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Heel Height the Effects on Gait

The purpose of this research proposal is to examine the impact of heel height on the gait of healthy human subjects.

Surveys have shown that between 37% and 69% of women wear high heels on a daily basis (Godwin, McKinzie and Royo, 2004). There have been concerns voiced by health professionals about the difficulties associated with high-heeled shoes, including increased risk of chronic back pain and osteoarthritis brought about by high heel strike transient forces. There is also an increased risk of foot-specific injuries such as bunions, blisters and hammer toes (Whittle, 1999).

Furthermore, constant heel elevation is associated with a reduction of the achilles tendon and, as stride length is diminished by walking in heels, the mobility range may be impaired in the long term (Godwin et al, 2004). Further research is required to investigate the impact of heeled shoes on the health and gait of physically able individuals, and users of leg prosthesis (Bergmann, Kniggerndorf, Graichen and Rohlmann, 1995).

A review of studies examining the biomechanical impact of wearing high heeled shoes suggests that the compensation for wearing heels would appear to occur lower in the body at the knee and ankle, rather than in the lumbar region (Hansen and Childress (2004)). This was verified in one study on the effect of shoe heel height on the walking performance of eight healthy adult female subjects (Hansen and Childress (2004)). The ankle and foot rollover shapes of subjects wearing different types of shoes with variable heel height were recorded.

Gait analysis motion measurements were obtained from all the women while they walked at three speeds (slow/usual pace/ fast) in shoes of a high heel, medium heel and no heel. Rollover shapes measured during slow, fast and self-selected walking pace were similar, but the largest adaptation occurred at the ankle when heel height increased. While rollover characteristics do not markedly change in healthy, human subjects wearing shoes of different heel heights, there were differences in the forward arc measure. Forward shift measurements did not change significantly from the heel-free shoes and the medium heel shoes, but did change significantly between the heel-free and high heel shoes.

This suggests that individuals adapt when wearing shoes of different heel heights to maintain effective rollover characteristics. However, for high heel wearers, there is a postural shift brought about by the lack of ability of the ankle to compensate for the actual height of the shoes. As with most gait to heel studies, there were methodological limitations to this study including the lack of standardisation in footwear where subjects brought in their own heeled shoes, a small sample size and restricting the experiment to stress effects of a block heel (Hansen and Childless, 2004).

Godwin et al (2004) have examined the effects of wearing shoes of different heel height on the function and adaptation of the lower limbs while walking. This study examined the impact of wearing flat shoes and five inch heels at usual pace of walking, and barefoot pace of walking of one healthy female subject. The results showed that both high heeled conditions were associated with greater relative joint angles than the barefoot condition, and there was a decrease in stride length when walking in heels.

Furthermore, wearing high heels was associated with the most gait distortion as reflected by the researchers observation that, maximum angle values for the high heel conditions occurred following heel strike, where as during barefoot gait the values surrounding heel strike were considerably less than the peak angle found at toe-off (p 465). Esenyel, Walsh, Walden and Gitter (2003) have found similar findings in their study of the gait of 15 female subjects and, in particular, confirm that high-heeled shoes are associated with lower-limb, knee and hip adaptation during walking that is not present in flat-shoe walking.

The aim of the present study will be to replicate the work of Godwin et al (2004) with five healthy adult female subjects, of similar weight and age to the original study. The main hypothesis will be that wearing high heeled shoes decreases the stride length and speed of each stride while walking, compared to the no-heel footwear. Other hypotheses that were proposed in the original study by Godwin et al (2004) will also be considered as part of the present study. By including five separate subjects it is hoped that individual differences in the impact of heeled shoes on stride length can be explored.

Subjects will be filmed during walking activities under the separate conditions of the experiment to measure the heel size by walking pace effects that will form the basis for hypothesis testing. A gait cycle will be measured as left toe-on platform to left toe off-platform angles and obtained for the three conditions of the experiment. The variables under measurement in the experiment will be knee and hip angles measured during a gait cycle, along with angular velocity in the ankle, knee and hip joints.

The experimental conditions are two heel sizes (flat heel/ high heeled shoes) and walking at natural pace, and a further condition of walking in five inch heels at a natural pace. In the original study by Godwin et al (2004), a number of statistical results have been reported on the relationship between heel size and stride length and limb angles. It will be the intention of the present study to compare results from five women tested under similar conditions, to this earlier finding. No formal statistical testing will be appropriate since only five subjects will be included in the present study. However, means and standard deviations associated with each condition will be presented, along with a qualitative exploration of individual differences between the women where appropriate.

As with many research studies in this field, the research design has methodological limitations. Most research has been conducted on healthy, young, human subjects of normal weight and with few mobility difficulties. It is unclear how useful the research findings are to the actual experience of disabled and/ or aged subjects, or individuals that are outside normal weight range who appear to suffer from more walking pain and reduced range of movement (Hulens, Vansant, Claessens, Lysens and Muls, 2003).

Furthermore, all the studies have included a small number of research subjects, usually based on opportunistic sampling and with a lack of randomisation of shoe conditions. Furthermore, the impact of different soft and hard footwear materials are also likely to contribute to human gait, irrespective of heel height, as demonstrated by Klinke, Graichen, Wolpert and Zichmer (1998). However, this has not generally been considered in other research studies. Finally Schollhorn, Nigg, Stefanyshyn and Liu (2002) have demonstrated that individual gait characteristics of 13 female human subjects, even in the highest heels, were marked by individual differences in walking style, as much as the heel conditions of the experiment. This underlies the need to explore data findings qualitatively as much as quantitatively.

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Conclusion

In conclusion, when walking in high heels, stride length would appear to be reduced and gait is therefore affected (Godwin et al, 2004). A small research study is proposed in this report that, along with other studies of similar design, can be integrated into a meta-analysis in the future to establish the overall relationship between heel height and gait for healthy subjects. In replicating the study, it is hoped that the validity of the hypothesis that high heels affect gait can be tested further. If the proposed study was to obtain similar findings to the earlier study, this could form the basis of further research in more controlled conditions and using a larger number of human subjects of different mobility levels to assess the relationship between gait and footwear in more detail.

References

Bergmann G, Kniggendorf H, Graichen F and Rohlman A (1995) Influence of shoes and heel strike on the loading of the hip joint. Journal of Biomechanics 28.7, pp 817 - 827

Esenyel M, Walsh K, Walden J and Gitter A (2000) Kinetics of high heeled gait. Journal of the American Podiatric Medical Association 93.1, pp 27 - 32

Godwin L, McKinzie T and Royo M (2004) The effect of heel height on gait: a kinematic approach. Journal of the American Podiatric Medical Association 94, pp 461 - 469

Hansen A and Childress D (2004) Effects of shoe heel height on biologic rollover characteristics during walking. Journal of Rehabilitation Research & Development 41.4, pp 547 - 554

Hulens M, Vansant G, Claessens A, Lysens R and Muls E (2003) Predictors of 6 minute walk test results in lean, obese and morbidly obese women. Scandinavian Journal of Medical Sports Science 13, pp 98 - 105

Klinke M, Graichen F, Wolpert W and Zichmer L (1998) Influence of different sport shoes on human gait. (11^th ESB Conference ESB, Toulouse)

Schollhorn W, Nigg B, Stefanyshyn D and Liu W (2002) Identification of individual walking patterns using time discrete and time continuous data sets. Gait and Posture 15, pp 180 - 186

Whittle M (1999) Generation and attenuation of transient impulsive forces beneath the foot: a review. Gait and Posture 10, pp 264 - 275

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