The result points to a potentially important sensory cost of high heels: while descending stairs, participants may be less able to determine the position and movement of their ankles. The investigators described this as impaired ankle inversion proprioception, meaning reduced accuracy in distinguishing small differences in joint angle. The finding does not establish that any participant actually fell, developed an ankle injury or required treatment. Instead, it identifies a measurable difference in sensory performance under a common movement condition.

The study was designed to resemble everyday stair walking while separating two potential influences: the type of shoe and the height of the step. Eighteen women aged 18 to 30 took part. Their average age was 20.89 years, average height was 161.97 cm and average body mass was 54.35 kg. None had undergone lower-limb surgery in the previous six months, reported a lower-limb deformity or had another condition affecting normal walking. Participants also reported wearing high heels for no more than six hours per month over the preceding two years, reducing the likelihood that long-term adaptation to heels had substantially trained their movement strategies.

Researchers tested two shoe styles with the same 1 cm forefoot sole thickness. The flat shoes had a level sole, with the heel and forefoot both 1 cm high, while the high heels added a 7 cm heel. Each participant completed stair-descent trials in both shoe types at riser heights of 15 cm and 30 cm. The 15 cm height corresponds to the standard riser height cited for public residential stairs in Chinese and Australian standards, whereas 30 cm represented a more extreme step resembling some outdoor stairs and sports-training environments.

Proprioception was measured with the Ankle Inversion Discrimination Apparatus for Landing, or AIDAL, a device designed to reproduce ankle inversion angles encountered during stair descent. Before testing, each participant became familiar with four inversion angles of 10°, 12°, 14° and 16°. During formal trials, a participant stepped with the dominant leg onto a tilting platform while placing the other foot on level ground, then reported which of the four angles she perceived. Participants were instructed to look ahead rather than down at the apparatus, and a 10-minute rest was inserted between testing sessions to reduce the influence of fatigue.

To convert the angle reports into a discrimination score, the investigators recorded the frequency of every stimulus-percept pairing in a 4-by-4 matrix. They then used nonparametric signal-detection analysis to construct three receiver operating characteristic curves for adjacent angle pairs. The mean area under those curves became the final score for each footwear and stair-height combination. On this scale, 0.5 represents chance discrimination and 1.0 represents perfect discrimination. A two-way repeated-measures analysis of variance was used to test the effects of footwear, riser height and their interaction, with partial eta squared used to quantify effect size.

Footwear was the only factor to show a statistically significant effect. The repeated-measures analysis produced a main effect of footwear type, with F = 7.513, p = 0.014 and partial eta squared = 0.306. By contrast, the effect of riser height was not significant, with F = 0.245, p = 0.627 and partial eta squared = 0.014. The interaction between footwear and riser height was also nonsignificant, with F = 1.109, p = 0.307 and partial eta squared = 0.061. Thus, the experiment did not show that the high-heel effect became stronger as the stairs rose, nor that stair height independently impaired angle discrimination in this sample.

The investigators proposed that the high-heel condition may blur ankle position signals through changes in mechanics and the starting posture of the foot. A 7 cm heel plantarflexes the ankle and rearfoot and can increase foot inversion and internal rotation, leaving the calf muscles in a more shortened position. This may change the length-tension relationship of muscle spindles, whose signals help convey muscle length and movement. Earlier work cited by the study also found that 7 cm heels reduced ankle joint net work, work contribution and stiffness compared with a 1 cm heel. Lower stiffness could permit more unintended inversion under load while reducing baseline tension in sensory structures such as muscle spindles.

That explanation remains a mechanism proposed by the authors rather than a directly demonstrated causal chain. The experiment did not record ankle motion, plantar pressure, muscle activity or joint stiffness, so it could not measure the proposed changes in sensory input. The authors also suggested that the shoe sole may have attenuated cutaneous signals and helped mask the increased proprioceptive demand associated with the taller step. That possibility was not tested directly and should be regarded as a hypothesis for future sensory studies. The results also diverge from earlier barefoot research in which increasing riser height reduced ankle proprioceptive performance, underscoring the need to distinguish shod from barefoot conditions.

Several limits constrain what can be concluded. The sample was small, consisted only of healthy young women and may have lacked the statistical power to detect a small or moderate interaction between footwear and riser height. Findings therefore should not be generalized to people with chronic ankle instability, older adults, men or other footwear and stair conditions. The tested heel was limited to 7 cm, and there was no barefoot baseline, making it impossible to isolate the independent contribution of each shoe design from the broader effect of wearing shoes. The authors also call for larger samples, direct sensory measurements, additional heel heights and biomechanical assessments involving ankle kinematics, plantar pressure, muscle activity and joint stiffness.

For healthy young women negotiating stairs, the most defensible takeaway is that flat shoes supported better ankle angle discrimination than 7 cm high heels in this experiment. The lower scores in heels are consistent with altered joint mechanics and potentially less precise sensory feedback, but the study did not directly test injury rates or prove that heels caused falls or ankle sprains. Its practical relevance lies in showing that a familiar fashion choice can measurably change how accurately the nervous system judges ankle position during a demanding, balance-sensitive task. Whether that difference translates into fewer injuries, particularly in vulnerable populations, remains an open question requiring larger and more diverse studies.

Subject of Research: Effects of high-heeled versus flat footwear on ankle inversion proprioception during stair descent in healthy young women

Article Title: Effects of footwear type and stair riser height on ankle inversion proprioception during stair descent in healthy young females

Article References: Chen, Y., Cao, J., Lyu, M., Xu, C., Zhang, L., Liu, L., Li, X., Tang, X., Han, J., & Lyu, J. (2026). Effects of footwear type and stair riser height on ankle inversion proprioception during stair descent in healthy young females. Frontiers in Bioengineering and Biotechnology, 14, Article 1911629. https://doi.org/10.3389/fbioe.2026.1911629

Image Credits: AI Generated

DOI: 10.3389/fbioe.2026.1911629

Keywords: ankle proprioception, high heels, stair descent, footwear, joint position sense, balance control, young women, stairs, sensorimotor control, biomechanics, Effects, type