Kalie Holub knows she could sprain her ankle or cause a stress fracture when she puts on heels — but that doesn’t matter to her right now.

The senior studying international business and marketing said she feels powerful when she puts them on. She wore heels almost everyday of her summer internship with Sport Inspired in London, switching between the five pairs she brought. She even bought two more pairs while there.

“I didn’t mind,” she said.

With an extensive history, heels can still stand as a symbol of power and fashion, despite the pain and injury that can be associated with the heightened style.

A high heel can be defined in a variety of ways, depending on its style. For example, according to Steve Madden’s “Glossary of Shoe Types, Materials, and Construction,” stilettos have higher, thinner heels with the heel itself tapering in width toward the ground, although kitten heels are about 1 to 2 inches in height. Wedges are also classified as a high heel, though the sole covers the entire foot rather than just supporting the heel.

There is more that goes into the footwear than just simply slipping on a pair.

Dr. Jeff Russell is able to see the science behind the shoes. Russell is the director of Ohio University’s SHAPe (Science and Health in Artistic Performance) Clinic, working specifically with performing artists.

He works with dancers who use pointe shoes, a type of ballet footwear with a flat toe, which dancers stand directly on. That position, called en pointe, is the “farthest, most extreme position (a ballerina) can be when she’s pointing her foot.”

Slightly less extreme are two positions called demi-pointe and three-quarter pointe, which are both similar to the position the foot is in while wearing high heels, specifically stilettos — it is not directly on the toes, but on the heads of the metatarsals, or toe bones.

“Your entire weight is coming down through that foot, and it’s those metatarsals … that are taking much of that weight,” Russell said. “Over time, you can (develop) a stress fracture because you’re putting so much load on those foot bones, and the forces are transmitted up through the bones and (to) areas where (the bones) are weak.”

That position can cause the Achilles tendon to shorten, so Russell recommends stretching one’s feet after wearing heels so they do not remain that way permanently.

According to a study published by the University of Alabama at Birmingham in May 2015, more than 123,000 injuries related to wearing heels were treated across 100 emergency departments in the United States between 2002 and 2012 — with the highest affected age category being 20- to 29-year-olds.

Wearing heels makes it more difficult to balance, as the support surface is in a more peculiar shape than it would be in a pair of tennis shoes. The center of gravity also then is disrupted and “goes up and comes forward,” Russell said.

“Basically, your pelvis tips forward, and you have more lower back curvature than normal, and that can put a lot of stress on your lower back. It’s basically like walking downhill all the time,” Russell said. “So, if you think about walking downhill all the time, it can be very uncomfortable on your low back because you’re wanting to fall forward because you’re on a slope. … In order to keep yourself from falling forward, your body naturally responds by curving your lower back more to help stabilize you.”

And when it comes to actually going downhill — something that comes with the Athens terrain — Russell was pretty clear in his recommendations.

“Walking downhill in stiletto heels — that’s not a good plan,” Russell said. “You will wreck yourself.”

Russell said there should be an understanding of the science behind such extreme shoes, and he recommends paying attention to the pain caused by them, if it does occur.

“Your body has pain for a purpose,” Russell said. “It’s supposed to be a signal to you, and you’re supposed to listen to it. So, if something is a little uncomfortable because your shoes don’t fit right ... something that’s not a big problem — that’s one thing.

“But when you start having pain, that’s a signal you should listen to, and you need to do something about that and have yourself looked at by someone who understands the foot and the ankle and the injuries to it.”

Marissa Santiago-Meyers, a sophomore studying English and Spanish, said she has avoided pain by having her family teach her how to walk in high heels, rather than putting on her first pair of pumps right before a school dance.

“I was taught how to walk in them from a … younger (age),” she said, adding that she owns about 40 pairs of heels. “You definitely have to build up in height. My mom was super strict on that when we were growing up. We couldn’t get super tall ones when we were, like, 14. She made us go through the steps in the inches.”

Holub learned how to walk properly in heels by attending modeling etiquette school.

“We had to wear them eight hours a day,” she said.

Holub said that helped her learn how wear heels regularly. She wears heels now about three times a week.

Erika Peyton, assistant director for employer relations and marketing at the Career and Leadership Development Center at OU, said she likes to wear heels because she feels it dresses up an outfit. According to an article from the National Law Review, however, businesses cannot demand women wear heels unless the same expectation is given to men under Title VII of the Civil Rights Act. Under that, it is illegal to discriminate based on race, color, sex, religion or national origin.

When attending career fairs or interviews, the question may be whether or not to put on a pair of high heels to fit conservative, corporate standards. Peyton said dress codes all depend on the industry and type of company, but there is one thing for all applicants to keep in mind.

“What we recommend to students if they do chose to wear heels is it really should be something that you can comfortably walk in — they shouldn’t be a distraction,” Peyton said. “We always want the content of a student’s experience, the content of their character to be the focus, not the fact that they’re wearing heels that are an encumbrance.”

Finance and corporate law were two industries where Peyton said people generally dress “business professional,” which means suits are usually expected. But even in everyday dress outside of the office, heels are not the norm for most, and it has been that way since the '50s, said Trina Gannon, an adjunct instructor at OU with degrees in clothing and retail with a focus on history and anthropology.

Gannon said high heels started out as platform sandals, which royalty would wear. The shoes were intended to make the elite stand out, and throughout history, people would follow the standards set by royalty.

Gannon said although they might not be considered "high heels" in today's context, men's shoes — such as tennis shoes and dress shoes — even have added height.

“Women’s shoes became more of a focus of fashion during probably sometime in the late 1700s when women’s hemlines shortened a little bit,” Gannon said. “But when women’s hemlines lengthen, that’s when shoes become a little more plain, a little more dull.”

Heel height can also change in response to war and times of national conflict, such as the period following 9/11.

“In times of conflict, not only do women’s clothing become more subtle, but their shoe heel shortens,” Gannon said. “So, like in times of conflict, like in World War II, the heel was an average of 1 1/2- to 2-inches high. In the late ’90s, if you look at what was trending for women, it was stiletto high heels, the 4- or 5-inch heels; after 9/11, it went straight back down to 2-inch heels.”

The style today has transitioned back to higher heels and wedges. In Athens, specifically, business owners sell heels throughout the year. Marissa Whaley, store manager of Bluetique on West State Street, said the beginnings of Fall and Spring Semesters are when she most often sees people coming in to buy heels. The store’s most popular-selling heel depends on what is in style.

“Comfort is never really an option,” Whaley said of what customers want in a pair of heels. “It’s whatever looks cute with an outfit.”

April Almond, manager of The Other Place on Court Street, said the store tries not to stock particularly high heels. Lynsey Long, a sales associate at The Other Place, said the store sells a lot of TOMS wedges due to their comfort. Those can cost between $69 and $99 depending on the style.

Both Almond and Whaley said sorority recruitment during Fall Semester creates a higher demand for high heels. Lynne Francisco, owner and buyer for Figleaf on Court Street, said the college-aged demographic tends to be more geared toward trendy purchases.

Holub said she has experienced blisters when breaking in a new pair. However, Holub said when it comes to purchasing high heels, she buys higher-quality shoes, which she said makes the shoes more comfortable.

Even with the pain and the injuries associated, though, people still purchase and wear heels.

“I think a lot of women in general wear heels because it makes them hold themselves in a different way,” Gannon said. “It’s like an alternate personality-type thing. You go out at night, you’re a different person than you are during the day.”

Gannon said she started wearing heels more frequently when she started teaching, living by the old adage that she should “dress for the job you want, not the job you have.”

Santiago-Meyers said people should wear what makes them feel the best. For her, that is a pair of heels.

“You get more confidence, I think,” Santiago-Meyers said. “It just makes you feel all put-together. … I always feel way more confident in a pair of heels. It changes your walk. It changes the way you stand.”

And for Holub, it can be as simple as others knowing that she is passing by.

“I like the sound,” Holub said. “I like being taller.”

Development by: Hannah Debenham / Digital Production Editor

Illustrations via Thinkstock.com