Is Heel Height Associated with Pain Exacerbations in Hip Osteoarthritis Patients?-Results from a Case-Crossover Study.

Kai Fu,Ben R Metcalf,Yuqing Zhang,Leticia A Deveza,Kathryn Mills,K Douglas Gross,Sarah R Robbins,Kim L Bennell,David J Hunter

doi:10.3390/jcm9061872

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.

Highlights

Osteoarthritis (OA) of the hip is the second most common site of lower limb OA after the knee, with an estimated overall prevalence in the general adult population of 11%, and somewhat higher in older adults [1,2].Pain is the ubiquitous symptom of OA and a major driver of clinical decision-making
Tehaerrienigs nsohsouebsstwanittihal hdiefefelrehnecieght ≥2.5 cm during the past 24 h was significantly associated with a decreased odds of pain exacerbations
In univariable conditional logistic regression analysis, wearing shoes with heel height ≥ 2.5 cm during the past 24 h was significantly associated with a decreased odds of pain exacerbations

Summary

Introduction

Osteoarthritis (OA) of the hip is the second most common site of lower limb OA after the knee, with an estimated overall prevalence in the general adult population of 11%, and somewhat higher in older adults [1,2].Pain is the ubiquitous symptom of OA and a major driver of clinical decision-making. Appropriate footwear may be a cost-effective and safe intervention for managing the painful symptoms of hip OA [8]. There are many studies that have measured the biomechanical effects of shoes with higher heels in people with knee OA, but not hip OA, showing that wearing heels of increasing height could increase the medial tibiofemoral compartment and patellofemoral joint loading [9]. There is a strong association between medial knee load and increased pain during walking in patients with knee OA [10]. These results cannot necessarily be generalized from knee OA to hip OA, given differences in risk factors, biomechanics and response to treatment [11]

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