Heel Height Research Articles

Использование видеоанализа походки для оптимизации локомоторного стереотипа у пациентов с перемежающейся хромотой

Introduction Intermittent claudication (IC) is a condition of ischemic symptoms in the lower limbs associated with increasing pain in limbs due to physical loading (walking, running and mounting) that relieves after some rest. Dosed walking is recommended as a primary treatment to prevent possible complications in such patients. The purpose of this work was to investigate the effect of different targeted footwear features on the biomechanics of human musculoskeletal system to define optimal footwear designs for reduction of loading on calf muscles and metabolic needs aimed at increasing painless walking distance. Method The study recruited 15 healthy male volunteers aged 25.3 ± 2.73 years for the analysis of kinematics, kinetics and EMG-activity during walking in various types of footwear. Eight subjects with IC were also included. Results were recorded using 16 cameras Oqus 3 + (Qualisys), four Force Platforms AMTI (USA), and an EMG system Noraxon (USA). Data were produced and analysed using QTM, Visual3D (C-Motion), and IBM SPSS Statistics. Results This study demonstrated that to reduce the load on the calf muscles and not to change the biomechanics of the knee and femur, the most potentially effective footwear were with the length of the beginning of roll over from the heel to the metatarsal area was equal to 55% of the foot length, shoe heel height of 4.5 cm, angle of lifting toes of 20 degrees (p less 0.05). Combination of those footwear conditions resulted in increase of pain-free walking distance by 39%. Conclusion The results showed the potential of the applied system of video analysis for designing orthopaedic footwear.

Heel Height as an Etiology of Hallux Abductus Valgus Development: An electromagnetic Static and Dynamic First Metatarsophalangeal Joint Study.

Background: Hallux abductus valgus (HAV) is a forefoot condition produced by extrinsic and intrinsic factors. Shoes with a high heel height and a typical narrow tip toe box can induce deviations in both the proximal phalanx of the hallux (PPH) and the first metatarsal (IMTT) bones. Nevertheless, the isolated role of heel height remains unclear in the development of HAV pathology. Objectives: The goal was to determine if the heel height increase of shoes without a narrow box toe could augment the PPH and IMTT deviation in frontal, sagittal, and transverse planes toward the first metatarsophalangeal joint (MPJ) and the first metatarsocuneiform joint (MCJ), respectively, during static and dynamic conditions in relation to precursor movements of HAV. Methods: Women with an average age of 25.10 ± 4.67 years were recruited in this cross-sectional study to assess the three planes of motion of PPH and IMTT while wearing high heels with heights at 3, 6, 9 cm and unshod conditions via sandals. The measurements used an electromagnetic goniometer device with sensors placed on medial aspects of the PPH and IMTT bones under static and dynamic conditions. Results: Wearing shoes with a 6 cm heel in dynamic condition may increase the PPH valgus and abduction deviation from 3.15 ± 0.10° to 3.46 ± 0.05° (p < 0.05) and from 1.35 ± 0.28° to 1.69 ± 0.30° (p < 0.001), respectively. In addition, a PPH abduction increase from 1.01 ± 0.36° to 1.31 ± 0.46° (p < 0.05) after wearing shoes with a 6 cm heel height was observed under static conditions. Conclusions: Wearing shoes with a heel height of 6 cm without a narrow box toe interference may produce PPH abduction and valgus deviations related to HAV formation.

Effects of different heel heights on lower extremity joint loading in experienced and in-experienced users: a musculoskeletal simulation analysis

This study examined the effects of different high-heeled footwear heights on lower extremity compressive joint loading and triceps-surae muscle–tendon kinematics during walking, using a musculoskeletal simulation-based approach, in both experienced and in-experienced high heel users. The current investigation examined 12 experienced and 12 in-experienced high-heel wearers, walking in four different footwear (high heel, medium heel, low heel, and trainer). Walking kinematics were collected using an eight-camera motion capture system and kinetics via an embedded force plate. Lower extremity joint loading and triceps-surae muscle kinematics were explored using a musculoskeletal simulation approach. Irrespective of experience, when wearing high heels of increasing height, compressive loading parameters at the medial tibiofemoral compartment and patellofemoral joint were significantly greater and exceeded the minimum clinically important difference (MCID). Furthermore, irrespective of wearers’ experience, the triceps-surae muscle–tendon units were placed in a shortened position when wearing high heels of increasing height, with the differences exceeding the MCID. It can be concluded that heeled footwear increases the mechanical factors linked to the aetiology of degenerative joint osteoarthritis and chronic shortening of the triceps-surae muscle–tendon units. Therefore, the current investigation provides evidence that irrespective of experience, heeled footwear of increasing height may negatively influence female’s lower extremity musculoskeletal health.

An investigation into the effects of, and interaction between, heel height and shoe upper stiffness on plantar pressure and comfort

High heeled shoes remain popular; nevertheless it is not clear what influence manipulating characteristics of this footwear has on their functioning. It is accepted that shoe features other than heel height can affect plantar pressures. However, few investigations have compared such features, and none have compared the influence of modifying upper material stiffness, whilst systematically increasing heel height. A firm understanding of the interactions of footwear properties is essential to ensure that footwear designers can optimise design for the comfort and health of the wearer. This paper investigates a feature that is known to reduce comfort (heel height) and a feature that is easy to change without affecting aesthetics (material stiffness) to better understand the effects of their interaction on plantar pressure and comfort. Sixteen female participants with experience wearing high heels wore a range of shoes with five effective heel heights (35–75 mm) and two upper materials (with different stiffness). In-shoe plantar pressure was recorded and participants completed a comfort questionnaire. Increasing heel height increased plantar pressure under the metatarsal heads, while reducing pressure in the hallux and heel. Higher heel heights also lead to increased discomfort, particularly in the toes where discomfort increased 154.3% from the 35 to 75 mm heels. Upper stiffness did not affect plantar pressure. However, stiffer uppers significantly increased reported discomfort, most notably on top of the foot (108.6%), the back of the heel (87.7%), the overall width (99%) and the overall comfort (100.7%). Significant interaction effects between heel height and upper material existed for comfort questionnaire data. Manipulating heel height alters plantar pressure and comfort, and choice of upper material is paramount to achieving wearer comfort in heels.

Relationship between foot morphology and toe muscle strength in female university students.

[Purpose] The purpose was to clarify the relationship between foot morphology and toe muscle strength in female university students. [Participants and Methods] Data from 103 female university students (age, 20.4 ± 1.6 years) on height, body weight, pain in the foot and toes, heel height (cm) of shoes worn in everyday life, and the number of times (per week) shoes with heels ≥3 cm were worn were collected. The hallux valgus angle and medial longitudinal arch height ratio of the foot were measured, and toe muscle strength was evaluated according to the strength of the toe flexor and abductor hallucis muscles. [Results] Arch height ratio was significantly lower with hallux valgus angle ≥16°. In the 206 feet, a very weak negative correlation was found between hallux valgus angle and arch height ratio. In 150 feet with hallux valgus angle <16°, a very weak correlation was found between toe flexor strength and arch height ratio. [Conclusion] Body mass index was within the normal range, and the period of wearing high-heeled shoes was short; these factors have no effect on hallux valgus angle. Hallux valgus may be prevented by increasing toe flexor strength to prevent downward movement of the navicular and first cuneiform bones.

New opportunities to correct equvinus foot deformity in orthopedic-traumatological practice

Aim. To prove the efficiency of using a new variant of leg tutor for correction of locomotor system pathology in treatment of equvinus foot deformity.&#x0D; Materials and methods. A mean age of 23 patients with hemiparesis and equvinus foot deformity was 42.5 years. Tonus and strength of legs was assessed. Angulometric and stabilometric studies were realized.&#x0D; Results. The developed model of leg tutor was used. To eliminate equvinus foot deformity, hyperextension of the knee joint was gradually eliminated using individual choice of the heel form and height, thus strengthening a quadriceps muscle of the thigh. The knee joint stability increased, the intensity of pain syndrome reduced. Arthropathies and deformities of the knee joint were prevented. Innovation of the developed model is the following: a soft glue-based responsive side of textile band “Contact” “Velcro” was stably fixed to the outside surface of posterior third of the plantar part of tutor sleeve. To the responsive side of a textile band, there were fixed removable heel pads (heels from microporous rubber of different height (from 5 to 25 mm) with a responsive hard (with hooks) part of textile band “Contact” “Velcro”). Tutor provided the ability to move and guaranteed stable holding of the extremity segments in the posterior position. There was observed a positive dynamics of changes in the muscular tonus of paralyzed leg.&#x0D; Conclusions. The developed tutor model can be used in orthopedic-traumatological practice to correct equvinus foot deformity; the model efficiency is confirmed by clinical and stabilometric parameters.

Risk Factors Associated With Musculoskeletal Injury: A Prospective Study of British Infantry Recruits.

Musculoskeletal Injury (MSKI), a common problem in both military and physically active civilian populations, has been suggested to result from both extrinsic and intrinsic factors. To investigate prospectively whether gait biomechanics, aerobic fitness levels and smoking status as well as entry military selection test variables can be used to predict MSKI development during recruit training. British infantry male recruits (n = 562) were selected for the study. Plantar pressure variables, smoking habit, aerobic fitness as measured by a 1.5 mile run time and initial military selection test (combination of fitness, Trainability score) were collected prior to commencement of infantry recruit training. Injury data were collected during the 26 week training period. Incidence rate of MSKI over a 26 week training period was 41.28% (95 % CI: 37.28 - 45.40%). The injured group had a higher medial plantar pressure (p < 0.03), shorter time to peak heel rotation (p < 0.02), current smoking status (p < 0.001) and a slower 1.5 mile run time (p < 0.03). In contrast, there were no significant differences (p > 0.23) in lateral heel pressure, age, weight, height, BMI and military selection test. A logistic regression model predicted MSKI significantly (p= 0.03) with an accuracy of 34.50% of all MSK injury and 76.70% of the non-injured group with an overall accuracy of 69.50%. The logistic regression model combining the three risk factors was capable of predicting 34.5% of all MSKI. A specific biomechanical profile, slow 1.5 mile run time and current smoking status were identified as predictors of subsequent MSKI development. The proposed model could include evaluation of other potential risk factors and if validated then further enhance the specificity, sensitivity and applicability.

HIGH HEEL SHOES

Object: Outcome of wearing high heel shoes in young generation: A CrossSectional Study. Introduction/ Background: High heels increase the heel height, thusincreasing the pressure under the metatarsal head in forefoot, they push the center of mass of thebody forward taking the hips and spine out of alignment moreover the altered posture of walking1-5 in high heels places excessive forces on the inside of the knee joint . All these factors contributein causing deleterious pathologic deformities. The studies carried out previously were morefocused on the adult population furthermore there isn’t much work done to investigate the effectof heels in Pakistan therefore, this was a non-invasive study the purpose of which was to evaluatethese complications particularly targeting the medical students of medical colleges, Karachi.Methods: A total of 220 respondents aged between 15 to 25 years were selected as potentialrespondents meeting the criteria for selection. A convenience based randomized samplingmethod was adopted, where the participants were required to fill questionnaires and give theirdemographic details. They were inquired about the presence of any co morbidities which was anessential part of the exclusion criteria. They were also inquired about their usage of high heelshoes, their size, duration and frequency of usage, and if they had been causing anycomplications such as bunions, heel spur, callosities or pain in soles, calf or back. The dataobtained was analyzed through SPSS and the graphs of frequency for all the complications werecomputed. Results: After analyzing the 220 participants it was found that 7.7% were males while92.3% were females, and 61.8% were found to be within 21 to 23 years of age. After the analysesof data for the complications it was found that out of the total participants 18.8% experience footswelling, 19.4% blisters, 16.4% foot numbness, 12.3% foot callosities, 2.8% heel spur, and 3.7%experience bunions. Conclusions: From this study conducted on the students of medicalcollege it was found that wearing high heel shoes is not associated with any significantcomplications among most of the students

Effects of heel height and high-heel experience on foot stability during quiet standing

BackgroundThe use of high-heeled shoes (HHS) introduces instability into the wearer’s balance system but how high-heel experience might influence standing balance is less examined in literature. Research question(1) Does foot stability decrease in both the antero-posterior (AP) and medial-lateral (ML) directions with increasing heel height during quiet standing?(2) Does high-heel experience improve the wearer’s foot stability during quiet standing in high-heeled conditions? MethodsTwenty-four young females (12 regular and 12 non-regular HHS wearers) were recruited to perform quiet standing while wearing shoes with heel heights of 1 cm, 5 cm, 8 cm and 10 cm. The effects of heel height on the mean center of pressure (COP), their variability (standard deviations) and mean COP velocities in both the AP and ML directions were analysed by one-way repeated measures ANOVA and Bonferroni post-hoc test. The effects of high-heel experience were analysed through independent samples t-tests. ResultsThe variability of the COP in both directions increased with heel height, although significance was found only in the ML direction. The COP velocities in both directions were highest for the 1 cm heel, decreased as the heel increased to 8 cm and increased again for the 10 cm heel. Experienced HHS wearers exhibited significantly smaller COP variances (AP) for the 8 cm and 10 cm heels, smaller COP velocities (AP) for all heels, and smaller COP variances (ML) and COP velocities (ML) for the 10 cm heel. SignificanceThe use of HHS results in greater stability distortions in both AP and ML directions but high-heel experience improves balance control under high-heeled conditions. Our findings enhance the understanding of how high-heel experience might influence standing balance in different heel height, and highlights the importance of the ML components of the in-foot COP measures in the examination of standing balance in HHS.

Wearing high-heeled shoes increases the foot arch angle inducing measurable changes in the musculoskeletal system.

The study determined the effects of females wearing high-heeled shoes on the lower extremity musculoskeletal system and somatometry. The study was carried out with 136 females between 18 and 45 years old. The first group consisted of 66 females wearing 5 cm or higher high-heeled shoes, at least 5 hours a day, three days a week, and at least one year. The second group consisted of 70 females wearing shoes with heel height less than 5 cm for at least one year. Differences in length parameters may result from the narrow and pointed toe of the high-heeled shoe. These shoes distribute the pressure on the caput ossis metatarsi I and compress the foot in this area. Differences in anthropometric measurements show that females wearing high-heeled shoes have more slender and smaller foot structure. These findings show that regular wearing of high-heeled shoes causes changes via the increased foot arch structure. These alterations result from regional, racial, gender, heel height, shoe type (shape), and shoe habits.

Changes in lower limb muscle synchronisation during walking on high-heeled shoes.

The goal of this research was to investigate the effect of wearing high-heeled shoes (HHS) on lower limb muscle synchronisation during walking, using beta band (15–30 Hz) coherence analysis. Fifteen females with no previous neuromuscular disorders volunteered in this study. Surface electromyography in frequency domain was studied from rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM) and semitendinosus (ST) muscles during walking by subjects wearing HHS of three different heel heights (low – 4 cm, medium – 6 cm and high – 10 cm). Average coherence values were calculated for RF-VL, RF-VM and RF-ST muscles in beta band to analyse muscle pair synchronisation. In this study, significant increase in beta band coherence was found in all three muscle pairs during walking on HHS of different heel heights (p<0.05). Increased beta band coherence obtained from this study suggested that walking on HHS demands higher muscle pair synchronisation, to maintain stability around the knee joint.

Effects of In-Shoe Midsole Cushioning on Leg Muscle Balance and Co-Contraction with Increased Heel Height During Walking.

The midsole is an essential assembly of footwear for retaining the shape of the shoe, delivering support to the foot, and serving as a cushioning and stability device for walking. To improve leg muscle balance and muscle co-contraction, we propose a new midsole design for high heels with different hardness levels at the forefoot region. Five healthy women participated in the study, with a mean ± SD age of 21.80 ± 4.09 years, and duration of high-heeled shoe wear of 5.20 ± 4.09 years. Two midsole conditions, control and multiple-hardness midsole (MHM), with heel heights of 2 (flat), 5, and 8 cm were used. The main outcome measures were to examine the acute effects of MHM by electromyography on muscle activity balance and co-contraction at varying heel heights during shuttle walk. Use of the MHM significantly reduced the muscle activity ratio between the medial and lateral gastrocnemius muscles ( P = .043) during push-off to heel strike with a heel height of 5 cm (-22.74%) and heel strike to midstance with a heel height of 8 cm (-22.26%). The increased co-contraction indices of the tibialis anterior-peroneus longus muscles (14.35% with an 8-cm heel height) and tibialis anterior-soleus muscles (15.18% with a 5-cm heel height) are significant ( P = .043), with a large effect size ( d = 0.8). These results deliver important implications in advancing the engineering of MHM design without changing the in-shoe volume to enhance leg muscle balance and co-contraction during walking.

Association of Biometric Traits with Growth Hormone Gene Diversity in Raini Cashmere Goats

In recent years, the important effects of growth hormone on a broad variety of physiological parameters, such as lactation, reproduction, growth, and metabolism, have attracted many researchers' attentions. To detect GH gene polymorphism and its association with the biometric traits of Raini Cashmere goats, 300 animals were selected and the animals’ genotype was determined using PCR-RFLP. Two different genotypes (AA and AB) were observed in exons 2 and 3 within the goat GH gene. The genotype frequencies for AA, AB, and BB were 0.15, 0.85, and 0, and frequencies of the A and B alleles were 0.575 and 0.425, respectively. The number of observed alleles, number of effective alleles, expected heterozygosity, observed heterozygosity, mean of heterozygosity, expected homozygosity, observed homozygosity, Nei’s index, Shannon’s index, and Fixation index (Fis) were 2, 1.96, 0.49, 0.85, 0.49, 0.51, 0.15, 0.49, 0.69, and -0.74, respectively. Birth type had a significant effect on the Chest height to earth (T26) trait (P-value = 0.032304). Furthermore, a significant effect of age on some biometric traits were observed in this study. The frequency of the AB genotype for most of the traits were higher in comparison to the AA genotype, although some traits did not show a significant effect, which might be explained by the heterosis phenomenon. According to the results, it can be concluded that allele A of growth hormone is a suitable allele for the THH (Toe height of hand hoof), THF (Toe height of foot hoof), HHF (Heel height of foot hoof), and CHE (Chest height to earth) traits, and allele B is a worthy allele for the NI (Nasal interval), LCI (Lip corner interval), NL (Neck length), CC (Chest circumference), AC (Abdominal circumference), LLF (Leg length of foot), WHC (Wither height to under the chest), and DAD (Dorsal angle distance of scapula to Hänsch point) traits. Therefore, better results in the breeding programs for these traits can be achieved from this information, along with other phenotypic records.

The influence of high heeled shoes on balance ability and walking in healthy women.

[Purpose] The purpose of this study was to investigate the influence of high heeled shoes on balance ability and walking on healthy women. [Subjects and Methods] Thirty healthy female subjects, without orthopedic history of the lower extremity were selected for the present study. The 3 cm, 6 cm, and 9 cm shoes were worn according to the prescribed order to perform a balance and walking test. [Results] Significant difference was shown after the experiment, in comparison of the groups in all variance, and as the result of post hoc test. Time, anterior-posterior length and medial-lateral length of balance variables as well as velocity of walking variables showed a significant increase between 3 cm and 6 cm, 6 cm and 9 cm, 3 cm and 9 cm. In addition, the balance index of the balance variables as well as the step length and single support ratio of the walking variables showed a significant decrease between 3 cm and 6 cm, 6 cm and 9 cm, 3 cm and 9 cm. [Conclusion] It was found that the higher the shoe heel height, the lower the balance and the less the efficiency of walking.

Can Foot Exercises and Going Barefoot Improve Function, Muscle Size, Foot Pressure During Walking and Qualitative Reports of Function in People with Flat Foot?

Category: Midfoot/Forefoot Introduction/Purpose: Specific exercises to train foot muscles for barefoot running (i.e. doming seated[DS] and standing[DSt]) and post foot and ankle injury (i.e. seated plantar flexion and inversion[SPFI]) are common. Exercise programs specifically for the foot claim improvement in foot posture (foot posture index [FPI]) and foot strength. However, rigorous assessment of foot function as a result of exercise is lacking (i.e. foot posture, strength, and plantar pressure). Further, no studies specifically address patients with flat foot. The purpose of this case series study was to assess the immediate effects of an 8-week foot exercise and barefoot weight bearing program on clinical and biomechanical measures of foot function. Methods: Thirty three participants, 23 with a severe flatfoot (SFF), measured by FPI (&gt; 6/12, average = 9.4±1.5, age=28.9 ±11.0) and 10 age/gender matched controls (AMC) with a normal foot (FPI average=4.6±1.5, age = 29.8±7.8) participated. The SFF group completed 4 foot exercises (DS, DSt, SPFI, and toe spreading) and spent 2 hours/day barefoot weight bearing 5 days/week for 8 weeks. The SFF group was tested pre- and post exercise and the AMC group once. Testing included plantar pressure during walking (cadence 120 bpm), abductor halluces cross sectional area(CSA) using diagnostic ultrasound, paper pull test (PPT) quantified 1st metatarsophalangeal joint(MTP) flexion strength using a force plate, and heel raises (repetitions and heel height). ANOVA models and T-tests were used to assess the effects of pre- to post exercise and make comparisons between the SFF group and the AMC group. Post exercise interviews were transcribed and subjected to word count analysis. Results: Although no calf training was included, heel rise repetition (Right: Pre=28.0 to Post 35.0, Left: Pre=30.6 Post= 38.2) and heel height (Increased Right: 1.7 cm, Left: 1.8 cm) improved (Figure 1). The PPT test indicated increased 1st MTP flexion force post exercise bilaterally (Right p=0.002, Left p=0.007). Consistent with increased force of the PPT, abductor halluces muscle CSA increased bilaterally (Right &amp; Left = 0.3 cm2 or 12.5%). However, plantar pressures were not different post exercise (p&gt;0.05). Post exercise the SFF group and AMC group were similar across variables(p&gt;0.05). Compliance logs indicated 87.7% completion of prescribed exercises and 111% of time targeted barefoot weight bearing. The top 6 words mentioned in post exercise interviews were: exercise, time, stronger, standing, hard, and easy. Conclusion: This is the first data to demonstrate that foot only exercises have a significant influence on ankle plantar flexion function (i.e. increased heel rise repetition and height) and patient qualitative assessments of their foot. The argument that this increase in ankle function derives from the training effects within the foot is supported by significantly higher 1st MTP force (increased PPT test) and increased cross sectional area of the abductor halluces muscle. Despite having significant flat foot deformity participants enhanced their foot and ankle function. This suggests that other foot problems with similar deformity may also benefit from exercise.

Walking variations in healthy women wearing high-heeled shoes: Shoe size and heel height effects

BackgroundThe 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 questionThe 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. MethodsWe 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. ResultsComparing 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. SignificanceRegardless 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.

Can knee osteoarthritis pain flares be predicted?

Purpose: Knee pain is the main cause of disability and reduced function in knee osteoarthritis (KOA). Though it is established that KOA pain fluctuates, there is currently no method to predict knee osteoarthritis pain flares. This project aims to identify risk factors which predict KOA pain flares in the following 30 days. Methods: Study participants were selected from SPARK, a 90-day web-based longitudinal study that examined risk factors for KOA pain flares. Participants were requested to complete an online questionnaire at 10 day intervals from day 0 (control period assessment points) and at time points whenever they experienced knee pain flare (case period assessment points) during the follow-up period. A KOA pain flare was defined as current pain >=2 points on a 0-10 point numeric rating scale compared to usual background KOA pain intensity reported at day 0. The SPARK dataset was partitioned into 3 sections: Day 0–30, Day 31–60 and Day 61–90. Exposures to the following risk factors/derived variables from Day 0–30 (D0–30) were used to identify associations/ predict KOA flares in the next/following 30 days-that is Day 31–60. Predictors assessed for the D0-30 period were as follows: (1) any episodes of buckling of index knee between D0–30 (2) any injury to index knee between D0-30 (3) percentage of days of medication used (4) physical activity, classified as mild physical activity or any moderate or any vigorous physical activity performed between D0-30 and (5) heel height worn >2/3 of assessed time period (heel height categories <2.5 cm, 2.5–5 cm, >5 cm). The (6) positive and negative affect score, (7) Intermittent and Constant Osteoarthritis Pain Score (ICOAP)/100 were assessed at D30. The participant's (8) age, (9) body mass index, (10) duration of having osteoarthritis, (11) usual background pain score and (12) worst pain score were assessed at recruitment. Patients who reported flares at the point of enrolment/baseline and those with missing observations were omitted. Logistic regression was used to identify significant risk factors. Step-wise elimination was done and only variables with P <0.1 were used for the prediction modelling. Data was analysed using STATA version 13. Results: 315 persons (62.3% females) with a mean age of 62.1 years (SD±8.2) with complete data on the variables of interest were selected. The mean body mass index was 29.8 kg/m2 (SD±6.5). The participants rated their baseline pain (on a visual analogue score) as 4.36 (SD±2) and worst pain as 7.91 (SD±1.74). 115 persons (36.3%) reported at least one flare from D31-60. The majority of variables were eliminated by step-wise elimination. Only the ICOAP constant pain sub scale at D30, the usual level of pain reported at baseline and history of any knee buckling 30 days prior were significant predictors for the occurrence of any flare in the ensuing 30 days (Table 1). Area under the receiver operating characteristic curve was 0.72 (95% Confidence Interval 0.66-0.78), suggesting a moderate predictive ability for the occurrence of knee pain flare. Conclusions: Higher ICOAP constant sub scale values at baseline, higher background pain levels reported by the patient at recruitment and any knee buckling 30 days prior predicted KOA pain flares in the ensuing 30 days.

The influence of heel height related on quality of life on the foot in a sample of women.

Many women have worn high-heel shoes (HHS) at some point in their lives and many wear them on a daily basis, with higher prevalence between 39% and 78% observed in institutional and clinical settings. The purpose of this study was to describe and compare the scores obtained with regard to foot health and health in general in a sample of women that use HHS as opposed to a sample of women without HHS with normalized reference values. A sample of 120 participants with a mean age of 41.94 ± 13.912 came to a health center where self-reported data were registered. The subjects with and without HHS were determined and the scores obtained were compared in the Foot Health Status Questionnaire (FHSQ). This questionnaire is made of 13 questions that assess 4 health domains of the feet, namely pain, function, general health and footwear. The women in the HHS group showed a worse quality of life related to health in general and to foot health specifically. Differences between the two groups were evaluated by means of a t-test for independent samples, showing statistical significance (P<0.01). Women with HHS present a negative impact on the quality of life related to foot health.

Effect of various foot wedge conditions on the electromyographic activity of lower extremity muscles during load lifting

AbstractThe level of muscle activity can be decreased with optimized foot wedge condition. The aim of this study was to evaluate the effect of different foot wedge conditions on the activity of selected lower extremity muscles during load lifting. Nine able‐bodied male subjects participated in this study. Electromyography activity of the vastus medialis (VM), vastus lateralis (VL), medialis gastrocnemius (MG), and soleus (SOL) muscles was recorded during dynamic load lifting using the squat technique in 5 conditions: i) non‐wedge (NW), ii) 1 cm heel height increasing (PW1), iii) 3 cm heel height increasing (PW3), iv) 1 cm in front of the feet (AW1), and v) 1 cm inside the feet (MW1). The results showed that the VM activity decreases in the MW1 compared to other conditions and significantly compared to the PW1 and PW3 conditions (p &lt; .05). Decreases in the VL activity in the AW1 as well as in descending and ascending phases of MW1 were observed (p &lt; .05). Also in the descending phase, the SOL activity in AW1 decreased significantly compared to NW condition (p &lt; .05). However, there was no significant difference in MG activity between different conditions (p &gt; .05). It seems that placing wedges in the anterior and medial area of the feet may decrease quadriceps muscles activity and probably can delay reaching time to fatigue during load lifting. These findings may be helpful in designing special shoes for ergonomics fields and work environments.

Effects of Different Heel Heights on Heel Pressure Distribution for Calcaneal Spur Patients During Standing: Finite Element Analysis

This study was performed to investigate heel height shoe for every patient which peak pressure in the heel area is lower than pain minimum compressive pressure. Heel heights of the shoes are standardized as 0-4 cm. Sixteen patients with symptomatic heel spur participated in this study. Peak pressure due to its own weight is estimated using FEM and compared with the results of measurement using FSR (force sensing resistor). As heel height increased, peak pressure in heel region in the heel height 2 cm, 3 cm and 4 cm are larger 3.86% and smaller 5.04% and 22.11% respectively compared to the smallest pain compressive pressure. These peak pressures are significantly higher than the average pressure in CH (center of heel) measurement results due to the difference in the location of peak pressure to CH at average of 8.64 ± 1.44 mm.