Kerrigan DC, Johansson JL, Bryant MG, Boxer JA, Della Croce U, Riley PO. Moderate-heeled shoes and knee joint torques relevant to the development and progression of knee osteoarthritis

Università degli Studi di Sassari, Sassari, Sardinia, Italy
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 06/2005; 86(5):871-5. DOI: 10.1016/j.apmr.2004.09.018
Source: PubMed


To determine if women's dress shoes with heels of just 1.5 in (3.8 cm) in height increases knee joint torques, which are thought to be relevant to the development and/or progression of knee osteoarthritis (OA) in both the medial and patellofemoral compartments.
Randomized controlled trial.
A 3-dimensional motion analysis gait laboratory.
Twenty-nine healthy young women (age, 26.7+/-5.0 y) and 20 healthy elderly adult women (age, 75.3+/-6.5 y).
Not applicable.
Peak external varus knee torque in early and late stance and prolongation of flexor knee torque in early stance. Three-dimensional data on lower-extremity torques and motion were collected during walking while (1) wearing shoes with 1.5-in high heels and (2) wearing control shoes without any additional heel. Data were plotted and qualitatively compared; major peak values and timing were statistically compared between the 2 conditions using paired t tests.
Peak knee varus torque during late stance was statistically significantly greater with the heeled shoes than with the controls, with increases of 14% in the young women and 9% in the elderly women. With the heeled shoes, the early stance phase knee flexor torque was significantly prolonged, by 19% in the young women and by 14% in elderly women. Also, the peak flexor torque was 7% higher with the heeled shoe in the elderly women.
Even shoes with moderately high heels (1.5 in) significantly increase knee torques thought to be relevant in the development and/or progression of knee OA. Women, particularly those who already have knee OA, should be advised against wearing these types of shoes.

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Available from: Ugo Della Croce,
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    • "They reported a reduction of peak knee external adduction moment in flip-flops and barefoot compared to a clog shoe and a stability shoe and attributed this to the reduced heel height in the flip-flop and barefoot conditions compared to the clog and stability shoes. Kerrigan et al. [16] reported that a moderate heeled shoe produced a significantly greater knee external adduction moment compared to a no-heel flat shoe. The lack of differences in the peak knee internal abduction moments between barefoot/minimal open-toe shoes and the running shoe in the current study may be related to the fact that the heel height in the running shoes used in the study was not sufficiently high enough to produce an increase in peak frontal-plane knee joint moment. "
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    ABSTRACT: Flip-flops and sandals are popular choices of footwear due to their convenience. However, the effects of these types of footwear on lower extremity biomechanics are still poorly understood. Therefore, the objective of this study was to investigate differences in ground reaction force (GRF), center of pressure (COP) and lower extremity joint kinematic and kinetic variables during level-walking in flip-flops, sandals and barefoot compared to running shoes. Ten healthy males performed five walking trials in the four footwear conditions at 1.3 m/s. Three-dimensional GRF and kinematic data were simultaneously collected. A smaller loading rate of the 1st peak vertical GRF and peak propulsive GRF and greater peak dorsiflexion moment in early stance were found in shoes compared to barefoot, flip-flops and sandals. Barefoot walking yielded greater mediolateral COP displacement, flatter foot contact angle, increased ankle plantarflexion contact angle, and smaller knee flexion contact angle and range of motion compared to all other footwear. The results from this study indicate that barefoot, flip-flops and sandals produced different peak GRF variables and ankle moment compared to shoes while all footwear yield different COP and ankle and knee kinematics compared to barefoot. The findings may be helpful to researchers and clinicians in understanding lower extremity mechanics of open-toe footwear.
    Journal of Foot and Ankle Research 11/2013; 6(1):45. DOI:10.1186/1757-1146-6-45 · 1.46 Impact Factor
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    • "The mean weight is 172 AE 19.6 g, ranging from 142 to 193 g depending on the size. The modern heeled shoes, worn habitually by the subjects, were made of soft leather with a wide-base heel [9] [21] [22] "
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    ABSTRACT: Recent literature has highlighted that the flexibility of walking barefoot reduces overload in individuals with knee osteoarthritis (OA). As such, the aim of this study was to evaluate the effects of inexpensive, flexible, non-heeled footwear (Moleca) as compared with a modern heeled shoes and walking barefoot on the knee adduction moment (KAM) during gait in elderly women with and without knee OA. The gait of 45 elderly women between 60 and 70 years of age was evaluated. Twenty-one had knee OA graded 2 or 3 according to Kellgren and Lawrence's criteria, and 24 who had no OA comprised the control group (CG). The gait conditions were: barefoot, Moleca, and modern heeled shoes. Three-dimensional kinematics and ground reaction forces were measured to calculate KAM by inverse dynamics. For both groups, the Moleca provided peak KAM and KAM impulse similar to barefoot walking. For the OA group, the Moleca reduced KAM even more as compared to the barefoot condition during midstance. On the other hand, the modern heeled shoes increased this variable in both groups. Inexpensive, flexible, and non-heeled footwear provided loading on the knee joint similar to a barefoot gait and significant overload decreases in elderly women with and without knee OA, compared to modern heeled shoes. During midstance, the Moleca also allowed greater reduction in the knee joint loads as compared to barefoot gait in elderly women with knee OA, with the further advantage of providing external foot protection during gait.
    Gait & posture 05/2011; 34(1):126-30. DOI:10.1016/j.gaitpost.2011.03.026 · 2.75 Impact Factor
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    • "Kerrigan et al. [8] [9] demonstrated that women's high heeled shoes change the extrinsic forces of the lower extremity, in particular increasing the knee varus moment and prolonging the knee flexor moment compared to barefoot walking. Later they found that the addition of even a moderate heel in women's dress shoes increased the peak knee varus moment and prolonged the knee flexor moment in women; men's dress shoes and sneakers also increased the extrinsic knee varus moment in early stance in shod compared to barefoot walking in men [10] [11]. "
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    ABSTRACT: The effects of current athletic footwear on lower extremity biomechanics are unknown. The aim of this study was to examine the changes, if any, that occur in peak lower extremity net joint moments while walking in industry recommended athletic footwear. Sixty-eight healthy young adults underwent kinetic evaluation of lower extremity extrinsic joint moments while walking barefoot and while walking in current standard athletic footwear matched to the foot mechanics of each subject while controlling for speed. A secondary analysis was performed comparing peak knee joint extrinsic moments during barefoot walking to those while walking in three different standard footwear types: stability, motion control, and cushion. 3-D motion capture data were collected in synchrony with ground reaction force data collected from an instrumented treadmill. The shod condition was associated with a 9.7% increase in the first peak knee varus moment, and increases in the hip flexion and extension moments. These increases may be largely related to a 6.5% increase in stride length with shoes associated with increases in the ground reaction forces in all three axes. The changes from barefoot walking observed in the peak knee joint moments were similar when subjects walked in all three footwear types. It is unclear to what extent these increased joint moments may be clinically relevant, or potentially adverse. Nonetheless, these differences should be considered in the recommendation as well as the design of footwear in the future.
    Gait & posture 03/2011; 33(3):350-5. DOI:10.1016/j.gaitpost.2010.09.019 · 2.75 Impact Factor
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