Barnish Max, Morgan Heather May, Barnish Jean
Child Health, University of Aberdeen, Aberdeen, UK.
Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
BMC Public Health. 2017 Aug 1;18(1):37. doi: 10.1186/s12889-017-4573-4.
High-heeled shoes (high heels) are frequently worn by many women and form an important part of female gender identity. Issues of explicit and implicit compulsion to wear high heels have been noted. Previous studies and reviews have provided evidence that high heels are detrimental to health. However, the evidence base remains fragmented and no review has covered both the epidemiological and biomechanical literature. In addition, no review has considered the psychosexual benefits that offer essential context in understanding the public health challenge of high heels.
We searched seven major bibliographic databases up to November 2016, in addition to supplementary searches. We initially identified all review articles of any design that assessed either the psychosexual benefits or negative musculoskeletal health effects of high heels, the latter looking at both the epidemiological and biomechanical perspectives. We additionally considered additional primary studies on areas that had not been reviewed before or in which a marked lack of evidence had been noted. Data were extracted onto standardised forms. Proportionate second review was conducted.
A total of 506 unique records were identified, 27 full-text publications were screened and 20 publications (7 reviews and 13 additional studies) were included in our evidence synthesis. The most up-to-date epidemiological review provides clear evidence of an association between high heel wear and hallux valgus, musculoskeletal pain and first-party injury. The body of biomechanical reviews provides clear evidence of changes indicative of increased risk of these outcomes, as well as osteoarthritis, which is not yet evidenced by epidemiological studies. There were no reviews on psychosexual benefits, but all five identified original studies provided evidence of increased attractiveness and/or an impact on men's behaviour associated with high heel wear. With regard to second-party injury, evidence is limited to one descriptive study and eight case reports.
Our evidence synthesis clearly shows that high heels bring psychosexual benefits to women but are detrimental to their health. In light of this dilemma, it is important that women's freedom of choice is respected and that any remaining issues of explicit or implicit compulsion are addressed.
许多女性经常穿着高跟鞋，高跟鞋是女性性别认同的重要组成部分。人们已经注意到存在明确和隐性的穿高跟鞋的强迫行为问题。先前的研究和综述提供了证据表明高跟鞋对健康有害。然而，证据基础仍然零散，没有综述涵盖流行病学和生物力学文献。此外，没有综述考虑到心理性益处，而这些益处对于理解高跟鞋的公共卫生挑战提供了重要背景。
截至2016年11月，我们搜索了七个主要的文献数据库，并进行了补充搜索。我们最初识别了所有评估高跟鞋心理性益处或负面肌肉骨骼健康影响的任何设计的综述文章，后者从流行病学和生物力学角度进行研究。我们还考虑了之前未被综述或明显缺乏证据的领域的其他原始研究。数据被提取到标准化表格上。进行了比例二次审查。
共识别出506条独特记录，筛选了27篇全文出版物，20篇出版物（7篇综述和13项其他研究）纳入我们的证据综合分析。最新的流行病学综述提供了明确证据表明穿高跟鞋与拇外翻、肌肉骨骼疼痛和一级损伤之间存在关联。生物力学综述的主体提供了明确证据表明存在一些变化，这些变化表明这些结果以及骨关节炎的风险增加，而流行病学研究尚未证实骨关节炎。没有关于心理性益处的综述，但所有五项识别出的原始研究都提供了证据表明穿高跟鞋会增加吸引力和/或对男性行为产生影响。关于二级损伤，证据仅限于一项描述性研究和八篇病例报告。
我们的证据综合分析清楚地表明，高跟鞋给女性带来心理性益处，但对她们的健康有害。鉴于这一困境，尊重女性的选择自由并解决任何剩余的明确或隐性强迫问题很重要。
