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Zeng Z, Liu Y, Hu X, Li P, Wang L. Effects of high-heeled shoes on lower extremity biomechanics and balance in females: a systematic review and meta-analysis. BMC Public Health 2023; 23:726. [PMID: 37081521 PMCID: PMC10120101 DOI: 10.1186/s12889-023-15641-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 04/10/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND High-heeled shoes (HHS) are widely worn by women in daily life. Limited quantitative studies have been conducted to investigate the biomechanical performance between wearing HHS and wearing flat shoes or barefoot. This study aimed to compare spatiotemporal parameters, kinematics, kinetics and muscle function during walking and balance between wearing HHS and flat shoes or barefoot. METHODS According to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, PubMed Medline, Cochrane, EMBASE, CINAHL Complete and Web of Science databases were searched from the earliest record to December 2021. A modified quality index was applied to evaluate the risk of bias, and effect sizes with 95% confidence intervals were calculated as the standardized mean differences (SMD). Potential publication bias was evaluated graphically using funnel plot and the robustness of the overall results was assessed using sensitivity analyses. RESULTS Eighty-one studies (n = 1501 participants) were included in this study. The reduced area of support requires the body to establish a safer and more stable gait pattern by changing gait characteristics when walking in HHS compared with walking in flats shoes or barefoot. Walking in HHS has a slight effect on hip kinematics, with biomechanical changes and adaptations concentrated in the knee and foot-ankle complex. Females wearing HHS performed greater ground reaction forces earlier, accompanied by an anterior shift in plantar pressure compared with those wearing flat shoes/barefoot. Furthermore, large effect sizes indicate that wearing HHS resulted in poor static and dynamic balance. CONCLUSION Spatiotemporal, kinematic, kinetic and balance variables are affected by wearing HHS. The effect of specific heel heights on women's biomechanics would benefit from further research.
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Affiliation(s)
- Ziwei Zeng
- Key Laboratory of Exercise and Health Sciences (Shanghai University of Sport), Ministry of Education, Shanghai, China
| | - Yue Liu
- Key Laboratory of Exercise and Health Sciences (Shanghai University of Sport), Ministry of Education, Shanghai, China
| | - Xiaoyue Hu
- Key Laboratory of Exercise and Health Sciences (Shanghai University of Sport), Ministry of Education, Shanghai, China
| | - Pan Li
- Key Laboratory of Exercise and Health Sciences (Shanghai University of Sport), Ministry of Education, Shanghai, China
| | - Lin Wang
- Key Laboratory of Exercise and Health Sciences (Shanghai University of Sport), Ministry of Education, Shanghai, China.
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Hwang YT, Lee SH, Lin BS. Assessment System for Predicting Maximal Safe Range for Heel Height by Using Force-Sensing Resistor Sensors and Regression Models. SENSORS 2022; 22:s22093442. [PMID: 35591131 PMCID: PMC9103558 DOI: 10.3390/s22093442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023]
Abstract
Women often wear high-heeled shoes for professional or esthetic reasons. However, high-heeled shoes can cause discomfort and injury and can change the body’s center of gravity when maintaining balance. This study developed an assessment system for predicting the maximal safe range for heel height by recording the plantar pressure of participants’ feet by using force-sensing resistor (FSR) sensors and conducting analyses using regression models. Specifically, 100 young healthy women stood on an adjustable platform while physicians estimated the maximal safe height of high-heeled shoes. The collected FSR data combined with and without personal features were analyzed using regression models. The experimental results showed that the regression model based on the pressure data for the right foot had better predictive power than that based on data for the left foot, regardless of the module. The model with two heights had higher predictive power than that with a single height. Furthermore, adding personal features under the condition of two heights afforded the best predictive effect. These results can help wearers choose maximal safe high-heeled shoes to reduce injuries to the bones and lower limbs.
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Affiliation(s)
- Yi-Ting Hwang
- Department of Statistics, National Taipei University, New Taipei City 237303, Taiwan;
| | - Si-Huei Lee
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Correspondence: (S.-H.L.); (B.-S.L.)
| | - Bor-Shing Lin
- Department of Computer Science and Information Engineering, National Taipei University, New Taipei City 237303, Taiwan
- Correspondence: (S.-H.L.); (B.-S.L.)
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Perry TA, Dando C, Spector TD, Hart DJ, Bowen C, Arden N. Effect of Heeled Shoes on Joint Symptoms and Knee Osteoarthritis in Older Adults: A 5-Year Follow-Up Study. ACR Open Rheumatol 2021; 3:614-621. [PMID: 34288584 PMCID: PMC8449034 DOI: 10.1002/acr2.11298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Our aims were to examine the effects of heeled shoes on incident knee osteoarthritis (OA) and joint pain. METHODS We used longitudinal data from the Chingford 1000 Women Study (Chingford Study), a prospective cohort of women aged 50 years or older. Participants with musculoskeletal disorders and/or a history of knee-related injury/surgery were excluded. Participants were followed for up to 5 years for incident outcomes including 1) radiographic knee OA (RKOA) and 2) joint pain (feet, knees, hips, and back). Footwear data, including ever worn heels of 2 inches or more and daytime/evening hours (per week) spent wearing heeled shoes over five decades (ages <20 years, 20-30 years, 30-40 years, and >50 years), were available at Year 10 whereas knee radiographs and joint symptom data were also collected at Year 15. Cumulative time spent wearing heeled shoes was calculated for women reporting ever-use of heeled shoes (≥2 inches). Multiple logistic regression was used to examine the relationship between exposures and outcomes (from Year 10 to Year 15). RESULTS A total of 356 women were eligible at Year 10 with a median (interquartile range) age of 60 (56-65) years. Compared with non-use, ever-use of heeled shoes (≥2 inches) was not associated with incident RKOA (1.35; 95% confidence interval: 0.56-3.27). No associations were observed between increasing cumulative time spent wearing heels and incident outcomes. CONCLUSION Compared with the non-use of heeled shoes, ever-use of heels (≥2 inches) was not associated with incident RKOA and incident joint symptoms. Further, increasing cumulative time spent wearing heels was not associated with any of our outcomes.
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Affiliation(s)
| | | | | | | | | | - Nigel Arden
- University of Oxford, Oxford, United Kingdom, and University of Southampton, Southampton, United Kingdom
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Abstract
Introduction Women with lower limb loss represent a relevant and growing patient cohort with unique rehabilitation needs. These needs are emphasized in a growing body of literature and the most recent Veteran Affairs/Department of Defense clinical practice guidelines. Prosthetics Challenges Women with limb loss experience greater dissatisfaction with prosthetic fit, appearance, and types of footwear they can use. There is a lack of prosthetics solutions to accommodate the desire of women to wear different footwear varieties, including high heels. The choice to wear a variety of footwear is important to attire and hence community participation. Despite these recognized challenges, women are still underserved in prosthetics research, which limits available information to guide the rehabilitation process. Research Initiatives This narrative review describes considerations of lower limb prosthesis prescription and use by women, and examples of current research to address these topics. Research efforts are beginning to explore factors that contribute to prosthetics prescription for women, and design creative prosthetics solutions to expand the range of available footwear options. Research is still needed to characterize the types of footwear women with limb loss prefer to use, and the effects of prosthesis designs, footwear, and lower limb loss on women mobility outcomes and community participation. Conclusions Through targeted research initiatives, scientists and clinicians can be responsive to the specific needs of women to provide evidence-based guidelines for prosthetics prescription and improve the patient-centered care after limb loss.
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A preliminary study on the influence of high heel footwear on lumbar spine proprioception. BIOMEDICAL HUMAN KINETICS 2020. [DOI: 10.2478/bhk-2020-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Summary
Study aim: High heel footwear (HHF) alters posture and kinetics of the lower limbs and spine. Various musculoskeletal disorders in the lower quadrant can occur as a consequence of HHF use. This study aimed to investigate the effect of habitual use of HHF on lumbar spine proprioception.
Material and methods: Thirty young healthy women (mean age: 21.6 ± 1.6 years; height: 157.6 ± 5.9 cm; weight: 57 ± 10.2 kg) participated in this study. Participants were randomly allocated to one of the two sequences of walking with HHF or walking barefoot for five minutes on a predetermined walkway consisting of an even surface, ramp and stairs. A 24-hour washout period was incorporated between each walking condition. Lumbar spine repositioning error was measured using a Back Range of Motion II (BROM II) device before and after walking for lumbar spine forward flexion, right, and left lateral flexion.
Results: Measurements showed that repositioning error was significantly higher in all spinal movements after walking with HHF (forward flexion p = 0.0044; right lateral flexion p = 0.0243 left lateral flexion p = 0.0379) as compared to barefoot walking.
Conclusion: The findings of this study suggest that HHF alters lumbar spine proprioception. This study provides evidence to support early assessment of proprioception and incorporation of retraining exercises in habitual users of HHF.
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Shang J, Chen L, Zhang S, Zhang C, Huang J, Wang X, Yan A, Ma X. Influence of high-heeled shoe parameters on biomechanical performance of young female adults during stair ascent motion. Gait Posture 2020; 81:159-165. [PMID: 32738740 DOI: 10.1016/j.gaitpost.2020.07.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND High-heeled shoes are currently preferred by women due to contemporary aesthetics. However, high-heeled shoes may increase the effort required to ascend stairs and, hence, alter biomechanical performance. RESEARCH QUESTION How do high-heel shoe parameters affect the pelvis position, lower extremities kinematics, and ground reaction force in young women during stair ascent motion? METHODS Stair ascent experiments were performed with 20 healthy adult women. The participants were instructed to ascend a 3-step staircase, wearing heeled shoes of different heel heights and heel types and one pair of flat shoes as the control group. Changes in lower body biomechanics were analyzed with kinematics and ground reaction force variables collected from the dominant limb. A two-way repeated ANOVA was performed to determine which variables were affected by heel type and which were affected by heel height or a combination of both. RESULTS As the heel height increased, an increased range of ankle dorsiflexion-plantarflexion, as well as pelvic rotation, was observed(P = 0.039 and P = 0.003, respectively). A thinner heel type displayed a larger pelvic forward tilt movement(P = 0.026)and 1st peak vertical force(P = 0.025), as well as a smaller 2nd peak vertical force (P = 0.002). With high heels, increased external rotation of the knee, inversion and plantar flexion, and flexion values of the knee were observed. We also observed decreased external rotation of the pelvis, ankle eversion, varum, and dorsiflexion. SIGNIFICANCE To stabilize body posture during stair ascent motion with high-heeled shoes, compensatory response including increasd pelvic range of motion and changing the joint angles of the lower extremities.
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Affiliation(s)
- Jiangyinzi Shang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | | | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Alan Yan
- Foot and Ankle Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
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Fu K, Metcalf BR, Bennell KL, Zhang Y, Gross KD, Mills K, Deveza LA, Robbins SR, Hunter DJ. Is Heel Height Associated with Pain Exacerbations in Hip Osteoarthritis Patients?-Results from a Case-Crossover Study. J Clin Med 2020; 9:jcm9061872. [PMID: 32560086 PMCID: PMC7356907 DOI: 10.3390/jcm9061872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 12/29/2022] Open
Abstract
The etiology of osteoarthritis (OA) pain exacerbations is not well understood. The purpose of this study is to evaluate the association of heel height and duration of wearing shoes with higher heels with pain exacerbations in people with hip OA. Eligible participants with symptomatic hip OA were instructed to complete online questionnaires every 10 days over a 90-day follow-up period. They were required to complete the questionnaire whenever they were experiencing hip pain exacerbation. Of 252 participants recruited, 137 (54.4%) contributed both case and control period data, and were included in the analysis. Wearing shoes with a heel height ≥ 2.5 cm during the past 24 h was associated with lower odds of pain exacerbations (OR: 0.54, 95% CI: 0.30 to 0.99). A longer duration (>6 h) of wearing shoes with heel height ≥ 2.5 cm was also associated with a lower risk of hip pain exacerbations (p for linear trend = 0.003). Wearing shoes with heel height ≥ 2.5 cm and longer duration in the past 24 h may be protective against hip pain exacerbations in people with symptomatic hip OA. Given the observational study nature, it would be prudent for this to be replicated in an independent data set.
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Affiliation(s)
- Kai Fu
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW 2065, Australia; (L.A.D.); (S.R.R.); (D.J.H.)
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW 2065, Australia
- Correspondence: ; Tel.: +61-468476117; Fax: +61-2-9463-1077
| | - Ben R. Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, VIC 3053, Australia; (B.R.M.); (K.L.B.)
| | - Kim L. Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, VIC 3053, Australia; (B.R.M.); (K.L.B.)
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA 02115, USA;
| | - K. Douglas Gross
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA 02129, USA;
| | - Kathryn Mills
- Department of Health Professions, Macquarie University, Sydney, NSW 2109, Australia;
| | - Leticia A. Deveza
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW 2065, Australia; (L.A.D.); (S.R.R.); (D.J.H.)
| | - Sarah R. Robbins
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW 2065, Australia; (L.A.D.); (S.R.R.); (D.J.H.)
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW 2065, Australia
| | - David J. Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW 2065, Australia; (L.A.D.); (S.R.R.); (D.J.H.)
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW 2065, Australia
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Everyday footwear: An overview of what we know and what we should know on ill-fitting footwear and associated pain and pathology. Foot (Edinb) 2019; 39:11-14. [PMID: 30851650 DOI: 10.1016/j.foot.2019.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 02/04/2023]
Abstract
Footwear has been used to protect feet for millennia with socially exclusive population adopting stylish and fashionable shoes with expensive materials. In terms of historic timeline, only more recently footwear has been worn by all classes in the western world as an integral part of their apparel. Traditionally, footwear has been constructed from natural materials, mainly leather, but has recently benefitted from the flexibility that technology has provided with a plethora materials and new design innovations. Although it has expanded the availability for a variety of consumers, the choice and fit continue to be problematic with many individuals wearing shoes that are ill-fitting. Provision of specific footwear advice for problem feet is poorly evidenced and is heavily practitioner dependant limiting its efficacy. There is limited understanding as to the changes that can occur from regularly wearing footwear that is unsuitable in shape, style and construction which is referred to as ill-fitting. Current research on the effect that everyday footwear has on foot function and pain focuses mainly on women's shoes, particularly high heels. Defining what is a good fitting shoe, that does not damage the foot or mechanics of walking, may need to be individualised, but best fit is based on loose historical parameters rather than research evidence. The aim of this overview is to highlight aspects of current research, establishing what is known about the effect's shoes have on the feet as well as exploring the mythology around footwear fit and advice that is often historical in nature.
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Kannan P, Fung B, Leung RW, Goonetilleke R, Winser SJ. Association between high-heeled shoes of varied heel height and bladder neck elevation in women: an exploratory study. FOOTWEAR SCIENCE 2019. [DOI: 10.1080/19424280.2019.1588922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | | | | | - Stanley J. Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Ultrasonographic Evaluation of the Femoral Cartilage, Achilles Tendon, and Plantar Fascia in Young Women Wearing High-Heeled Shoes. PM R 2019; 11:613-618. [PMID: 30217643 DOI: 10.1016/j.pmrj.2018.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Specific attention on the musculoskeletal impact of wearing high-heeled shoes (HHS) has mainly focused on knee osteoarthritis and the literature is limited to biomechanical changes. The distal femoral cartilage has not been morphologically studied. Additionally, although heel elevation is coupled with a shear stress at the heel and overloaded calf muscles, Achilles tendon (AT) and plantar fascia (PF) thicknesses have not been assessed either. OBJECTIVE To investigate whether the distal femoral cartilage, AT, and PF were different in women wearing HHS and flat-heeled shoes (FHS) and specifically, different in terms of AT/PF and distal femoral cartilage thicknesses. DESIGN Cross-sectional observational study. SETTING Tertiary care center. PARTICIPANTS There were 34 women (mean age; 31.1 ± 6.4, body mass index [BMI]; 21.6 ± 2.4 kg/m2 ) in the HHS group and 54 women (mean age; 29.5 ± 7.2 years, BMI 22.5 ± 2.9 kg/m2 ) in the FHS group (P = .271, P = .102, respectively). Women wearing shoes with a heel height of >5 cm were enrolled in the HHS group, and those wearing shoes with a heel height of <1.4 cm were included in the FHS group. MAIN OUTCOME MEASUREMENTS Distal femoral cartilage from the lateral condyle, intercondylar area and medial condyle (MFC), AT and PF thicknesses, and any abnormalities were evaluated bilaterally by ultrasound. RESULTS Within-group comparisons yielded thicker right MFC (P = .022) and left AT (P = .028) only in the HHS group. Between-group comparisons yielded thicker left AT in the HHS group (P = .040). PF thicknesses were similar both within and between group comparisons (all P > .05). Right AT thickness was positively correlated with right (r = .469, P = .005) and left (r = .402, P = .018) PF thicknesses only within the HHS group. Only calcaneal irregularity/spur was found to be common in the HHS group (P = .038). CONCLUSIONS We found thickening of the right MFC and left AT in those wearing HHS, whereas PF thickness was not significantly different between those wearing HHS and those wearing FHS. LEVEL OF EVIDENCE III.
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11
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Vitton V, Luciano L, Ortiz S, Baumstarck K, Bouvier M. Can wearing high heels influence anal canal pressure and the severity of fecal incontinence? Int Urogynecol J 2019; 30:2049-2054. [PMID: 30796476 DOI: 10.1007/s00192-019-03902-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/05/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Wearing high heels may not only produce deleterious effects on the musculoskeletal system and on the general posture, but also on the activity of pelvic floor muscles. However, no data are currently available concerning the link between fecal incontinence and wearing high heels. Our aim was to determine whether wearing high-heeled shoes could influence anal canal pressure values in patients suffering from fecal incontinence. METHODS In this retrospective monocentric study, 338 female patients were included. Clinical data, including the Wexner score, and manometric data were recorded (using 3D high-resolution anorectal manometry). Wearing high heels was defined by the use of high-heeled shoes at least four times a week for 4 consecutive hours with at least 1 year of usage time and heels ≥3 cm. Two sub-groups were defined: "high heels" vs "no high heels." RESULTS The two subgroups were comparable for clinical data, including Wexner score, except for a higher age, menopause and hormone replacement therapy, and urinary incontinence in the group with "high heels." No statistical difference was observed concerning the anal canal pressure. Using analysis by logistic regression, only age was related to a significantly lower resting pressure. CONCLUSIONS In this retrospective cohort of women with fecal incontinence, no clinical or manometric differences were observed between women who wore high heels versus those who did not. Because there is limited knowledge on this potential link and because the pelvic tilt may vary according to age and the habit of walking with high heels, further studies are necessary.
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Affiliation(s)
- Veronique Vitton
- Service de Gastroentérologie, CHU Nord, Aix-Marseille Université, Marseille, France
| | - Laure Luciano
- Department of Gastroenterology, Instruction Hospital of French Army Laveran, Marseille, France. .,Department of Gastroenterology, French Military Hospital Laveran, 13384, Marseille Cedex, France.
| | - Sandra Ortiz
- Service de Gastroentérologie, CHU Nord, Aix-Marseille Université, Marseille, France
| | - Karine Baumstarck
- EA3279 Self-perceived Health Assessment Research Unit, University Hospital, Aix-Marseille Université, APHM, Marseille, France
| | - Michel Bouvier
- Service de Gastroentérologie, CHU Nord, Aix-Marseille Université, Marseille, France
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Russell Esposito E, Lipe DH, Rábago CA. Creative prosthetic foot selection enables successful ambulation in stiletto high heels. Prosthet Orthot Int 2018; 42:344-349. [PMID: 29189099 DOI: 10.1177/0309364617741937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Walking in high heels presents biomechanical challenges, yet they remain part of many women's attire. However, women with a lower limb amputation are limited in available footwear options. Case description and methods: This case study is in response to one patient's assertion that she walked better and more symmetrically in heels than flat shoes with her below-knee prosthesis. She underwent gait analysis in athletic shoes and 10-cm stiletto high heels worn with a pediatric running foot to determine if these claims could be substantiated through biomechanical measures. Global gait asymmetry indices were calculated. Findings and outcomes: Asymmetry indices were nearly identical between athletic shoes and heels but joint-level findings differed substantially. Ankle mechanics were more symmetrical in heels but hip mechanics were less. CONCLUSION The maintenance of symmetry in stiletto high heels does not imply maintenance of gait quality, as high heels are known to adversely affect some components walking mechanics. Clinical relevance Returning to high-heel wear is achievable for prosthesis users. Accommodations can be made using creativity in prosthetic foot selection to enable successful ambulation; however, attention to gait mechanics may be important for patient safety.
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Affiliation(s)
- Elizabeth Russell Esposito
- 1 Center for the Intrepid, Brooke Army Medical Center, Fort Sam Houston, TX, USA.,2 Extremity Trauma and Amputation Center of Excellence, San Antonio, TX, USA
| | - Delbert H Lipe
- 1 Center for the Intrepid, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Christopher A Rábago
- 1 Center for the Intrepid, Brooke Army Medical Center, Fort Sam Houston, TX, USA.,2 Extremity Trauma and Amputation Center of Excellence, San Antonio, TX, USA
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Walking variations in healthy women wearing high-heeled shoes: Shoe size and heel height effects. Gait Posture 2018; 63:195-201. [PMID: 29772495 DOI: 10.1016/j.gaitpost.2018.04.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/05/2018] [Accepted: 04/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of high heels is widespread in modern society in professional and social contests. Literature showed that wearing high heels can produce injurious effects on several structures from the toes to the pelvis. No studies considered shoe length as an impacting factor on walking with high heels. RESEARCH QUESTION The aim of this study is to evaluate walking parameters in young healthy women wearing high heels, considering not only the heel height but also the foot/shoe size. METHODS We evaluate spatio-temporal, kinematic and kinetic data, collected using a 8-camera motion capture system, in a sample of 21 healthy women in three different walking conditions: 1) barefoot, 2) wearing 12 cm high heel shoes independently from shoe size, and 3) wearing shoes with heel height based on shoe size, keeping the ankles' plantar flexion angle constant. The main outcome measures were: spatio-temporal parameters, gait harmony measurement, range of motion, flexion and extension maximal values, power and moment of lower limb joints. RESULTS Comparing the three walking conditions, the Mixed Anova test, showed significant differences between both high heeled conditions (variable and constant height) and barefoot in spatio-temporal, kinematic and kinetic parameters. SIGNIFICANCE Regardless of the shoe size, both heeled conditions presented a similar gait pattern and were responsible for negative effects on walking parameters. Considering our results and the relevance of the heel height, further studies are needed to identify a threshold, over which it is possible to observe that wearing high heels could cause harmful effects, independently from the foot/shoe size.
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Wiedemeijer MM, Otten E. Effects of high heeled shoes on gait. A review. Gait Posture 2018; 61:423-430. [PMID: 29475153 DOI: 10.1016/j.gaitpost.2018.01.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Walking in high heels (HH) may alter gait in various ways, which may be of importance to designers and physicians. RESEARCH QUESTION How does walking in high heels alter gait and how can this be explained from a biomechanical and control point of view. METHODS Relevant literature has been collected in which high heeled walking was studied, after which the results were bundled and interpreted in a framework of biomechanics and control. RESULTS Major changes were found in the rollover function of the feet, the ankle and knee joints and the lower back, while step length and balance were compromised. An increase in heel height forces the foot in an increased plantar flexion, which in its turn increases knee flexion and lordosis of the lower back. All changes can be related with each other in a plausible pattern of movement and control.
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Affiliation(s)
- M M Wiedemeijer
- Center for Human Movement Sciences, University Medical Center Groningen, Groningen, The Netherlands.
| | - E Otten
- Center for Human Movement Sciences, University Medical Center Groningen, Groningen, The Netherlands
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Lee KJ, Lee HS. Effects of Core Stabilization Exercise on the Dynamic Stability in Young Aged Women Wearing Heeled Shoes. THE ASIAN JOURNAL OF KINESIOLOGY 2018. [DOI: 10.15758/ajk.2018.20.1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Schroeder J, Hollander K. Effects of high-heeled footwear on static and dynamic pelvis position and lumbar lordosis in experienced younger and middle-aged women. Gait Posture 2018; 59:53-57. [PMID: 28987767 DOI: 10.1016/j.gaitpost.2017.09.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 08/25/2017] [Accepted: 09/26/2017] [Indexed: 02/02/2023]
Abstract
There is still conflicting evidence about the effect of high-heeled footwear on posture, especially if methodological confounders are taken into account. The purpose of this study was to investigate the effect of high-heeled footwear on lumbopelvic parameters in experienced younger and middle-aged women while standing and walking. Thirty-seven experienced younger (n=19:18-25 years) and middle-aged (n=18:26-56 years) women were included in this randomized crossover study. Using a non-invasive back shape reconstruction device (rasterstereography), static (pelvic tilt and lumbar lordosis angle) and dynamic (pelvic rotation, median lumbar lordosis angle and range of motion) parameters representing pelvis position and lumbar curvature were measured. In order to analyse standing and walking on a treadmill (0.83m/s), the effects of high-heels (7-11cm) were compared to standard control shoes. There were no effects on the lumbar lordosis angle or range of motion under static or dynamic conditions (p>0.05, d≤0.06). But there was a small effect for a reduced pelvic tilt (p=0.003, d=0.24) and a moderate effect for an increased transversal pelvic rotation (p=0.001, d=0.63) due to high heel shoed standing or walking, respectively. There were no significant age-group or interaction effects (p>0.05). Altered pelvic parameters may be interpreted as compensatory adaptations to high-heeled footwear rather than lumbar lordosis adaptations in experienced wearers. The impact of these findings on back complaints should be revisited carefully, because muscular overuse as well as postural load relieving may contribute to chronic consequences. Further research is necessary to examine clinically relevant outcomes corresponding to postural alterations.
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Affiliation(s)
- Jan Schroeder
- Department of Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, Germany.
| | - Karsten Hollander
- Department of Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, Germany
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Aspiring to have the looks of a celebrity: young girls' engagement in appearance management behaviors. Eur J Pediatr 2017; 176:857-863. [PMID: 28497279 DOI: 10.1007/s00431-017-2918-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/20/2016] [Accepted: 04/27/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Research suggests that sexualizing media messages are present in teen media and negatively affect young girls' body image. Yet, it is unknown whether exposure to teen television programs is associated with girls' engagement in appearance management behaviors. Two-wave longitudinal data among 785 girls (Mage = 11.65 years) were collected. Results show that teen television exposure was longitudinally related to appearance management, while the reverse relation was not supported. Approximately half of the girls indicated to manage their appearance to some extent, and 13- to 14-year-old girls were more likely to invest in their appearance than younger girls. Thirty percent of those who did not manage their appearance at the start of the study indicated to have initiated appearance management 6 months later. Frequent viewers were four times, three times, and twice as more likely to style their hair, wear heels, and apply make-up compared to non-viewers. CONCLUSION The current study showed that teen media exposure plays a role in young girls' appearance management. The findings point to a need to teach young girls about stereotypical messages in media content directed towards them. Prevention efforts should focus on girls who frequently watch teen media. What is Known: • Sexualizing media messages are present in teen media. • Gender identity development is one of the key tasks during adolescence. What is New: • Tween television exposure predicts 9- to 14-year-old girls' engagement in appearance management over time. • Engagement in appearance management behaviors did not predict 9- to 14-year-old girls' exposure to tween television programs.
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Chien HL, Lu TW. Effects of shoe heel height on the end-point and joint kinematics of the locomotor system when crossing obstacles of different heights. ERGONOMICS 2017; 60:410-420. [PMID: 27153344 DOI: 10.1080/00140139.2016.1175672] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
High-heeled shoes increase the risk of falling during walking, especially in the presence of obstacles. The study aimed to compare the end-point (foot/shoe) trajectories and joint angles of the lower extremities in 12 healthy females crossing obstacles of different heights while barefoot and when wearing narrow-heeled shoes (heel heights: 3.9, 6.3 and 7.3 cm). During obstacle-crossing, young females in narrow-heeled shoes maintained the same leading toe-clearance as when barefoot, irrespective of the heel height, primarily through increased plantarflexion of the leading swing ankle. However, the shoe heel-clearance was significantly reduced when compared with barefoot, presumably related to the difficulty in precisely sensing the position of the shoe-heel tip. With an increasing obstacle height, the toe-clearance, heel-clearance and shoe heel-clearance were reduced linearly, indicating an increasing risk of tripping over the obstacle. The results will be helpful for the design and development of strategies to reduce the risk of falling when wearing narrow-heeled shoes. Practitioner Summary: Knowledge of the influence of narrow-heeled shoes and obstacles on lower limb joint and end-point kinematics helps in shoe design to address fall risks. Compared to barefoot, narrow-heeled shoes reduced shoe heel-clearances, which were further reduced linearly with increasing obstacle height, indicating an increasing risk of tripping over the obstacle.
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Affiliation(s)
- Hui-Lien Chien
- a Institute of Biomedical Engineering , National Taiwan University , Taipei City , Taiwan, ROC
| | - Tung-Wu Lu
- a Institute of Biomedical Engineering , National Taiwan University , Taipei City , Taiwan, ROC
- b Department of Orthopaedic Surgery, School of Medicine , National Taiwan University , Taipei , Taiwan, ROC
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Influence of high-heeled shoes on the sagittal balance of the spine and the whole body. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3658-3665. [PMID: 27206516 DOI: 10.1007/s00586-016-4621-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/27/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Wearing high heels is associated with chronic pain of the neck, lower back and knees. The mechanisms behind this have not been fully understood. The purpose of this study was to investigate the influence of high-heeled shoes on the sagittal balance of the spine and the whole body in non-habitual wearers of high heels. METHODS Lateral standing whole body low-dose radiographs were obtained from 23 female participants (age 29 ± 6 years) with and without high heels and radiological parameters describing the sagittal balance were quantified. These were analyzed for differences between both conditions in the total sample and in subgroups. RESULTS Standing in high heels was associated with an increased femoral obliquity angle [difference (Δ) 3.0° ± 1.7°, p < 0.0001], and increased knee (Δ 2.4° ± 2.9°, p = 0.0009) and ankle flexion (Δ 38.7° ± 3.4°, p < 0.0001). The differences in C7 and meatus vertical axis, cervical and lumbar lordosis, thoracic kyphosis, spino-sacral angle, pelvic tilt, sacral slope, and spinal tilt were not significant. Individuals adapting with less-than-average knee flexion responded to high heels by an additional increase in cervical lordosis (Δ 5.8° ± 10.7° vs. 1.8° ± 5.3°). CONCLUSIONS In all participants, wearing high heels led to increased flexion of the knees and to more ankle flexion. While some participants responded to high heels primarily through the lower extremities, others used increased cervical lordosis to adapt to the shift of the body's center of gravity. This could explain the different patterns of pain in the neck, lower back and knees seen in individuals wearing high heels frequently.
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Farrag A, Elsayed W. Habitual Use of High-Heeled Shoes Affects Isokinetic Soleus Strength More Than Gastrocnemius in Healthy Young Females. Foot Ankle Int 2016; 37:1008-16. [PMID: 27162223 DOI: 10.1177/1071100716649172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Habitual use of high-heeled shoes (HHS) has been reported to negatively impact different body structures. However, few studies have investigated its effect on plantarflexor performance. The aim of this study was to investigate the effect of habitual wear of HHS and knee joint position (to isolate the function of the gastrocnemius) on the isokinetic performance of the plantarflexors and ankle joint range of motion (ROM). METHODS A high-heel (HH) group included 12 women (25.4 ± 4.8 y) who have been wearing HHS for ≥40 hours/wk and for at least a year. A control group (CTRL) had 12 women (21.3 ± 0.5 y) who have occasionally been wearing HHS for <10 hours/wk. Participants performed isokinetic (60 degrees/s) plantarflexion movements through a range set between 15 degrees dorsiflexion and 30 degrees plantarflexion. Ankle joint ROM and average peak plantarflexion torque and power were recorded in 2 knee joint positions, extension and 90 degrees flexion. RESULTS Overall, torque was significantly affected by knee position (P = .04) and habitual use of HHS (P < .001), whereas power was impacted by knee position only (P < .001). Within each group, flexing the knee reduced isokinetic measurements. However, the reduction was greater for the HH group (torque: 54 Nm, power: 35.6 W) compared with the CTRL group (torque: 42 Nm, power: 32.5 W). Ankle joint ROM was significantly different between groups in knee flexion only. CONCLUSION Flexing the knee limited the plantarflexor muscular performance and the limitation was more significant in habitual users of HHS compared to nonusers. Thus, it is concluded that habitual use of HHS impacts the contractile properties of soleus more than gastrocnemius. CLINICAL RELEVANCE The soleus is important for walking and anterior cruciate ligament protection. Thus, HHS users could be susceptible to injury and may need longer and more intensive posttraumatic rehabilitation. Therefore, clinicians should consider knee position when examining the plantarflexors of habitual HHS users.
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Affiliation(s)
- Ahmed Farrag
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Walaa Elsayed
- Department of Physical Therapy, College of Applied Medical Sciences, University of Dammam, Dammam, Saudi Arabia
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Effects of duration of wearing high-heeled shoes on plantar pressure. Hum Mov Sci 2016; 49:196-205. [PMID: 27428595 DOI: 10.1016/j.humov.2016.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 05/27/2016] [Accepted: 06/11/2016] [Indexed: 11/23/2022]
Abstract
In the present study we investigated the effects of different durations of using high-heeled shoes on plantar pressure and gait. A questionnaire survey and dynamic plantar pressure measurements were performed in 20 control females and 117 females who had worn high-heeled shoes for a long time. According to the duration of using high-heeled shoes (as specified in the questionnaire), subjects were divided into a control group and five groups with different durations of use (i.e. <2years, 2-5years, 6-10years, 11-20years and >20years). Parameters, including peak pressure, impulse and pressure duration, in different plantar regions were measured with the Footscan pressure plate. The 2-5years group had smaller midfoot contact areas for both feet and higher subtalar joint mobility, while the 6-10years group had larger midfoot contact areas for both feet and prolonged foot flat phase during gait. The peak pressure and impulse under the second and fourth metatarsus were increased with the prolonged wearing of high-heeled shoes, and the pressure and impulse under the midfoot were substantially reduced in the 2-5years group. The findings suggest that long-term use of high-heeled shoes can induce changes in arch morphology: the longitudinal arch tends to be elevated within 2-5years; the longitudinal arch tends to be flattened within 6-10years; and the forefoot latitudinal arch tends to collapse in more than 20years.
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Park K, Kim Y, Chung Y, Hwang S. Effects of the height of shoe heels on muscle activation of cervical and lumbar spine in healthy women. J Phys Ther Sci 2016; 28:956-9. [PMID: 27134392 PMCID: PMC4842473 DOI: 10.1589/jpts.28.956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effects of different height of
high heels on muscle activation of the paraspinalis cervicis and erector spinae in healthy
young women. [Subjects and Methods] Thirteen healthy women were recruited in this study.
To examine the effects of different heights of heels on muscle activation, the
paraspinalis cervicis (cervical spine) and erector spinae (lumbar spine) were measured at
the time of heel strike and toe off during gait on three different conditions (barefoot,
4 cm high heels, and 10 cm high heels). There are no previous trials or reports that have
evaluated this approach in patients with chronic neck pain. [Results] A significant
increase in muscle activation of the paraspinalis cervicis and erector spinae at heel
strike and toe off (except that of the paraspinalis cervicis at toe off in healthy
subjects) was observed in the under 10 cm high heel condition as, compared to that with
barefoot condition, in all the subjects. [Conclusion] The height of the high heels affects
to the activation demand of the paraspinalis cervicis and erector spinae in patients with
neck pain.
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Affiliation(s)
- Kisu Park
- Department of Physical Therapy, The Graduate School, Sahmyook University, Republic of Korea
| | - Young Kim
- Department of Physical Therapy, The Graduate School, Sahmyook University, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health and Science, Sahmyook University, Republic of Korea
| | - Sujin Hwang
- Department of Physical Therapy, Division of Health, Baekseok University, Republic of Korea
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Moore JX, Lambert B, Jenkins GP, McGwin G. Epidemiology of High-Heel Shoe Injuries in U.S. Women: 2002 to 2012. J Foot Ankle Surg 2015; 54:615-9. [PMID: 25977152 DOI: 10.1053/j.jfas.2015.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Indexed: 02/03/2023]
Abstract
The purpose of the present study was to investigate the epidemiology of high-heel-related injuries among a nationally representative population of women in the United States and to analyze the demographic differences within this group. The data used in the present study were collected from the Consumer Product Safety Commission's National Electronic Injury Surveillance System. A total of 3294 injuries, representing an estimated 123,355 high-heel-related injuries, were treated in emergency departments within the United States from 2002 to 2012. The overall rate of high-heel-related injuries for the study was 7.32 per 100,000 females (95% confidence interval 7.08 to 7.56). The injury rate was greatest for young adult females, with the greatest rates observed for those aged 20 to 29 years (18.38 per 100,000 females) and those aged 30 to 39 years (11.07 per 100,000 females). The results from the present study suggest that high-heel-related injuries have nearly doubled during the 11-year period from 2002 to 2012. Injuries from high heels are differential by body region, with most injuries occurring as sprains and strains to the foot and ankle. Although high heels might be stylish, from a health standpoint, it could be worthwhile for females and those interested in wearing high heels to understand the risks of wearing high-heeled shoes and the potential harm that precarious activities in high-heeled shoes can cause. The results of the present study can be used in the development of a prospective cohort study to investigate the risk of injury from high-heeled shoes, accounting for the exposure time and studying differences in demographics (e.g., age and race).
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Affiliation(s)
- Justin Xavier Moore
- Research Assistant, Department of General Surgery, Division of Trauma and Burns, and Departments of Epidemiology and Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL.
| | - Brice Lambert
- Research Assistant, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Gabrielle P Jenkins
- Research Assistant, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Gerald McGwin
- Professor and Vice Chairman, Department of General Surgery, Division of Trauma and Burns, Department of Epidemiology, and Center of Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL
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Meier MR, Tucker KA, Hansen AH. Development of inexpensive prosthetic feet for high-heeled shoes using simple shoe insole model. ACTA ACUST UNITED AC 2015; 51:439-50. [PMID: 25019666 DOI: 10.1682/jrrd.2013.01.0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 11/07/2013] [Indexed: 11/05/2022]
Abstract
The large majority of prosthetic feet are aimed at low-heeled shoes, with a few models allowing a heel height of up to 5 cm. However, a survey by the American Podiatric Medical Association indicates that most women wear heels over 5 cm; thus, current prosthetic feet limit most female prosthesis users in their choice. Some prosthetic foot components are heel-height adjustable; however, their plantar surface shapes do not change to match the insole shapes of the shoes with different heel heights. The aims of the study were therefore (1) to develop a model that allows prediction of insole shape for various heel height shoes in combination with different shoe sizes and (2) to develop and field-test low-cost prototypes of prosthetic feet whose insole shapes were based on the new model. An equation was developed to calculate insole shapes independent of shoe size. Field testing of prototype prosthetic feet fabricated based on the equation was successful and demonstrated the utility of the equation.
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Affiliation(s)
- Margrit R Meier
- Department of Rehabilitation Therapy and Prosthetics and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postboks 4 St Olavs Plass, 0130 Oslo, Norway.
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Annoni I, Mapelli A, Sidequersky FV, Zago M, Sforza C. The effect of high-heeled shoes on overground gait kinematics in young healthy women. SPORT SCIENCES FOR HEALTH 2014. [DOI: 10.1007/s11332-014-0191-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chien HL, Lu TW, Liu MW, Hong SW, Kuo CC. KINEMATIC AND KINETIC ADAPTATIONS IN THE LOWER EXTREMITIES OF EXPERIENCED WEARERS DURING HIGH-HEELED GAIT. BIOMEDICAL ENGINEERING: APPLICATIONS, BASIS AND COMMUNICATIONS 2014. [DOI: 10.4015/s1016237214500422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
High-heeled shoes are associated with falling, leading to injuries such as fracture and ankle sprain. The study aimed to investigate the kinematic and kinetic adaptations in the lower extremities resulting from habitual use of high-heeled shoes. A total of 15 female experienced wearers and 15 matched controls walked with high-heeled shoes (7.3 cm) while kinematic and ground reaction force data were measured and used to calculate the joint angles and moments, as well as the temporal-distance parameters. Compared with inexperienced wearers, experienced wearers appeared to adopt a specific control strategy to improve the stability of the support ankle and knee while preventing excessive loading at the knee and hip. Increased hip abduction during early stance phase and increased pelvis rotation toward the ipsilateral side at contralateral heel-strike appeared to contribute toward the reduced step width for a better adjustment of the medio-lateral motion of the body's center of mass in order to maintain stability. At the hip, increased abductor moments may help to increase the pelvis stability and prevent excessive loading at the knee, and reduced internal rotator moments may reduce the torsional loading at the hip. At the knee, reduced ranges of flexion-extension and adduction-abduction motions may increase its stability. At the ankle, increased external rotation angles, together with increased pronator and external rotator moments through increased ground reaction force, may enhance the ankle stability. The current results identified the changes in the kinematics and kinetics of the lower extremities in females after long-term use of high-heeled shoes, providing a basis for future development of training programs and design of new high-heeled shoes to help those who have higher risks of falling and injuries during high-heeled gait.
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Affiliation(s)
- Hui-Lien Chien
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Wei Liu
- Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Shih-Wun Hong
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chien-Chung Kuo
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan
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Cronin NJ. The effects of high heeled shoes on female gait: a review. J Electromyogr Kinesiol 2014; 24:258-63. [PMID: 24508305 DOI: 10.1016/j.jelekin.2014.01.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/09/2014] [Accepted: 01/14/2014] [Indexed: 11/26/2022] Open
Abstract
Walking is the most common form of human locomotion. From a motor control perspective, human bipedalism makes the task of walking extremely complex. For parts of the step cycle, there is only one foot on the ground, so both balance and propulsion are required in order for the movement to proceed smoothly. One condition known to compound the difficulty of walking is the use of high heeled shoes, which alter the natural position of the foot-ankle complex, and thereby produce a chain reaction of (mostly negative) effects that travels up the lower limb at least as far as the spine. This review summarises recent studies that have examined acute and chronic effects of high heels on balance and locomotion in young, otherwise healthy women. Controversial issues, common study limitations and directions for future research are also addressed in detail.
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Affiliation(s)
- Neil J Cronin
- Neuromuscular Research Centre, Department of Biology of Physical Activity, University of Jyväskylä, Finland.
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Chien HL, Liu MW, Lu TW, Kuo CC, Chung PC. Inter-joint sharing of total support moments in the lower extremities during gait in narrow-heeled shoes of different heights. ERGONOMICS 2014; 57:74-85. [PMID: 24294947 DOI: 10.1080/00140139.2013.855325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The study aimed to investigate the influence of the base and height of shoe heels on the total support moment (Ms) and individual joint contributions during gait. Fifteen healthy females walked barefoot and with narrow-heeled shoes (heel heights: 3.9, 6.3 and 7.3 cm) while kinematic and kinetic data were measured. Compared with the barefoot condition, the subjects maintained unaltered Ms in the sagittal plane in shod conditions. This was achieved by increasing the knee extensor moment to compensate for the diminished ankle plantarflexor moments in medium and high heel conditions. In the frontal plane, subjects in shod conditions had to sustain an increased Ms for balance control during late single-leg stance with increased knee abductor and ankle pronator moments as a result of the reduced base of the heels. The results will be helpful for future shoe designs to reduce fall risks and prevent relevant musculoskeletal problems.
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Affiliation(s)
- Hui-Lien Chien
- a Institute of Biomedical Engineering, National Taiwan University , No. 1, Sec. 1, Jen-Ai Road, Taipei 100 , Taiwan, ROC
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Abstract
STUDY DESIGN The study group consisted of 90 young, healthy females, aged 20 to 25 years. Three types of measurements were conducted for each female: without shoes, with 4-cm heels, and with 10-cm heels. OBJECTIVE The aim of this study was to assess the impact of high-heeled shoes on chosen parameters characterizing body posture. SUMMARY OF BACKGROUND DATA For a long time, high-heeled shoes have been an attribute of femininity. Currently, there is an increasing amount of research being published investigating the effect of high-heeled shoes on selected biomechanical parameters. METHODS The study used a photogrammetric method, based on the chamber projection and Moiré phenomenon. The study was performed using predesignated points of anthropometric measures. We used 19 photogrammetric parameters characterizing body posture. RESULTS Results of the measurements showed no significant differences using the significance level P < 0.05 between the measurements taken with no shoes, with 4-cm high-heeled shoes, and with 10-cm high-heeled shoes. Statistically significant results were obtained only for the angle of trunk bend parameter. The value of the P coefficient in the Kruskal-Wallis analysis of variance test for the angle of trunk bend parameter was P = 0.0140. Analysis based on the multiple comparison test indicated differences between the group wearing no shoes, and those wearing 4-cm heels (P = 0.0226), and between the group wearing no shoes and the group wearing 10-cm heels (P = 0.0459). CONCLUSION High-heeled shoes increased the forward inclination of the trunk. This article shows that there are only certain trends for some parameters that require further scientific investigation. LEVEL OF EVIDENCE N/A.
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Mika A, Clark BC, Oleksy Ł. The influence of high and low heeled shoes on EMG timing characteristics of the lumbar and hip extensor complex during trunk forward flexion and return task. ACTA ACUST UNITED AC 2013; 18:506-11. [PMID: 23632370 DOI: 10.1016/j.math.2013.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 03/15/2013] [Accepted: 03/19/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent studies suggest that wearing high-heel shoes increases the risk of developing certain musculoskeletal pain conditions. In this study we sought to examine whether heel height alters lumbar and hip extensor muscle timing characteristics during a standardized trunk flexion task. METHODS Thirty-one young, healthy women (22-27 years; 168.6 ± 5.1 cm; 57.1 ± 11.8 kg) participated in this study. Lumbar erector spinae (ES), gluteus maximus (GM), and biceps femoris (BF) electromyographic (EMG) signals were recorded during a trunk flexion task where subjects were instructed to flex their trunk in the sagittal plane and then return to a neutral posture. The task was repeated under three footwear conditions: while wearing no footwear, while wearing shoes with 4-cm heels, and while wearing shoes with 10-cm heels. EMG onset and offset times, as well as EMG duration, were calculated for each muscle and compared across conditions. RESULTS We observed a significantly earlier onset of the ES EMG activity (1.36 ± 0.61 vs. 1.56 ± 0.67 s), and significantly delayed onset of the GM EMG activity (1.72 ± 0.66 vs. 1.28 ± 0.58 s) during the flexion phase of movement in the 10-cm heeled compared to the no footwear condition. The GM muscle also exhibited an earlier offset time in the 10-cm heel condition compared to the no footwear condition during the flexion movement (2.57 ± 0.67 vs. 3.30 ± 0.61 s) as well as during the return from flexion movement phase (10.87 ± 0.58 vs. 11.69 ± 0.65 s). These alterations in timing characteristic resulted in an overall decrease in the EMG duration for the GM muscle during the flexion movement. CONCLUSION The results of this study suggest that high-heels alter trunk and hip extensor muscle coordination patterns. These findings, when considered in combination with other recent findings on the biomechanical effects of wearing high-heels, raise concern about whether wearing high heels results in abnormal spine loading patterns and increases the risk for developing musculoskeletal injuries.
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Affiliation(s)
- Anna Mika
- Department of Clinical Rehabilitation, University School of Physical Education in Krakow, Al. Jana Pawla II 78, 31-571 Krakow, Poland.
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Park SY, Yoo WG. Effect of Wearing Tight Pants on the Pelvic and Hip Kinematics of Women’s Gait. J Phys Ther Sci 2013. [DOI: 10.1589/jpts.25.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Se-yeon Park
- Department of Physical Therapy, Graduate School, Inje University
| | - Won-gyu Yoo
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University and Elderly Life Redesign Institute: 607 Obangdong, Gimhae, Gyeongsangnam-do 621-749, Republic of Korea
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Glassy CM, Glassy MS, Guggenheim C. Relationship between self-reported high-heeled shoe use and bone mineral density using quantitative ultrasound at a community health fair. Clin Rheumatol 2012; 32:37-41. [PMID: 22983265 DOI: 10.1007/s10067-012-2088-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/05/2012] [Accepted: 09/06/2012] [Indexed: 11/29/2022]
Abstract
This is the first known study to examine the relationship between high-heel use and bone mineral density (BMD). Because women are disproportionately affected by osteoporosis, it is important to identify possible modifiable behaviors of women that may adversely affect bone health. Many studies have shown changes in body mechanics when wearing high-heeled shoes in comparison to normal gait. Because the composition of bone changes according to mechanical load and muscle activity, this study investigates whether wearing high heels may alter BMD. Two hundred and twenty-one participants at a community health fair in Lansing, Michigan, were surveyed on high-heel use and bone health risk (gender, thin/small frame, fair skin, family history of fracture, smoking history, walking, dairy consumption, and early menopause or oopherectomy at <45 years old). Quantitative ultrasound (QUS) of the heel by Hologic's Sahara Sonometer was used to measure BMD. The mean age was 45.2 (SD 13.7) years, and the majority of participants were female (208, 94 %). A significant difference between mean BMD and high-heel use was not found. Independent correlations existed between fair skinned/sunburn easily and BMD, r(212) = -0.14, p = 0.038, as well as history of smoking and BMD, r(212) = -0.14, p = 0.042. Bone health risk score was strongly correlated with heel use binary variable "yes/no," r(210) = 0.21, p = 0.003. Our study suggests that wearing high-heeled shoes does not lead to appreciable differences in BMD among community health fair participants as assessed by QUS.
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Affiliation(s)
- Crystal M Glassy
- Department of Family Medicine, University of California, Irvine, 101 The City Blvd South Bldg 200, Suite 835, Orange, CA 92868, USA.
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