Title: Radiographic analysis of foot bone alignment changes across different high heel heights: a case study

Authors: Hongbin Chang; Meizi Wang; Yang Song; Xuanzhen Cen; Qiaolin Zhang

Addresses: General Studies Teaching Department, Zhejiang Fashion Institute of Technology, Zhejiang, China ' Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China ' Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China ' Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary ' Faculty of Engineering, University of Szeged, Szeged, Hungary

Abstract: While the biomechanical effects of high heels (HHs) have been widely studied, their impact on foot morphology remains unclear. This study assessed variations in foot alignment across heel heights using radiographic analysis. Three healthy female subjects underwent weight-bearing X-rays of the right foot at five heel heights (0, 3, 5, 7, 9 cm) from lateral, anterior-posterior, and hindfoot perspectives. Twenty morphological parameters were measured independently by two investigators. Measurements showed high interobserver reliability. Deviations became evident at 5 cm and increased up to 9 cm. The midfoot demonstrated the greatest change, with arch height rising substantially. The forefoot revealed hallux valgus tendencies, while the hindfoot showed smaller changes but reduced ankle stability. Increasing heel height alters foot bone architecture, promoting deformities that may contribute to foot pathologies with prolonged high-heel use.

Keywords: foot morphology; bone alignment; radiographic angles; X-ray; high heels.

DOI: 10.1504/IJBET.2025.150729

International Journal of Biomedical Engineering and Technology, 2025 Vol.49 No.4, pp.279 - 293

Received: 05 Nov 2024
Accepted: 12 Jan 2025
Published online: 22 Dec 2025 *

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