Altered gait patterns exacerbate knee injury risk: A cross-sectional observational study of barefoot and high-heeled walking

Wearing high heels may adversely affect lower limb biomechanics and increase the risk of knee injury in women. This study aims to investigate gait kinematics and kinetics associated with barefoot and high-heeled walking and evaluate whether wearing high heels increases knee joint loading and alters joint stress patterns in healthy female college students. Twelve healthy female college students participated in this cross-sectional study. A Vicon motion capture system (Vicon, Oxford, UK) and AMTI force platforms (Advanced Mechanical Technology Inc., Watertown) were used to collect synchronized kinematic and kinetic data under 2 walking conditions (barefoot and high heels). Data collection was conducted between March and May 2025. Three-dimensional knee moments were calculated using inverse dynamics based on individual anthropometrics. Paired t tests were used to compare differences between conditions. Compared with barefoot walking, high heels significantly increased hip flexion and ankle plantarflexion angles, and reduced knee flexion during stance (P < .05). At toe-off, hip extension and ankle plantarflexion were also elevated. Kinetic results showed significant differences in peak flexion moment 1, adduction moments 1 and 2, and external rotation (P < .05), while peak extension moment 2 showed no difference. High heels altered the timing of adduction, internal, and external rotation peaks. Patellofemoral joint stress was significantly higher in the high-heeled condition (P < .05). High-heeled walking alters lower limb joint angles, knee moment characteristics, and increases patellofemoral joint stress in young women, suggesting a higher risk of knee injury compared with barefoot walking.