Women get osteoarthritis at nearly twice the rate of men.  The knees are particularly vulnerable.  One reason women are more susceptible has to do with women’s body types.  (Show figures)  The angle of the neck of the femur (thigh bone) as it fits into the hip is much different than that of males.  Because of this angle, the way the thigh bone fits into the knee joint is slightly altered.  In other words, it puts more of the load of the body on the outer part of the knee cartilage.  Throughout this website, we talk about research showing how being overweight contributes to developing osteoarthritis and causes osteoarthritis to get worse over time.  One reason this appears to be especially so in women is the different angle of the thigh bone.  As more weight is put on the knee, the likelihood of getting osteoarthritis is greater.  In one study of OA in women, the authors measured these angles and concluded, “Our findings suggest that occurrence of medial or lateral OA has a biomechanical background originating from pelvis and hip anatomy.”

[Weidow, I, Mars, J, Kärrholm, J. Medial and lateral osteoarthritis of the knee is related to variations of hip and pelvic anatomy.  Osteoarthr Cart 2005;13(6): 471-477.]

There has been speculation for some time that high heels may also contribute to OA.

Time to Heel: Knee Osteoarthritis in Women

Why do twice as many women have arthritic knees than men? Harvard researchers think – "It's gotta' be the shoes."

PM&R physician D. Casey Kerrigan, MD, wanted to see if high heels played any part in the higher incidence of knee osteoarthritis in women. Kerrigan is an associate professor at Harvard Medical School, and director, Center for Rehabilitation Science, Spaulding Rehabilitation Hospital. She found that women who wear 2 ½ inch heels strain the joints, muscles, and tendons in their knees. That increased pressure on the knees is believed to lead to osteoarthritis, a painful joint disease that destroys the cartilage surrounding the knee. PM&R physicians treat osteoarthritis and say that by the time some patients feel its effects, a lot of damage has already been done.

Think you're saving yourself future pain by wearing "chunky" high heels instead of stilettos? Think again. Kerrigan and her research team recently went back into the lab to see if the width of the heel makes any difference. They found that wide-heeled women's dress shoes caused the same, if not greater, pressures on the knees as narrow-heeled shoes.

And because these shoes are more comfortable than stilettos, women tend to wear them longer, exposing their knees to even more strain.
Dr. Kerrigan sums up her research with a statement that won't go over well on the runways of New York and Paris, "Heels are bad, whether they are thin or wide. My recommendation is simple and unpopular - don't wear them."
http://www.aapmr.org/condtreat/pain/highheels.htm