Altered gait patterns exacerbate knee injury risk: A cross-sectional observational study of barefoot and high-heeled walking

Summary Study aim: To determine the effects of non-habitual wearing of high-heeled shoes on loading coefficient, loading stress and forefoot-rearfoot load imbalance in females Materials and methods: Fifty young adult female subjects were selected using a convenience sampling technique, and studied utilising crossover control research design. They walked barefoot and thereafter, in high-heeled shoes; for a distance of 10- metre measured out in a gait laboratory. They demonstrated their gait twice for each speed, along a 10 metres walkway, at five speeds varying from very slow to very fast. Mean values of steps and time were recorded and used to calculate the values of velocity, stride length, stride frequency, double-support, swing, single-support, and stance phases of stride. These were adopted to form a modified velocity field diagram (MVFD). The data obtained were statistically analysed using a t-test for correlated means, with alpha set at 0.05. Results: The MVFDs revealed that the F/R load ratios were obtained as 0.67 and 1.5, while loading coefficient was 0.4 and 0.6, for barefoot and high-heeled walking, respectively. Loading coefficient and stress in high-heeled walking was 1.50 and 1.88 of the value in barefoot walking, respectively. Conclusions: Non-habitual wearing of high-heeled shoes increased F/R load imbalance, loading coefficient, and stress in the foot. However, there was no evidence of gait pathology in the subjects when they walked barefoot. Thus, non-habitual use of high-heeled shoes by the subjects did not translate to significant residual biomechanical derangements in the locomotor apparatus otherwise the kinematic data recorded for barefoot walking would have approximated the values obtained during high heeled walking.

Knee osteoarthritis and high-heeled shoes

The purpose of this study was to investigate the GRF(ground reaction force) parameters according to the shoes's heel heights and ground landing distances during downward stairs on bus. Participants selected as subject were consisted of young and healthy women(n=9, mean age: <TEX>$21.30{\pm}0.48$</TEX> yrs, mean height: <TEX>$164.00{\pm}3.05cm$</TEX>, mean body mass: <TEX>$55.04{\pm}4.41kg$</TEX>, mean BMI: <TEX>$20.47{\pm}1.76kg/m^2$</TEX>, mean foot length: <TEX>$238.00{\pm}5.37mm$</TEX>). They were divided into 2-types of shoe's heel heights(0 cm/bare foot, 9 cm) and also were divides into downward stairs with 3 types of landing distance(20 cm, 35 cm, 50 cm). A one force-plate was used to collect the GRF(AMTI, USA) data from the sampling rate of 1000 Hz. The GRF parameters analyzed were consisted of the medial-lateral GRF, anterior-posterior GRF, vertical GRF, loading rate, Center of Pressure(<TEX>${\Delta}COPx$</TEX>, <TEX>${\Delta}COPy$</TEX>, COP area) and Dynamic Postural Stability Index(MLSI, APSI, VSI, DPSI) during downward stairs on bus. Medial-lateral GRF and vertical GRF didn't show significant differences statistically according to the shoe's heel heights and landing distance, but 9 cm shoes heel showed higher vertical GRF than that of 0 cm bare foot in landing distance of 50 cm. Also anterior-posterior GRF didn't show significant difference statistically according to the shoe's heel heights, but landing distance of 20 cm showed higher than that of landing distances of 35 cm and 50 cm in anterior-posterior GRF. Loading rate didn't show significant difference statistically according to the landing distance, but 9 cm shoe's heel showed higher than that of 0 cm bare foot during downward stairs. The <TEX>${\Delta}COPy$</TEX> and COP area didn't show significant differences statistically according to the shoe's heel heights and landing distance, but 0 cm bare foot showed higher than that of 9 cm shoe's heel in <TEX>${\Delta}COPx$</TEX>. Dynamic Postural Stability Index(MLSI, APSI, VSI, DPSI) didn't show significant differences statistically according to the landing distance, but 9 cm shoe's heel showed decreased value than that of 0 cm bare foot in dynamics balance. Considering the above, parameters of GRF showed different characteristics according to the shoe's heel heights and ground landing distances during downward stairs on bus.

High heels as supernormal stimuli: How wearing high heels affects judgements of female attractiveness

Objective: The purpose of this study was to investigate the acute effect of walking on high heels on the behavior of fascicle length and activation of the lower limb muscles. Methods: Twelve healthy inexperienced high heel wearers (age: 23.1 ± 2.0 yr, height: 162.4 ± 4.9 cm, weight: 54.4 ± 8.5 kg) participated in this study. They walked in high heels (7 cm) and barefoot on a treadmill at their preferred speed. During the gait analysis, the lower limb joint kinematics were obtained using a motion analysis system. In addition, the changes in fascicle length and the level of activation of the medial gastrocnemius (MG) were simultaneously monitored using a real-time ultrasound imaging technique and surface electromyography, respectively. Results: The results of this study show that the MG fascicle operates at a significantly shorter length in high heel walking (37.64 ± 8.59 mm to 43.99 ± 8.66 mm) in comparison with barefoot walking (48.26 ± 9.02 mm to 53.99 ± 8.54 mm) (p < .05). In addition, the MG fascicle underwent lengthening during high heel walking with relatively low muscle activation while it remained isometric during barefoot walking with relatively high muscle activation. Conclusion: Wearing high heels alters the operating range of the MG fascicle length and the pattern of muscle activation, suggesting that prolonged wearing of high heels might induce structural alterations of the MG that, in turn, hinder normal functioning of the MG muscle during walking.

In vivo kinematic changes of the medial longitudinal arch during barefoot and high-heeled shoes walking.

The aim of the study was to investigate how walking in high heels on a treadmill affects the changes in timing of activation in selected lower limb muscles, pelvic muscles, and upper trunk muscles in young women. Surface electromyography (EMG) was used for data collection of selected muscles on the right half of the body: m. pectoralis major, m. trapezius pars transversa, m. obliquus abdominis externus, m. erector spinae in the lumbar spine, m. gluteus medius, m. gluteus maximus, m. rectus femoris, m. biceps femoris-caput longum. The research group consisted of 30 women (age: 24.2 ± 2.3 years; weight: 57 ± 3.2kg; height: 1.65 ± 0.04m). Statistical significance in changes in timing was confirmed for seven of the measured muscles. The timing of the m. trapezius muscle was not statistically affected by changes in walking in high heels (HH), but HH and treadmill walking increased the intensity of muscle contraction in all monitored muscles. Walking on a treadmill in flat shoes (FS) similarly increases the intensity of muscle contraction. This work expands the theoretical knowledge of bipedal locomotion in HH on a treadmill.

Introduction : The feet are the only anatomical structures of the body which are in touch with the ground and complete the lower limb chain to bear the ground reaction forces (GRFs). Inappropriate distribution of the GRF as a result of the long-term use of high-heeled shoes causes an excessive stress which results in a wide-range of musculo-skeletal disorders mainly in feet and leg areas. Due to the increased rate of using high-heeled shoes in the world and because of the lack of knowledge about feet pressure patterns in this condition, the current study focused on studying the pressure in different parts of the foot in barefoot women who used to(were accustomed to wearing) wear high-heeled shoes for a long time. Materials & Methods: In this observational analytical case-control study, two groups of 35 subjects, were recruited. The feet pressure indexes of the experimental group of women who were habituated to wearing high-heeled shoes for the last 2 years were compared with women in the control group who wore shoes with normal heel height. A Zebris pedobarograph (Zebris Company, Germany) system was used to study the subjects’ feet planter pressure during the static (double stance) and the dynamic (walking with self-selected speed) conditions. All tests were run amog subjects with their feet bare. Results: The statistical analysis showed a significantly stronger pressure on feet in participants with high-heeled shoes than the ones in the control group ( P <0.001) . Conclusion : The finding of this study suggested that long-term use of high-heeled shoes results in some changes on the distribution of body weight on feet even during barefoot standing and walking positions. In other words, individuals wearing high-heeled shoes involuntarily press a greater percentage of their body weight on the front part of their feet, which may results in pathological conditions of their feet such as callosity, corns or ulcers beneath their forefoot. Keywords: High-Heel Shoes, Foot Pressure, Pedobarography, Women

Objective: Research on ankle joint torques of healthy women with high heel compared with bare foot based on Inverse Dynamics. Methods: 12 women were recruited and tested by motion and force system. Kinematical, kinetic and personal segment parameter data were used to compute ankle joint torques and compare the differences between bare foot and high heel.Conclusion: compared with bare foot, It can infer that Soleus and Gastrocnemius access the contraction in advance and keep higher muscle force. Tibia Anterior and Posterior must have to make powerful contraction that could keep the ankle joint with higher torque. Compared with sagital and frontal plane, high heel doesnt change the joint torque in horizontal plane during the whole internal phase, but the fluctuations of torque value may influence the stability during normal level walking.

The purpose of this study was to assess the modifications in body center of mass (CoM), total mechanical work and walking characteristics during low-heeled and high-heeled gait performed in ecological conditions. The 3D coordinates of 19 body landmarks were recorded by an optoelectronic motion analyzer in 13 women while walking overground at self-selected speed with either low-heeled or high-heeled shoes (minimum height, 70 mm). Using mean anthropometric data, the CoM was estimated, and its position evaluated during normalized gait cycles. Shoulders, pelvic and knee orientations were also assessed together with estimates of total mechanical work. High-heeled walking was performed with significantly lower horizontal speed (p < 0.05) but with the same cadence than low-heeled walking. During the whole gait cycle, the CoM (calculated from the malleolus landmarks) was 3 % lower during high-heeled walking (p < 0.05), had higher vertical displacements and vertical velocity modifications (p < 0.001), and it was significantly more anterior (p < 0.01). On average, walking with high heels at self-selected speed required a 16 % higher total mechanical work, but the difference was not significant. At heel strike with high heels, the shoulders were more inclined (p < 0.05), the support limb knee was significantly more flexed (p < 0.05), with a 12 % reduced total range of motion (p < 0.001), while the back limb knee was less flexed (p < 0.05). Wearing high-heeled shoes significantly alters the normal displacement of human CoM; high-heeled gait exaggerated female walking characteristics with a more anterior CoM position, a wider vertical movement and a slower velocity.

Objective: This paper analyzes the changes on stride parameters, joint angles, and trajectories of the body parts due to high heels during walking and explains the causal relationship between the changes and high heels. Background: This study aims to indicate the comprehensive gait changes by high heels on the whole body for women wearing high heels and researchers interested in high-heeled walking. Method: The experiment was designed in which two different shoe heel heights were used for walking (1cm, 9.8cm), and twelve women participated in the test. In the experiment, 35 points on the body were tracked to extract the stride parameters, joint angles, and trajectories of the body parts. Results: Double support time increased, but stride length decreased in high-heeled walking. The knee inflexed more at stance phase and the spine rotation became more severe. The trajectories of the pelvis, the trunk and the head presented outstanding fluctuations in the vertical direction. Conclusion: The double support time and the spine rotation were changed to compensate instability by high heels. Reduced range of motion of the ankle joint influenced on the stride length, the knee flexion, and fluctuations of the body parts. Application: This study can provide an insight of the gait changes by high heels through the entire body.

Ankle and foot mechanics in individuals with chronic ankle instability during shod walking and barefoot walking: A cross-sectional study

This study addressed the effect of balance control problems of the high-heeled women. Clinical relationships have been proposed linking foot ailments or pain to wearing high heels, yet little quantitative research has been done on the relationship between bare foot and high feeled foot. The purposes of this study were to objectively quantify the displacements and velocities of center-of- pressure (COP) of body during two-way waist pulling and to compare the differences between barefooted and high-heeled situations. We used a waist pulling system which has three different magnitudes to sway the subjects. We found that the kinematic information of barefooted and high-heeled women's COP is very important in understanding the mechanism of postural balance control of women in every-day life. In the high-heeled's case, the displacement of COP increases in 200% as against bare footed. Also the velocity variation of COP grows two times than the bare footed.

Purpose: High heels have been a fashion mainstay for women for 100s of years despite the well-known fact that wearing them often causes pain in the feet, legs and back. The cause of this pain is complex and the root cause of it has not been determined because a study exploring the biomechanical effects on the vertebral torsion moment on wearers has not been undertaken. Methods: Using video raster stereography, 140 women were measured while in bare foot and while wearing high heels. The collected parameters formed the basis for biomechanical model calculation in order to make more accurate statements about the torsion moment and muscle strength. In addition, a multivariate regression analysis was carried out to evaluate influence factors on pain that occurred while wearing high heels. Results: One hundred and thirty-six women (97 %) aged 18 to 79 years finished the study. The comparison between the measurement points showed a significant difference in the torsion moment. In the regression analysis, the heel height and the frequency of wearing high heels were significant factors influencing the occurrence of pain. Conclusions: Wearing high heels is associated with changes in the posture parameters. The torsion moment is reduced but it does not influence the development of pain which is mainly affected by the height of the heels and the frequency of wearing high heels. In the present study especially, the wearer’s feet were affected.

First metatarsophalangeal (MTP) joint reaction forces were calculated for 11 normal females during the toe-off phase of gait while walking in bare feet and in high heeled shoes. A biomechanical model was used to calculate the forces utilizing kinematic, kinetic, footprint, and radiographic data. The results showed that the MTP joint reaction forces (FJ), the metatarsal-sesamoid forces (FS), and the resultant of these forces (FRES), were twice as large in high heels compared to barefoot walking. The average peak forces for barefoot and high-heeled gait were FJ: 0.8 and 1.58 times body weight, FS: 0.44 and 1.03 times body weight, and FRES: 0.93 and 1.88 times body weight. Also, the kinematics changed when wearing high heels, making angles of application of forces and sesamoidal articulations less favorable.