Transient pain and discomfort when wearing high-heeled shoes.

In the dynamic world of fashion, high-heeled footwear is revered as a symbol of style, luxury and sophistication. Yet, beneath the facade of elegance of classy footwear lies the harsh reality of discomfort and pain. Thus, this study aims to investigate the influence of wearing high-heeled shoes on the sensation of pain across different body regions over a period of 6 h. It involved fifty female participants, all habitual wearers of high-heeled shoes, aged between 20 and 30 years. Each participant kept a record of their perceptions of pain and discomfort every hour for a total of 6 h using a 0-10 pain scale with 0 indicating no pain and 10 indicating severe pain. The findings reveal a progressive rise in pain throughout wear, with the most intense pain reported in the back, calcaneus, and metatarsals. The analysis shows that after approximately 3.5 h, participants experience significant increases in pain levels. However, the relationship between heel height and pain is not linear. It appears that a heel height of 7.5 cm is the threshold where overall body pain becomes significant. The study suggests that a duration of 3.5 h of wear and a heel height of 7.5 cm serve as critical points to decrease overall body pain. Moreover, beyond this heel height, knee pain diminishes compared to other body areas possibly due to the shift towards a more neutral posture. The study findings, coupled with the recommendations, can assist footwear designers in crafting not only stylish but also comfortable shoes.

Immediate Effect of Simulated High Heels on Pelvic and Spinal Posture in Healthy Young Subjects: A Cross-Sectional Study.

Background Investigations regarding the role of high-heeled shoes in the alteration of the spinopelvic profile attempted to identify a correlation with pain in the lower back. Conclusions from these studies, however, are controversial. In authors knowledge no studies were carried out to investigate the effect of heels on male population, which has been overlooked due to gender-related customs. Research question What is the immediate effect of the height of heels on the sagittal back profile (trunk inclination (TI), pelvic inclination, lordotic lumbar angle (ITL-ILS), kyphotic dorsal angle, lumbar arrow, and cervical arrow) in females and males, not used to wearing high-heeled shoes? Methods One hundred healthy young adult subjects were enrolled. Three were excluded. The remaining 97 subjects (48 female and 49 male) underwent a three-dimensional analysis of the posterior surface of the trunk, using rasterstereography. The spinopelvic profile in the barefoot condition, and with the heel raised by 3 and 7 cm, was recorded. To evaluate the reproducibility of the measure, the neutral evaluation was repeated twice in 23 subjects (13 males, 10 females). Results The change of heel height did not show statistically significant differences for any of the variables used; instead, significant differences were found stratifying the results according to the sex of the subjects tested. Test-retest evaluation in the neutral condition showed no significant differences using the Student's t-test (p > 0.05). Repeatability was excellent and significant for all data used (minimum TI r = 0.85, maximum ITL-ILS r = 0.97). Significance Studying the effect of heels on the spino-pelvic profile also in the male population is crucial for promoting gender-inclusive healthcare, enhancing occupational health practices and developing possible preventive measures. Nevertheless, in the sample of females and males evaluated in this study, the different heights of heel lift did not immediately induce significant changes in pelvis and spine posture. If there is therefore a correlation between low-back pain and the use of heels, it should not reasonably be sought in the immediate change of the spino-pelvic profile caused by raising the heels. However, the variables analyzed differed according to sex.

The Effect of Walking in High Heels on the Activation and Deactivation of Upper Trunk Muscles.

The aim of the study was to investigate how high-heeled walking affects the coordination changes of timing of upper trunk muscle activation, and the possible occurrence of health problems in this part of the body of young women. We used surface electromyography (EMG) for data collection. The research group consisted of 30 women. Statistical significance of the changes in muscle coordination was confirmed when evaluating two of the four upper trunk muscles studied. M. trapezius and m. pectoralis major are not subject to changes in gait in high heels (HH) from the point of view of timing on a statistical level, but HH increase the intensity of muscle contraction of all monitored muscles, and therefore we recommend limiting the wearing of HH in case of health problems related to these muscles.

Biomechanical effects of high heeled shoes on neck pain among females: A narrative review.

Neck pain is the fourth leading cause of disability, and is the most common musculoskeletal disorder. High-heel shoes, one of the significant identities of females, cause pain in the neck as well as in feet and ankle regions. The current narrative review was planned to explore evidence to highlight the biomechanical factors of high-heel shoes as the source of neck pain, which mostly remains undiagnosed. PubMed and Google Scholar search engines were explored for full text of research articles published in English language from 2016 to 2021. Of the 82 studies initially found, 22(27%) were shortlisted for full-text assessment, and, of them, 6 (27.27%) were selected for detailed analysis. Despite other contributing factors, kinematics and kinetics should be considered primarily during neck pain management. Based on best available evidence, high heels increase the individual's height, but result in significant decrease in trunk flexion. Evidence also suggests that the type and width of heels do not affect as much as the height of the heels in the context of pain and functional issues in the cervical region.

Effect of wearing high-heeled shoes on postural control and foot loading symmetry.

Purpose: This study aimed to evaluate the effects of high-heeled shoes (HHS) and experience with such footwear on foot loading and standing balance using linear and nonlinear methods. Methods: Sixteen young female experts in wearing high-heeled shoes (HHE) and sixteen young females who occasionally wore high-heeled shoes (HHO) completed a Fall Risk Test (FRT) on the Biodex Balance System platform. They also underwent a both-leg standing test on the Zebris pressure mapping platform, both barefoot and while wearing 11 cm HHS. The study analyzed several parameters, including the FRT index, foot loading parameters, linear measures of postural stability (Center of Pressure (CoP) path length and velocity), and nonlinear postural control measures (sample entropy - SampEn, fractal dimension - FD, and the largest Lyapunov exponent - LyE). Results: HHS caused a significant increase the fall risk of more than 44%, but only in the HHE group. The presence of HHS caused a significant increase in CoP path length and CoP velocity by almost 78%. The values of these parameters increased by more than 67% in the HHO group and by more than 92% in the HHE group. HHS caused a significant increase in the values of nonlinear measures (FD and LyE) in the mediolateral direction. Higher FD and LyE values suggest the ability to react faster to destabilizing stimuli and better balance control related to plasticity and adaptability to new conditions. HHS also led to up to 70% loading on the supporting limb. Conclusions: High heels in the population of young women significantly worsen static balance.

A type-2 fuzzy index to assess high heeled gait deviations using spatial-temporal parameters.

This paper introduces an intelligent index that numerically assesses high-heeled gait deviations. Experiments were conducted on 14 young female volunteers, and the spatial-temporal gait parameters were calculated at each heel height. A type-2 fuzzy system index was built using the baseline case (barefoot). The index showed sensitivity to heel height changes. Moreover, its values divided the heel heights used in this study into three groups, depending on their effect on the gait parameters. A high correlation between the proposed index and the gait profile score (GPS) was found, this supports the index validity to evaluate different human gait deviations.

Effect of Low Versus High-Heeled Footwear on Spinopelvic Alignment at Different Phases of Menstrual Cycle in Young Adult Women: A Biopsychosocial Perspective.

High-heeled shoes adversely affect spinal curvature, increase the risk of low back pain, and disturb the normal gait pattern. The purpose of this study was to examine, from a biopsychosocial point of view, the combined effect of wearing two different heel heights and of hormonal oscillation throughout different phases of the menstrual cycle on spinopelvic alignment. Notably, 70 females with an average age of 20.42 ± 1.51 years participated in this study, wearing each female two different heel heights as follows: low (2.5 cm) and high (7 cm). Spinopelvic alignment was evaluated by rasterstereography formetric 3D analysis during early follicular, ovulatory, and mid-luteal phases of the menstrual cycle. Statistical analysis showed that there was no significant difference (p > 0.05) on spinopelvic alignment [kyphotic angle (KA), trunk inclination (TI), and pelvic inclination] between wearing low- or high-heeled shoes during early follicular, ovulatory, and mid-luteal phases of the menstrual cycle. Considering that high-heeled shoes are traditionally associated with femininity, body image, beauty, and charm, this research has important biopsychosocial implications that should be explored in detail in future studies.

Increased knee flexion and varus moments during gait with high-heeled shoes: A systematic review and meta-analysis.

BACKGROUND: High-heeled shoes have been thought to alter lower extremity joint mechanics during gait, however its effects on the knee remain unclear. RESEARCH QUESTION: This systematic review and meta-analysis aimed to determine the effects of high-heeled shoes on the sagittal- and frontal-plane knee kinetics/kinematics during gait. METHODS: 1449 studies from 6 databases were screened for the following criteria: 1) healthy adult females, 2) knee joint kinematics/kinetics reported for the early stance phase during gait under varying shoe heel heights (including barefoot). Excluded studies included those mixing different shoe styles in addition to altering the heel heights. A total of 14 studies (203 subjects) met the selection criteria, resulting in 51 and 21 Cohen's d effect sizes (ESs) comparing the differences in knee sagittal- (flexion) and frontal-plane (varus) moment/angle, respectively, between shoes with higher heels and shoes with lower heels/barefoot. RESULTS: Meta-analyses yielded a significant medium-to-large effect of higher heels compared to lower heels on increasing knee flexion moment (overall ES = 0.83; P < 0.01), flexion angle (overall ES=0.46; P < 0.01), and varus moment (overall ES=0.52; P < 0.01) during the early stance phase of gait. The results of meta-regressions used to explore factors explaining the heterogeneity among study ESs revealed that a greater ES in the knee flexion moment was associated with an elevated heel height of the high-heeled shoes (P = 0.02) and greater body mass of the individuals (P = 0.012). A greater ES in the knee varus moment during high-heeled gait was associated with a greater body height (P = 0.003) and mass (P = 0.006). SIGNIFICANCE: Given the association between increased knee flexion/varus moments and risk of developing knee osteoarthritis (OA), women who wear high-heel shoes frequently and for a long period may be more susceptible to knee OA. Preventive treatments, such as lower extremity muscle strengthening, may help improve shock absorption to decrease knee loading in high-heel users.

Biomechanic of ballroom dance: corporate adaptations with different footwear / Biomecânica da dança de salão: adaptações corporais com diferentes calçados

ABSTRACT The aim of this study was to compare the joint amplitude, spine angulation and displacement of the center of mass during the execution of gafieira samba with and without high heels at different speed. In addition, the reproducibility of the movement was tested. Fifteen experienced dancers performed a sequence of gafieira samba steps under the conditions: high heels (7.5cm) and flats at two speeds according to the beat of music (72 and 96bpm). Kinematic analysis was performed on the Vicon® system with 11 cameras (100 Hz). Twenty-one reflective markers were positioned over the participants' bodies to calculate the center of mass and joint angles of the lower limbs and spine. Reproducibility was determined by the intraclass correlation coefficient and the comparison between conditions was tested by a Two-way Analysis of Variance, with the factors footwear and speed. The results indicated to a moderate to very high reproducibility in all variables analyzed. No differences were found between lumbar curvature, thoracic and displacement of the center of mass. There was no interaction between types of footwear and step execution speed, but analyzing the main factors, there was a decrease in the left ankle plantiflexion angle with increasing speed. The ankle angles showed a significant decrease under the condition flats when compared to high heels. In conclusion, high heels do not alter lumbar curvature, displacement of the center of mass and knee and hip joint amplitude in the execution of gafieira samba.

RESUMO O objetivo deste estudo foi comparar a amplitude articular, angulação da coluna e deslocamento do centro de massa durante execução do samba de gafieira com e sem salto alto em diferentes velocidades. Adicionalmente, a reprodutibilidade do movimento foi testada. Quinze dançarinas experientes realizaram uma sequência de passos de samba de gafieira nas condições: salto alto (7,5 cm) e sapatilha em duas velocidades de execução de acordo com o compasso das músicas (72 e 96bpm). A análise cinemática foi realizada no sistema Vicon® com 11 câmeras (100 Hz). Vinte e um marcadores reflexivos foram posicionados sobre o corpo das participantes a fim de calcular o centro de massa e ângulos articulares dos membros inferiores e coluna. A reprodutibilidade foi determinada pelo coeficiente de correlação intraclasse e a comparação entre condições foi testada por uma análise de variância Two way, com os fatores calçados e velocidade. Os resultados indicaram para uma reprodutibildade de moderada a muito alta em todas as variavéis analisadas. Não foram encontradas diferenças entre as curvaturas da lombar, torácia e deslocamento do centro de massa. Não houve interação entre tipos de calçado e velocidade de execução dos passos, porém analisando os fatores principais, ocorreu uma diminuição do ângulo de plantiflexão do tornozelo esquerdo com o aumento da velocidade. Os ângulos de tornozelo apresentaram diminuição significativa em situação do uso de sapatilhas, quando comparados ao salto. Conclui-se que o salto alto não altera a curvatura da lombar, deslocamento de centro de massa e amplitude articular do joelho e quadril na execução do samba de gafieira.

Effect of heel base area and walking speed on the utilized coefficient of friction during high-heeled walking.

BACKGROUND: The utilized coefficient of friction (uCOF) and the risk of slipping are known to increase as the heel height of shoes increases. The heel base area of shoes can also affect the uCOF. OBJECTIVE: The purpose of this study is to investigate the effect of the heel base area of high heels and walking speed on the uCOF during walking and their interaction effect. METHODS: The walking experiment was conducted at the speed of 1.0 m/s and 1.25 m/s using four 9-cm high heels having different heel areas (narrow, moderate, wide, and wedge heels). RESULTS: The peak uCOF was significantly lower when wearing the wide heels than when wearing the other heels. Wearing the narrow and moderate heels reduced the vertical ground reaction force (GRF) owing to the early timing of the peak anterior-posterior GRF and increased the peak uCOF. As the walking speed became faster, the peak uCOF became greater with more increases by the interaction effect when wearing the narrow and moderate heels than when wearing the wide and wedge heels. CONCLUSIONS: These results imply that wearing narrow high heels should be considered carefully, as the potential for a slip could be high owing to the increase in the peak uCOF. If it is inevitable to wear narrow high heels, it is critical to walk at a slower speed than usual. It is better to wear high heels with a wide heel area, e.g., 3 cm*3 cm, rather than narrow high heels or even wedge heels to reduce the possibility of slipping.

Everyday footwear: An overview of what we know and what we should know on ill-fitting footwear and associated pain and pathology.

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.

Hallux valgus among sales promotion women wearing high heels in a department store.

BACKGROUND: Wearing high heels for an extended period of time can cause several pathological conditions in women's feet, one of such is the hallux valgus (HV), as shown by a number of cross-sectional studies. This study aims to evaluate the incidence of HV among sales promotion women and to know the association of the high heel shoes with the severity of HV in that population. METHOD: This study used comparative cross-sectional design between two groups, wearing high heel and flat shoes; sales promotion women who work for at least 1 year were recruited as subjects by means of purposive sampling and were given questionnaires, and then physical and radiological examination of the foot were performed to detect any HV and its severity. RESULT: Incidence of HV is 25.25% (25 of 99) among subjects who were wearing high heel shoes and 10.87% (10 of 92) for those who were wearing flat shoes. Subjects wearing high heel shoes are 2.77 times (95% confidence interval (CI): 1.25-6.15; p = 0.01) more at risk for developing HV than those who wore flat shoes. The incidence of HV increases with age ( p < 0.05). Those who have been working for >4 years are 5.2 times (95% CI: 1.95-14.31) at more risk for developing HV than those who have been working for ≤4 years ( p < 0.001). The duration of wearing shoes per day, the type of toe box, and body mass index are not statistically significant with HV ( p > 0.05). The incidence of HV increased among overweight and obese subjects ( p > 0.05). The severity of HV in subjects was mostly mild to moderate. CONCLUSION: The incidence of HV is higher among sales promotion women who wear high heel shoes than flat shoes. Age and working experience are also related to the development of HV. Factors that affect the severity of HV cannot be shown in this study.

Recognition of a Person Wearing Sport Shoes or High Heels through Gait Using Two Types of Sensors.

Biometrics is currently an area that is both very interesting as well as rapidly growing. Among various types of biometrics the human gait recognition seems to be one of the most intriguing. However, one of the greatest problems within this field of biometrics is the change in gait caused by footwear. A change of shoes results in a significant lowering of accuracy in recognition of people. The following work presents a method which uses data gathered by two sensors: force plates and Microsoft Kinect v2 to reduce this problem. Microsoft Kinect is utilized to measure the body height of a person which allows the reduction of the set of recognized people only to those whose height is similar to that which has been measured. The entire process is preceded by identifying the type of footwear which the person is wearing. The research was conducted on data obtained from 99 people (more than 3400 strides) and the proposed method allowed us to reach a Correct Classification Rate (CCR) greater than 88% which, in comparison to earlier methods reaching CCR’s of <80%, is a significant improvement. The work presents advantages as well as limitations of the proposed method.

Analysis of foot kinematics wearing high heels using the Oxford foot model.

Wearing high heels is thought to lead to various foot disorders and injuries such as metatarsal pain, Achilles tendon tension, plantar fasciitis and Haglund malformation. However, there is little available information explaining the specific mechanisms and reasons why wearing high heels causes foot deformity. Therefore, the purpose of this study was to investigate the foot kinematics of high heel wearers and compare any differences with barefoot individuals using the Oxford Foot Model (OFM). Fifteen healthy women aged 20-25 years were measured while walking barefoot and when wearing high heels. The peak value of angular motion for the hallux with respect to the forefoot, the forefoot with respect to the hind foot, and the hind foot with respect to the tibia were all analyzed. Compared to the barefoot, participants wearing high heels demonstrated larger hallux dorsiflexion (22.55∘± 1.62∘ VS 26.6∘± 2.33∘ for the barefoot; P= 0.001), and less hallux plantarflexion during the initial stance phase (-4.86∘± 2.32∘ VS -8.68∘± 1.13∘; P< 0.001). There were also greater forefoot adduction (16.15∘± 1.37∘ VS 13.18∘± 0.79∘; P< 0.001), but no significant differences were found in forefoot abduction between the two conditions. The hind foot demonstrated a larger dorsiflexion in the horizontal plane (16.59∘± 1.69∘ VS 12.08∘± 0.9∘; P< 0.001), greater internal rotation (16.72∘± 0.48∘ VS 7.97∘± 0.55∘; P< 0.001), and decreased peak hind foot extension rotation (-5.49∘± 0.69∘ VS -10.73∘± 0.42∘; P= 0.001). These findings complement existing kinematic evidence that wearing high heels can lead to foot deformities and injuries.

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

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.

Effects of high heeled shoes on gait. A review.

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.

Why Women Wear High Heels: Evolution, Lumbar Curvature, and Attractiveness.

Despite the widespread use of high-heeled footwear in both developing and modernized societies, we lack an understanding of this behavioral phenomenon at both proximate and distal levels of explanation. The current manuscript advances and tests a novel, evolutionarily anchored hypothesis for why women wear high heels, and provides convergent support for this hypothesis across multiple methods. Using a recently discovered evolved mate preference, we hypothesized that high heels influence women's attractiveness via effects on their lumbar curvature. Independent studies that employed distinct methods, eliminated multiple confounds, and ruled out alternative explanations showed that when women wear high heels, their lumbar curvature increased and they were perceived as more attractive. Closer analysis revealed an even more precise pattern aligning with human evolved psychology: high-heeled footwear increased women's attractiveness only when wearing heels altered their lumbar curvature to be closer to an evolutionarily optimal angle. These findings illustrate how human evolved psychology can contribute to and intersect with aspects of cultural evolution, highlighting that the two are not independent or autonomous processes but rather are deeply intertwined.

The 2016 HIGh Heels: Health effects And psychosexual BenefITS (HIGH HABITS) study: systematic review of reviews and additional primary studies.

BACKGROUND: High-heeled shoes (high heels) are frequently worn by many women and form an important part of female gender identity. Issues of explicit and implicit compulsion to wear high heels have been noted. Previous studies and reviews have provided evidence that high heels are detrimental to health. However, the evidence base remains fragmented and no review has covered both the epidemiological and biomechanical literature. In addition, no review has considered the psychosexual benefits that offer essential context in understanding the public health challenge of high heels. METHODS: We searched seven major bibliographic databases up to November 2016, in addition to supplementary searches. We initially identified all review articles of any design that assessed either the psychosexual benefits or negative musculoskeletal health effects of high heels, the latter looking at both the epidemiological and biomechanical perspectives. We additionally considered additional primary studies on areas that had not been reviewed before or in which a marked lack of evidence had been noted. Data were extracted onto standardised forms. Proportionate second review was conducted. RESULTS: A total of 506 unique records were identified, 27 full-text publications were screened and 20 publications (7 reviews and 13 additional studies) were included in our evidence synthesis. The most up-to-date epidemiological review provides clear evidence of an association between high heel wear and hallux valgus, musculoskeletal pain and first-party injury. The body of biomechanical reviews provides clear evidence of changes indicative of increased risk of these outcomes, as well as osteoarthritis, which is not yet evidenced by epidemiological studies. There were no reviews on psychosexual benefits, but all five identified original studies provided evidence of increased attractiveness and/or an impact on men's behaviour associated with high heel wear. With regard to second-party injury, evidence is limited to one descriptive study and eight case reports. CONCLUSIONS: Our evidence synthesis clearly shows that high heels bring psychosexual benefits to women but are detrimental to their health. In light of this dilemma, it is important that women's freedom of choice is respected and that any remaining issues of explicit or implicit compulsion are addressed.

High-heeled walking decreases lumbar lordosis.

An estimated 78% of women regularly walk in high heels. However, up to 58% complain about low back pain, which is commonly thought to be caused by increased lumbar lordosis. However, the extent to which a subject's posture is modified by high-heeled shoes during dynamic activities remains unknown. Therefore, we sought to evaluate whether low- or high-heeled shoes influence the kinematics of the pelvis and the spine during walking. Twenty-three inexperienced women, and seventeen women experienced in wearing high-heeled shoes, all aged 20-55 years, were measured barefoot and while wearing low- (4cm) and high-heeled (10cm) shoes during gait at a self-selected speed. A 22-camera motion capture system was used to assess the gait patterns for each condition. No significant inter-experience-group kinematic differences were found. In contrast to the results of some studies, our results show that the heels' height does indeed influence the motion of the pelvis and the spine during walking, whereby low-heeled shoes influenced the subjects' trunk kinematics during gait less than high-heeled shoes compared to barefooted walking. However, inexperienced high-heel wearers showed less thoracic curvature angle while wearing high-heels than while wearing low-heels. Importantly, both groups exhibited significantly lower maximum and minimal lumbar and thoracic curvature angles when wearing high-heeled shoes compared to the barefoot condition. As a result, it seems that low back pain might be associated with other factors induced by high-heels.

Effects of shoe heel height on the end-point and joint kinematics of the locomotor system when crossing obstacles of different heights.

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.