Short communicationThe influence of heel height on lower extremity kinematics and leg muscle activity during gait in young and middle-aged women
Highlights
► In young and middle-aged women muscle activity and lower limbs kinematics were assessed during gait in heeled shoes. ► Footwear of the stiletto type increases the leg muscle activity and changes knee and ankle kinematics during gait. ► Permanent wearing of heeled footwear could contribute to muscle overuse and repetitive strain injuries. ► Age-related changes alter in certain body segments the biomechanical adjustments associated with wearing heeled shoes.
Introduction
Many women in western countries have worn high-heel shoes at some time in their lives and many wear them regularly. Some researchers [1], [2] have suggested that high-heeled shoes may contribute to the development and progression of knee pain [3], and may alter muscle activation patterns [4], [5]. In this work we take a comprehensive approach and examine the effects of both low- and high-heeled gait utilizing advanced electrophysiologic and biomechanical techniques to more fully determine the effects of heeled gait. Further, we address the independent effects of age and height of the heel on changes in leg muscle activity and hip, knee, and ankle kinematics during heeled gait.
Section snippets
Methods
Thirty-one young women (20–25 years; 167.6 ± 5.8 cm; 60.35 ± 6.49 kg), and fifteen middle-aged women (45–55 years; 161.3 ± 4.2 cm; 65.8 ± 6.2 kg) ambulated in the stiletto-heeled (1 cm2 base) type shoes in one of three conditions: (1) without footwear, (2) in shoes with 4 cm heels (‘low heels’), and (3) in shoes with a height of 10 cm (‘high heels’). All measurements were performed during gait on a flat six-meter walkway with natural, self-selected speed. All study participants reported wearing high-heeled
Results
There were no significant differences in body height and weight between young and middle-aged women (167.6 ± 5.8 cm vs. 161.3 ± 4.2 cm; 60.35 ± 6.49 kg vs. 65.8 ± 6.2 kg) (p > 0.05).
Middle-aged women exhibited significantly lower hip ROM values only in the sagittal plane when compared to younger women (p < 0.05). In both groups the knee ROM in the sagittal plane was significantly greater in the low-heeled condition in comparison to barefoot gait (Fig. 1A); however, in the high-heeled condition the knee ROM was
Discussion
The most novel finding from this study is that footwear of the stiletto type significantly increases the leg muscle activity, with this effect being similar across young and middle-aged women. Additionally, we observed that high-heeled shoes restricted knee and ankle ROM, increased knee flexion, and decrease ankle eversion at the initial contact phase of gait. Below we briefly discuss the potential clinical effects and consequences of these findings.
Our observation of an increase in knee
Acknowledgement
The authors thank Edyta Mikolajczyk for help during data collection.
Conflict of interest statement
The authors declare that they have no conflict of interest.
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