Introduction:
Wearing high heels is common not only in young women but also in a wide range of ages. However, the vital question remains what is the effect of wearing these high heels shoes on musculoskeletal of body structures? The recognition of the effect mechanism can reveal many musculoskeletal issues and problems. On the other hand, musculoskeletal modeling is a novel way to estimate the biomechanical variables. Therefore, the main aim of the current study was to evaluate the effect of wearing high-heel shoes on women by musculoskeletal modeling.

Methods:
Thirty-six healthy females (68.4±6.5 kg, 161±6.5 cm, 29.5±8.5 years) performed walking tasks with and without high-heel shoes (5cm heel) in the motion analysis lab with twelve Vicon motion captures (Vicon MX, Oxford, UK, 200 Hz) and two force plates (Kistler Instrumente AG, Winterthur, Switzerland, sampling rate 2000 Hz). The Gait2354_Simbody model of OpenSim consists of joints with 23 degrees of freedom and 92 muscle-tendon actuators to represent 76 muscles in the lower extremities and the torso was used to simulate the high heel gait. The generic model was scaled by mass, height, isometric strength, and markers data in the static position. The inverse kinematics, Inverse dynamics, and static optimization were used to evaluate the effect of wearing high-heeled shoes. The validation processing was performed by electromyography data.

Results:
The results indicate that wearing high-heeled shoes in young women can lead to significant changes in the kinematics and kinetics variables in musculoskeletal modeling. Specifically, by wearing high-heeled shoes, the joint contact force significantly increased (P=0.0025) in ankle, knee, and hip joints. In addition, muscle activation of some muscles of lower extremity significantly changed (p=0.0016). Furthermore, wearing high-heeled shoes can increase pressure on specific areas of the foot and knee, potentially leading to issues such as pain and tissue damage.

Discussion:
This study investigated the effect of wearing high-heeled shoes on kinematics and kinetics variables. Based on the results, by wearing these shoes, the musculoskeletal system was significantly influenced. These changes can help us better understand how wearing high-heeled shoes can alter movement patterns and walking patterns. Consequently, understanding these changes can lead to improved shoe design and prevention strategies for problems associated with high heels.