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. 2025 May 9;17(5):e83768.
doi: 10.7759/cureus.83768. eCollection 2025 May.

Postural Adaptations of the Spinopelvic Parameters in the Sagittal Plane Induced by the Use of High-Heeled Shoes in a Sample of Young Healthy Female Subjects: A Pilot Study

Saverio Colonna  1   2 , Corrado Borghi  2   1 , Eleonora Canova  3
Affiliations

Postural Adaptations of the Spinopelvic Parameters in the Sagittal Plane Induced by the Use of High-Heeled Shoes in a Sample of Young Healthy Female Subjects: A Pilot Study

Saverio Colonna et al. Cureus. .

Abstract

This pilot study aimed to investigate postural adaptations in spinopelvic parameters on the sagittal plane following the use of high-heeled shoes over a prolonged period in a population of healthy young women. Thirty-four female participants were assessed using rasterstereography at three time points: standing barefoot (T1), immediately after wearing their own high-heeled shoes (T2), and after two consecutive hours of standing or walking while wearing the shoes (T3). The evaluation focused on trunk inclination, pelvic tilt, lumbar lordotic angle, and thoracic kyphotic angle. Participants were also stratified into two subgroups based on self-reported history of low back pain (LBP) during high-heel use: 13 symptomatic and 21 asymptomatic individuals. The statistical analysis, conducted using both parametric and non-parametric tests due to the borderline normality of the data, revealed no significant postural changes between T2 and T3, nor any relevant differences between the two subgroups. Only a modest variation in the kyphotic angle was observed between T1 and T3, which may not be clinically relevant. Notably, none of the participants reported pain after the two-hour protocol. These findings suggest that, in inexperienced users, high-heeled shoes do not induce significant spinopelvic compensations or acute lumbar discomfort following moderate-duration use. As this is the first study to evaluate postural outcomes after sustained use rather than immediate heel elevation, further research with larger and more diverse samples is warranted to better elucidate the potential role of heel-induced adaptations in the etiology of LBP.

Keywords: anterior pelvic tilt; high heels; low back pain; lumbar lordotic angle; postural adaptations; raster-stereography; spinopelvic profile.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. IRB-Manus Sapiens issued approval 002-2023, dated October 30, 2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Spinopelvic rasterstereographic parameters collected
A: Pelvic inclination angle (PI), lordotic angle (LA) and kyphotic angle (KA); B: antero-posterior trunk flexion (trunk inclination (TI)) ILS: lumbosacral junction, ITL: thoracolumbar junction, ICT: cervicothoracic junction, VP: prominent cervical vertebra, DM: two dimples Reproduced from Colonna et al. [10] under a Creative Commons Attribution License (CC BY).
See this image and copyright information in PMC

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