Moderate-Heeled Shoes and Knee Joint Torques Relevant to the Development and Progression of Knee Osteoarthritis


      Kerrigan DC, Johansson JL, Bryant MG, Boxer JA, Della Croce U, Riley PO. Moderate-heeled shoes and knee joint torques relevant to the development and progression of knee osteoarthritis.


      To determine if women’s dress shoes with heels of just 1.5in (3.8cm) in height increases knee joint torques, which are thought to be relevant to the development and/or progression of knee osteoarthritis (OA) in both the medial and patellofemoral compartments.


      Randomized controlled trial.


      A 3-dimensional motion analysis gait laboratory.


      Twenty-nine healthy young women (age, 26.7±5.0y) and 20 healthy elderly adult women (age, 75.3±6.5y).


      Not applicable.

      Main outcome measures

      Peak external varus knee torque in early and late stance and prolongation of flexor knee torque in early stance. Three-dimensional data on lower-extremity torques and motion were collected during walking while (1) wearing shoes with 1.5-in high heels and (2) wearing control shoes without any additional heel. Data were plotted and qualitatively compared; major peak values and timing were statistically compared between the 2 conditions using paired t tests.


      Peak knee varus torque during late stance was statistically significantly greater with the heeled shoes than with the controls, with increases of 14% in the young women and 9% in the elderly women. With the heeled shoes, the early stance phase knee flexor torque was significantly prolonged, by 19% in the young women and by 14% in elderly women. Also, the peak flexor torque was 7% higher with the heeled shoe in the elderly women.


      Even shoes with moderately high heels (1.5in) significantly increase knee torques thought to be relevant in the development and/or progression of knee OA. Women, particularly those who already have knee OA, should be advised against wearing these types of shoes.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Guccione A.A.
        • Felson D.T.
        • Anderson J.J.
        Defining arthritis and measuring functional status in elders.
        Am J Public Health. 1990; 80: 945-949
        • Verbrugge L.M.
        Women, men, and osteoarthritis.
        Arthritis Care Res. 1995; 8: 212-220
        • Kerrigan D.C.
        • Todd M.K.
        • Riley P.O.
        Knee osteoarthritis and high-heeled shoes.
        Lancet. 1998; 351: 1399-1401
        • Schipplein O.D.
        • Andriacchi T.P.
        Interaction between active and passive knee stabilizers during level walking.
        J Orthop Res. 1991; 9: 113-119
        • Sharma L.
        • Hurwitz D.E.
        • Thonar E.J.
        • et al.
        Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis.
        Arthritis Rheum. 1998; 41: 1233-1240
        • Morrison J.B.
        The mechanics of the knee joint in relation to normal walking.
        J Biomech. 1970; 3: 51-61
        • Windsor R.E.
        • Insall J.N.
        Surgery of the knee.
        in: Sledge C.B. Ruddy S. Harris E.D. Kelley W.N. Arthritis surgery. WB Saunders, Philadelphia1994: 794-817
        • Ogata K.
        • Whiteside L.A.
        • Lesker P.A.
        • Simmons D.J.
        The effect of varus stress on the moving rabbit knee joint.
        Clin Orthop. 1977; Nov–Dec: 313-318
        • Winter D.A.
        The biomechanics and motor control of human gait.
        2nd ed. Univ Waterloo Pr, Waterloo (ON)1991
        • Perry J.
        Gait analysis.
        Slack, Thorofare1992
        • Reilly D.T.
        • Martens M.
        Experimental analysis of the quadriceps muscle force and patello-femoral joint reaction force for various activities.
        Acta Orthop Scand. 1972; 43: 126-137
        • Kerrigan D.C.
        • Lelas J.L.
        • Karvosky M.E.
        Women’s shoes and knee osteoarthritis.
        Lancet. 2001; 357 ([letter]): 1097-1098
      1. Your podiatric physician talks about women’s feet. Information from the American Podiatric Medical Association. Available at: Accessed September 27, 2004.

        • Ebbeling C.J.
        • Hamill J.
        • Crussemeyer J.A.
        Lower extremity mechanics and energy cost of walking in high-heeled shoes.
        J Orthop Sports Phys Ther. 1994; 19: 190-196
        • Kadaba M.P.
        • Ramakrishnan H.K.
        • Wootten M.E.
        • Gainey J.
        • Gorton G.
        • Cochran G.V.
        Repeatability of kinematic, kinetic, and electromyographic data in normal adult gait.
        J Orthop Res. 1989; 7: 849-860
        • Winter D.A.
        Biomechanics and motor control of human movement.
        2nd ed. John Wiley & Sons, New York1990
        • Gage J.R.
        Gait analysis. An essential tool in the treatment of cerebral palsy.
        Clin Orthop. 1993; May: 126-134
        • Kerrigan D.C.
        • Glenn M.B.
        An illustration of clinical gait laboratory use to improve rehabilitation management.
        Am J Phys Med Rehabil. 1994; 73: 421-427
        • Meglan D.
        • Todd F.
        Kinetics of human locomotion.
        in: Rose J. Gamble J.G. Human walking. 2nd ed. Williams & Wilkins, Baltimore1994: 73-99
        • O’Connell P.G.
        • Siegel K.L.
        • Kepple T.M.
        • Stanhope S.J.
        • Gerber L.H.
        Forefoot deformity, pain, and mobility in rheumatoid and nonarthritic subjects.
        J Rheumatol. 1998; 25: 1681-1686
        • Kerrigan D.C.
        • Riley P.O.
        • Nieto T.J.
        • Croce U.D.
        Knee joint torques.
        Arch Phys Med Rehabil. 2000; 81: 1162-1165
        • Kadaba M.P.
        • Ramakrishnan H.K.
        • Wootten M.E.
        Measurement of lower extremity kinematics during level walking.
        J Orthop Res. 1990; 8: 383-392
        • Sasaki T.
        • Yasuda K.
        Clinical evaluation of the treatment of osteoarthritic knees using a newly designed wedged insole.
        Clin Orthop. 1987; Aug: 181-187
        • Yasuda K.
        • Sasaki T.
        The mechanics of treatment of the osteoarthritic knee with a wedged insole.
        Clin Orthop. 1987; Feb: 162-172
        • Kerrigan D.C.
        • Lelas J.L.
        • Goggins J.
        • Merriman G.J.
        • Kaplan R.J.
        • Felson D.T.
        Effectiveness of a lateral-wedge insole on knee varus torque in patients with medial knee osteoarthritis.
        Arch Phys Med Rehabil. 2002; 83: 889-893
        • Crenshaw S.J.
        • Pollo F.E.
        • Calton E.F.
        Effects of lateral-wedged insoles on kinetics at the knee.
        Clin Orthop. 2000; Jun: 185-192
        • Lelas J.
        • Merriman G.
        • Riley P.
        • Kerrigan D.
        Predicting peak kinematic and kinetic parameters from gait speed.
        Gait Posture. 2003; 17: 106-112
        • Kerrigan D.C.
        • Lelas J.L.
        • Karvosky M.E.
        • Riley P.O.
        Men’s shoes and knee joint torques relevant to the development and progression of knee osteoarthritis.
        J Rheumatol. 2003; 30: 529-533