Meta-Analysis of the Effect of Prolonged Use of High Heels on Low Back Pain in Female Sales Employees


  • Fadhila Firmanurulita Master’s Program in Public Health, Universitas Sebelas Maret
  • Agus Kristiyanto Study Program of Sports, Faculty of Sports, Universitas Sebelas Maret
  • Hanung Prasetya Study Program of Acupuncture, Health Polytechnics, Ministry of Health Surakarta



Background: Low Back Pain is the pain that is felt from the lower back area to the lower buttocks crease area (Gluteal inferior fold). One of the causes of Low Back Pain is a prolonged and excessive use of high heels. This study aims to analyze and estimate the effect of the use of high heels on Low Back Pain in sales promotion girls.

Subjects and Method: Meta-analyses were carried out according to the PICO model. Population: female sales promotion employee. Intervention: Wearing High Heels. Comparison: Not using High Heels. Outcome: Low Back Pain. The article search in this study was conducted through databases that included PubMed, Google Schoolar, ScienceDirect. The keywords included: "Low Back Pain" AND "Low Back Pain" AND "High Heels" AND "Low Back Pain" "Employee sales" AND "High Heels" "Sales Low Back Pain" (aOR) "Employee sales" And "Employe sales" "Low Back Pain" AND "High Heels" AND "Employe sales", "High Heels AND High Heels" "Low Back pain Employee Sales" AND "High Heels". Full-paper articles with cross-sectional study design. The subjects of the study were users of high heels toward low back pain, the measure of association used was the adjusted odd ratio. The article selection used was PRISMA flow diagram. The analysis was performed using Revman 5.3

Results: A meta-analyss included 10 cross-sectional studies from Africa and Asia. Prolonged use of high heels increased the risk of low back pain in female sales promotion employee (aOR= 1.41; 95% CI= 1.16 to 1.171 p=0.001).

Conclusion: Female sales promotion employee who wear high heels have a higher risk of experiencing low back pain.

Keywords: sales promotion girl, high heels, low back pain.

Fadhila Firmanurulita. Master’s Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: Mobile. +6285740045026.



Barnish MS, Barnish J (2016). High-heeled shoes and musculoskeletal injuries: a narrative systematic re-view. BMJ Open. Doi: 10.1136/-bmj¬open-2015-010053.

Güren HG, Kaygısız BB, Gözgen H (2020). Phy¬si¬cal Activity Level and Pain Inci¬dence in Women Wearing High Heel¬ed Shoes. J Med Sport. 16(2): 3252-3257.

Halimatusyadiah, Deta D (2018). Hubu-ngan penggunaan high heels dengan keluhan low back pain pada sales promotion girl di grand yogya kepatihan bandung. Jurnal Ilmia. (The relationship between the use of high heels and com¬plain¬ts of low back pain in sales promo¬tion girls at Grand Yogya Kepati¬han Bandung. Scientific Journal). JKA. 6(17). Doi:

Hoon J, One B, Yeon S, Sei J, Sang B (2021). Negative Impacts of Prolo-nged Standing at Work on Muscu-loskeletal Symptoms and Physical Fatigue: The Fifth Korea Working Conditions Suvery. Yonsei Med J. 2(6) 510-519. Doi: 10.3349/¬y¬m¬j.-20¬

Hylton B, Menz, Edward R, Michelle M, Martin J, Thomas, Trishna R, et al. (2016). Epidemiology of Shoe We-ar¬ing Patterns Over Time in Older Women: Associations With Foot Pain and Hallux Valgus. J Gerontol A Biol Sci Med Sci. 71(12):1682-1687. Doi: 10.1093/gerona/glw004

Jan S, Karsten H (2017). Effects of high-heeled footwear on static and dy¬na-mic pelvis position and lumbar lordosis in experienced younger and middle-aged women. Gait Pos-ture. 59:53-57. Doi: 10.1016/j.gait-post.2017.09.034

Jia Y, Jaon T, Duo W, Yan C, Ming Z (2013). Biomechanical simulation of high-heeled shoes donning and walking. Jbiomech. 1(8). Doi: org/-10.1016/l.jbiomech.2013.05.009.

Kim JY, Shin JS, Lim MS, Choi HG, Kim SK, Kang HT, Koh SB, et al., (2018). Relationship between si-mul¬ta¬¬neo¬us exposure to ergonomic risk fac¬tors and work-related lower back pain: a cross-sectional study based on the fourth Korean work¬ing con¬di¬tions survey. Ann Occup Environ Med. 30:58. Doi: 10.11¬86/¬s40557-018-0269-1.

Lee CM, Jeong EH, Freivalds (2001). Biomechanical Effects of Wearing High-Heeled Shoes. Int. J. Ind. Ergon. 28(1): 321-326. Doi: htt¬ps:-//

Lee JG, Kim GH, Jung SW, Kim SW, Lee JH, Lee KJ (2018). The association between long working hours and work-related musculoskeletal sym-p¬toms of Korean wage workers: data from the fourth Korean work-ing conditions survey (a cross-sec-tional study). Ann Occup Environ Med. 30:67. Doi: 10.1186/s40557-018-0278-0.

Maarouf MA (2015). The Impact of Wearing High Heels on Women’s Health and Attractiveness: A Field Study. Egypt. Int. j. basic appl. sci. 5(8):54-61.

Mariana PS (2010). Faktor-faktor mempengaruhi insidensi Nyeri Punggung Bawah (Low Back Pain) Pada Pasien rumah sakit Immanuel Bandung Periode Janurai- Desember 2009. Universitas Maranatha. (Factors Influencing the Incidence of Low Back Pain in Immanuel Bandung Hospital Patients in the Janurai-December 2009 Period. Maranatha University). Repository Maranatha.

Meskó N, Őry F, Csányi E, Juhász L, Szilágyi G, Lubics O, Putz Á, et al., (2021). Women Walk in High Heels: Lumbar Curvature, Dyna-mic Motion Stimuli and Attracti-veness. Int J Environ Res Public Health. 18(1):299. Doi: 10.3390/-ijerph18010299.

Mikolajewicz N, Komarova SV (2019). Meta-Analytic Methodology for Basic Research: A Practical Guide. Front Physiol. 10:203. Doi: 10.338-9¬/¬fp¬h¬ys.¬2019.00203.

Murti B (2018). Prinsip dan metode riset epidemiologi (5th ed). Master’s Program in Public Health Univer-sitas Sebelas Maret.

Negash NA, Tadele A, Jember Ferede A (2022). Prevalence and Associated Factors of Low Back Pain Among Healthcare Professionals at Uni-ver¬sity of Gondar Comprehensive and Specialized Hospital, North-west Ethiopia: Cross-Sectional Stu-dy. J Pain Res. 15:1543-1552. Doi: 10.2147/JPR.S351987.

Nikolakopoulou A, Chaimani A, Veroniki AA, Vasiliadis HS, Schmid CH, Salan¬ti G (2014). Characteristics of networks of interventions: a des-crip¬tion of a database of 186 Pub-lished Networks. PLoS ONE. 9(1). Doi: 10.1371/journal.¬pone.008¬675-4.

Park J, Kim Y (2020). Association of Ex-po¬sure to a Combination of Ergo-no¬mic Risk Factors with Muscu-loskeletal Symptoms in Korean Work¬ers. Int J Environ Res Public Health. 17(24):9456. Doi: 10.339-0/¬ijerph17249456.

Henderson P, State P,Piazza S. (2014). A Biomechanical Evaluation of standing in High-Heeled Shoes. Depertements of Kinesiology, Mechanical Engineering, Bioengineering, and Orthopedics and Reabilition Penn State. Forms Gradsch Pusu Edu.25-38.

Pratihast M, Al-Ani A, Chai R, Su S, Naik G (2018). Changes in lower limb muscle synchronisation during walking on high-heeled shoes. Healthc Technol Lett. 5(6):236-238. Doi: 10.1049/htl.2018.5032.

Rahmanto S, Rahim AF, Salampessy FAS (2021). Hubungan masa pemakai-an high heels terhadap nyeri otot gastrocnemius karyawan sales pro-motion girl di kota malang. (The relationship between the period of wearing high heels and pain in the gastrocnemius muscle of sales pro-motion girl employees in Malang City). Journal fisioterapi dan reha-bilitas. 5(1) 1-9. Doi: https://doi.-org/10.33660/jfrwhs.v5i1.120.

Sari SAAY (2017). Perbedaan Pengaruh Antara Transcutaneus Electical Nerve Stimulation (Tens) Dengan Terapi Massange Terhadap Penurunan Nyeri Pada Penderita Nyeri Punggung Bawah Non Spesifik. (Differences in Effect Between Transcutaneous Electrical Nerve Stimulation (Tens) and Massage Therapy on Pain Reduction in Patients with Non-Specific Low Back Pain). Jurnal Ilmu Kesehatan. 6(1):101-111. Doi: Org/10.37341/interest.93.

Shin JS, Seo K, Oh HJ, Lim M, Kang HT, Jeong KS, Koh SB, et al., (2021). Relationship between job rotation and work-related low back pain: a cross-sectional study using data from the fifth Korean working con-di¬tions survey. Ann Occup Environ Med. 33:e3. Doi: 10.35371/ao¬em.-20¬21.

Siddaway AP, Wood AM, Hedges LV (2019). How to Do a Systematic Re¬view: A Best Practice Guide for Conducting and Reporting Narra-tive Reviews, Meta-Analyses, and Meta-Syntheses. Annu Rev Psy-chol. 70:747-770. Doi: 10.1146/¬an-nu¬rev-psych-010418-102803.

Smallwood L, Adam J, Christoper W, Wedi W (2013). Influencee Of Heel Type on Stride Length. E-journal Aduburn University. Abuburn University. 1(1): 1-2.

Tomioka K, Shima M, Saeki K (2021). Occupational status and self-re-ported low back pain by gender: a nation-wide cross-sectional study among the general population in Japan. Environ Health Prev Med (26)111. Doi:¬10.11-86/s12199-021-01031-2.




How to Cite

Firmanurulita, F., Kristiyanto, A., & Prasetya, H. (2023). Meta-Analysis of the Effect of Prolonged Use of High Heels on Low Back Pain in Female Sales Employees. Journal of Epidemiology and Public Health, 8(4), 478–486.




Most read articles by the same author(s)

1 2 3 4 > >>