posterolateral reach non-dominant side (p=0.934).

Conclusion: Habitual high heel wearers and flat shoe wearers showed no significant differences in balance across most SEBT directions, except for a significantly poorer anterior reach in high heel wearers. These findings suggest that high heel use may specifically impact anterior balance, highlighting the need for further investigation into the biomechanical and physiological impacts of high heels on balance.