Influence of high-heeled shoes on the sagittal balance of the spine and the whole body

The effect of ethnicity on the age-related changes of spinopelvic characteristics: a systematic review

Aims

Spinopelvic characteristics influence the hip’s biomechanical behaviour. However, to date there is little knowledge defining what ‘normal’ spinopelvic characteristics are. This study aims to determine how static spinopelvic characteristics change with age and ethnicity among asymptomatic, healthy individuals.

Methods

This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify English studies, including ≥ 18-year-old participants, without evidence of hip or spine pathology or a history of previous surgery or interventional treatment, documenting lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). From a total of 2,543 articles retrieved after the initial database search, 61 articles were eventually selected for data extraction.

Results

When all ethnicities were combined the mean values for LL, SS, PT, and PI were: 47.4° (SD 11.0°), 35.8° (SD 7.8°), 14.0° (SD 7.2°), and 48.8° (SD 10°), respectively. LL, SS, and PT had statistically significant (p < 0.001) changes per decade at: −1.5° (SD 0.3°), −1.3° (SD 0.3°), and 1.4° (SD 0.1°). Asian populations had the largest age-dependent change in LL, SS, and PT compared to any other ethnicity per decade at: −1.3° (SD 0.3°) to −0.5° (SD 1.3°), –1.2° (SD 0.2°) to −0.3° (SD 0.3°), and 1.7° (SD 0.2°) versus 1.1° (SD 0.1°), respectively.

Conclusion

Ageing alters the orientation between the spine and pelvis, causing LL, SS, and PT to modify their orientations in a compensatory mechanism to maintain sagittal alignment for balance when standing. Asian populations have the largest degree of age-dependent change to their spinopelvic parameters compared to any other ethnicity, likely due to their lower PI.

Cite this article: Bone Joint Res 2023;12(4):231–244.

Wearing high-heeled shoes on a side slope makes standing balance unstable

INTRODUCTION

Many women wearing high-heeled footwear are at high risk of falls. Past studies have examined the balance on level ground or balance during walking. We measured the standing balance on the ground and side slopes for 18 healthy women.

METHOD

Body sway was evaluated based on the center of pressure (COP) while participants stood on level ground on a side slope. The total locus length as well as rectangular and outer peripheral areas were then measured using a Zebris system. Measurements were compared under bare feet, normal shoe, and high-heeled shoe conditions.

RESULTS

On level ground, there were no significant differences among the three conditions. On the side slope, the total locus length (TLL), rectangular area (RA) and outer peripheral areas (OPA) were significantly greater for the high-heeled shoes than for the bare feet and normal shoes. Standing on the side slope caused larger body sway than on the level ground, along with a higher risk of falling.

DISCUSSION

In TLL, OPA, and RA, the COP moved outside substantially when participants stood on a slope in high heels than in shoes. High heels were highly unstable for standing on a slope since the ankle joint of one leg is in plantar flexion, the foot is pronated, and the other side is plantarflexed at the ankle with pronation of the foot.

CONCLUSION

High-heeled shoes significantly alter a person's balance when standing on a side slope, suggesting a high risk of falling.

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.

THE INFLUENCE OF DIFFERENT-HEIGHT HEEL SHOES ON MOTOR FUNCTION OF LOWER LIMB JOINTS IN THE YOUNG FEMALE PERFORMERS

Objective: This study aims to explore how shoes with different height heels affect female gait characteristics and motor function of lower limb joints. Methods: Video analysis and myoelectricity tester were applied to the walking test of 12 female models wearing shoes with 0, 3, 6, 10, and 18[Formula: see text]cm heels. Results: (1) When being barefoot and wearing the flat shoes, the models took a longest step, and the step length decreased with the increase of the shoe heel. (2) When walking in the flat shoes, the models kept the center of gravity highly stable. With the increase of the shoe heel, the center of gravity went ups and downs obviously in the direction of Z and Y when models were walking. (3) When models walked in the flat shoes, the smallest changes occurred in the hip joint angle. With the increase of the shoe heel, the stretching ranges of knee joint angle and ankle joint angle decreased. (4) When models walked in the flat shoes, electromyographic mean power frequency (MPF) indicated that active frequency of gastrocnemius and soleus were the highest and time-domain parameter suggested that active scope of biceps femoris and soleus increased most. There was difference in active frequency between the dominated leg and the nondominated leg. Conclusion: Flat shoes or 3–6[Formula: see text]cm heel shoes were the best for walking. It is recommended to choose shoes with a heel height higher than 10[Formula: see text]cm when walking,and try to control wear more than 10[Formula: see text]cm heel walking time, otherwise, there will be a risk of falls. When choosing a heel with a height higher than 10[Formula: see text]cm, the walking speed and walking length must be reduced. At the same time, try to control the walking time of wearing high heels with the heel height over 10[Formula: see text]cm, otherwise it will cause the risk of fall.

Bionic Footwear Effect to Lower Limb Locomotion in Biomechanical Analysis

Many scientific data have proven that regular wearing of high-heeled shoes adversely affects human health. Recent evidence suggested that bionic heels imitated hoofed animals have attracted widespread attention. However, few biomechanical studies have investigated the effects of bionic high-heeled footwear on the lower limbs. Accordingly, this study aimed to examine the impact of bionic high-heeled shoes (HHS) on the biomechanical characteristics of lower limbs by comparing kinematics and kinetics of walking in HHS and bionic flat-bottomed shoes (FBS). they find that when the subjects wore HHS, the loading is concentrated in the forefoot region for a much longer time. Couple with HHS lacks the cushioning effect of the complete sole, the sole has to rely only on plantar flexion and dorsiflexion of the ankle joint to cushion the impact force, which will undoubtedly increase the fatigue damage of the ankle joint. The unique split-toe structure balances the loading between the toes could reduce the risk of toes injury during walking. However, there are still risks of injury to the lower limbs of HHS, especially the ankle and knee joints.

A preliminary study on the influence of high heel footwear on lumbar spine proprioception

Study aim: High heel footwear (HHF) alters posture and kinetics of the lower limbs and spine. Various musculoskeletal disorders in the lower quadrant can occur as a consequence of HHF use. This study aimed to investigate the effect of habitual use of HHF on lumbar spine proprioception.

Material and methods: Thirty young healthy women (mean age: 21.6 ± 1.6 years; height: 157.6 ± 5.9 cm; weight: 57 ± 10.2 kg) participated in this study. Participants were randomly allocated to one of the two sequences of walking with HHF or walking barefoot for five minutes on a predetermined walkway consisting of an even surface, ramp and stairs. A 24-hour washout period was incorporated between each walking condition. Lumbar spine repositioning error was measured using a Back Range of Motion II (BROM II) device before and after walking for lumbar spine forward flexion, right, and left lateral flexion.

Results: Measurements showed that repositioning error was significantly higher in all spinal movements after walking with HHF (forward flexion p = 0.0044; right lateral flexion p = 0.0243 left lateral flexion p = 0.0379) as compared to barefoot walking.

Conclusion: The findings of this study suggest that HHF alters lumbar spine proprioception. This study provides evidence to support early assessment of proprioception and incorporation of retraining exercises in habitual users of HHF.

Influence of high-heeled shoe parameters on biomechanical performance of young female adults during stair ascent motion

BACKGROUND

High-heeled shoes are currently preferred by women due to contemporary aesthetics. However, high-heeled shoes may increase the effort required to ascend stairs and, hence, alter biomechanical performance.

RESEARCH QUESTION

How do high-heel shoe parameters affect the pelvis position, lower extremities kinematics, and ground reaction force in young women during stair ascent motion?

METHODS

Stair ascent experiments were performed with 20 healthy adult women. The participants were instructed to ascend a 3-step staircase, wearing heeled shoes of different heel heights and heel types and one pair of flat shoes as the control group. Changes in lower body biomechanics were analyzed with kinematics and ground reaction force variables collected from the dominant limb. A two-way repeated ANOVA was performed to determine which variables were affected by heel type and which were affected by heel height or a combination of both.

RESULTS

As the heel height increased, an increased range of ankle dorsiflexion-plantarflexion, as well as pelvic rotation, was observed(P = 0.039 and P = 0.003, respectively). A thinner heel type displayed a larger pelvic forward tilt movement(P = 0.026)and 1st peak vertical force(P = 0.025), as well as a smaller 2nd peak vertical force (P = 0.002). With high heels, increased external rotation of the knee, inversion and plantar flexion, and flexion values of the knee were observed. We also observed decreased external rotation of the pelvis, ankle eversion, varum, and dorsiflexion.

SIGNIFICANCE

To stabilize body posture during stair ascent motion with high-heeled shoes, compensatory response including increasd pelvic range of motion and changing the joint angles of the lower extremities.

Decreased Vertical Trunk Inclination Angle and Pelvic Inclination as the Result of Mid-High-Heeled Footwear on Static Posture Parameters in Asymptomatic Young Adult Women

The influence of high-heel footwear on the lumbar lordosis angle, anterior pelvic tilt, and sacral tilt are inconsistently described in the literature. This study aimed to investigate the impact of medium-height heeled footwear on the static posture parameters of homogeneous young adult standing women. Heel geometry, data acquisition process, as well as data analysis and parameter extraction stage, were controlled. Seventy-six healthy young adult women with experience in wearing high-heeled shoes were enrolled. Data of fifty-three subjects were used for analysis due to exclusion criteria (scoliotic posture or missing measurement data). A custom structured light surface topography measurement system was used for posture parameters assessment. Three barefoot measurements were taken as a reference and tested for the reliability of the posture parameters. Two 30-degree wedges were used to imitate high-heel shoes to achieve a repeatable foot position. Our study confirmed the significant (p < 0.001) reduced vertical balance angle and pelvis inclination angle with large and medium-to-large effects, respectively, due to high-heel shoes. No significant differences were found in the kyphosis or lordosis angles. High-heeled shoes of medium height in young asymptomatic women can lead to a straightening effect associated with a reduced vertical balance angle and decreased pelvic inclination.

The shape and mobility of the thoracic spine in asymptomatic adults - A systematic review of in vivo studies

A comprehensive knowledge of the thoracic shape and kinematics is essential for effective risk prevention, diagnose and proper management of thoracic disorders and assessment of treatment or rehabilitation strategies as well as for in silico and in vitro models for realistic applications of boundary conditions. After an extensive search of the existing literature, this study summarizes 45 studies on in vivo thoracic kyphosis and kinematics and creates a systematic and detailed database. The thoracic kyphosis over T1-12 determined using non-radiological devices (34°) was relatively less than measured using radiological devices (40°) during standing. The majority of kinematical measurements are based on non-radiological devices. The thoracic range of motion (RoM) was greatest during axial rotation (40°), followed by lateral bending (26°), and flexion (21°) when determined using non-radiological devices during standing. The smallest RoM was identified during extension (13°). The lower thoracic level (T8-12) contributed more to the RoM than the upper (T1-4) and middle (T4-8) levels during flexion and lateral bending. During axial rotation and extension, the middle level (T4-8) contributed the most. Coupled motion was evident, mostly during lateral bending and axial rotation. With aging, the thoracic kyphosis increased by about 3° per decade, whereas the RoM decreased by about 5° per decade for all load directions. These changes with aging mainly occurred in the lower region (T6-12). The influence of sex on thoracic kyphosis and the RoM has been described as partly contradictory. Obesity was found to decrease the thoracic RoM. Studies comparing standing, sitting and lying reported the effect of posture as significant.

Effects of high-heeled footwear on static and dynamic pelvis position and lumbar lordosis in experienced younger and middle-aged women

There is still conflicting evidence about the effect of high-heeled footwear on posture, especially if methodological confounders are taken into account. The purpose of this study was to investigate the effect of high-heeled footwear on lumbopelvic parameters in experienced younger and middle-aged women while standing and walking. Thirty-seven experienced younger (n=19:18-25 years) and middle-aged (n=18:26-56 years) women were included in this randomized crossover study. Using a non-invasive back shape reconstruction device (rasterstereography), static (pelvic tilt and lumbar lordosis angle) and dynamic (pelvic rotation, median lumbar lordosis angle and range of motion) parameters representing pelvis position and lumbar curvature were measured. In order to analyse standing and walking on a treadmill (0.83m/s), the effects of high-heels (7-11cm) were compared to standard control shoes. There were no effects on the lumbar lordosis angle or range of motion under static or dynamic conditions (p>0.05, d≤0.06). But there was a small effect for a reduced pelvic tilt (p=0.003, d=0.24) and a moderate effect for an increased transversal pelvic rotation (p=0.001, d=0.63) due to high heel shoed standing or walking, respectively. There were no significant age-group or interaction effects (p>0.05). Altered pelvic parameters may be interpreted as compensatory adaptations to high-heeled footwear rather than lumbar lordosis adaptations in experienced wearers. The impact of these findings on back complaints should be revisited carefully, because muscular overuse as well as postural load relieving may contribute to chronic consequences. Further research is necessary to examine clinically relevant outcomes corresponding to postural alterations.