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Changes in Ankle Range of Motion and Muscle Strength in Habitual Wearers of High-Heeled Shoes

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Although cross-sectional biomechanical studies have reported that wearing high-heeled shoes can change the musculoskeletal system of the lower extremities, the long-term effects of wearing such shoes on the ankle remain unknown. The aim of this study was to reveal changes in ankle range of motion and muscle strength in habitual wearers of high-heeled shoes and to provide information for clinicians undertaking functional evaluations of the ankles of such patients. Habitual wearers of high-heeled shoes (n = 10; age, 23.9 ± 2.7 years) and wearers of flat shoes (n = 10; age, 23.8 ± 2.1 years) were selectively recruited, and the range of motion, maximal voluntary isometric force, and concentric contraction power of their ankles were measured. Wearers of high-heeled shoes showed increased ankle range of motion on plantarflexion at 25 degrees and inversion at 10 degrees compared to flat shoe wearers (P < .05) but decreased dorsiflexion (about 17 degrees) and eversion (13 degrees; P < .05). Concentric contraction power in ankle eversion was also 2 times higher in wearers of high-heeled shoes (P < .05). These subjects had functional deformity of the ankle in a supinated direction and increased eversion power. We cautiously recommend that habitual wearers of high-heeled shoes (those who walk in such shoes for more than 5 hours more than 6 times a week) undertake intensive ankle stretching exercises in the direction of dorsiflexion as well as eversion.
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Foot & Ankle International
34(3) 414 –419
© The Author(s) 2013
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DOI: 10.1177/1071100712468562
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Various studies have warned women that wearing high-
heeled shoes (HHS) for a long time can cause musculoskel-
etal changes in the kinematics and kinetics of the lower
extremities and trunk.2,24 Kinematic changes that occur during
walking, such as increased ankle plantarflexion and hyperex-
tension of the metatarsophalangeal joint, are caused by wear-
ing HHS.7,12 In particular, the risk of metatarsalgia caused by
increased plantar pressure at the metatarsal head is increased
with frequent wearing of HHS.1,15,18,25 Kinetic changes also
occur; that is, plantar pressure moves inward,20,22 and the
center of mass moves forward.14
The kinematic and kinetic changes caused by HHS might
induce deformities of the ankle and metatarsophalangeal
joints. However, most studies performed to determine the
musculoskeletal changes induced by HHS have included a
period during which HHS were not worn. Therefore, it is
necessary to undertake a survey to measure the changes that
accompany the actual frequency of wearing HHS.
Previous studies have shown that habitual wearers of
HHS have limited full extension of the knee during walk-
ing,23 increased fatigue of the peroneus muscle,11 and
increased Achilles tendon stiffness.6 However, the long-
term effects of HHS on ankle range of motion (ROM) and
muscle strength remain to be discovered.
The purpose of this study was to compare the ankle
ROM and muscle strength of habitual wearers of HHS and
flat shoes (FS) and to identify characteristics of the ankles
of habitual wearers of HHS. When women wear HHS, their
ankle joints are placed in a more plantarflexed position and
require more stability. We postulate that frequent wearing of
HHS for a long time increases the maximal range of ankle
plantarflexion and inversion and eversion strength.
Methods
Participants
A total of 20 women (age range, 21-29 years) participated
in our study. Participants with dysfunction of the neural or
musculoskeletal system or pain were excluded. All completed
468562FA
IXXX10.1177/1071100712468562Foot & Ankle InternationalKim et al
2013
1Korea University, Seoul, Republic of Korea
2Gachon University of Medicine and Science, Republic of Korea
Corresponding Author:
BumChul Yoon, Korea University, Primary Work, Physical Therapy,
San1, Jeongneung 3-dong, Sungbuk-gu, Seoul, 136-703, Republic of Korea
Email: yoonbc@korea.ac.kr
Changes in Ankle Range of Motion
and Muscle Strength in Habitual
Wearers of High-Heeled Shoes
Yushin Kim, PT, MHSc1, Jong-Min Lim, PT, BSc2, and BumChul Yoon, PT, OT, PhD1
Abstract
Background: Although cross-sectional biomechanical studies have reported that wearing high-heeled shoes can change
the musculoskeletal system of the lower extremities, the long-term effects of wearing such shoes on the ankle remain
unknown. The aim of this study was to reveal changes in ankle range of motion and muscle strength in habitual wearers of
high-heeled shoes and to provide information for clinicians undertaking functional evaluations of the ankles of such patients.
Methods: Habitual wearers of high-heeled shoes (n = 10; age, 23.9 ± 2.7 years) and wearers of flat shoes (n = 10; age,
23.8 ± 2.1 years) were selectively recruited, and the range of motion, maximal voluntary isometric force, and concentric
contraction power of their ankles were measured.
Results: Wearers of high-heeled shoes showed increased ankle range of motion on plantarflexion at 25 degrees and
inversion at 10 degrees compared to flat shoe wearers (P < .05) but decreased dorsiflexion (about 17 degrees) and eversion
(13 degrees; P < .05). Concentric contraction power in ankle eversion was also 2 times higher in wearers of high-heeled
shoes (P < .05).
Conclusions: These subjects had functional deformity of the ankle in a supinated direction and increased eversion power.
Clinical Relevance: We cautiously recommend that habitual wearers of high-heeled shoes (those who walk in such
shoes for more than 5 hours more than 6 times a week) undertake intensive ankle stretching exercises in the direction of
dorsiflexion as well as eversion.
Keywords: ankle, muscle strength, muscle power, physical examination, range of motion, high-heeled shoes
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Kim et al 415
a questionnaire with demographic information, medical
history, and the duration of the period over which they wore
HHS over the preceding 6 months. The participants were
divided into 2 groups based on the criteria outlined in
another study7: an HHS group and a FS group. The HHS
group included 10 women who had worn HHS at least
3 days a week over the past 6 months. The FS group
included 10 women who had worn HHS less than 3 days a
week over the past 6 months. The 2 groups were not sig-
nificantly different in terms of age, height, weight, foot
length, foot width, or total period of wearing HHS.
Furthermore, none had regularly participated in any sports,
strength training, or stretching exercises for the past
6 months. Two subjects were excluded from the study
because they had a low likelihood of wearing HHS over the
past 6 months, although they had often worn HHS for more
than 3 days a week for the previous 1 month. A total of
22 participants were recruited in this study. The Ethics
Committee of Korea University approved this study. All
participants provided their informed consent, and their
identities were coded to protect their privacy.
Measurement of ROM
To examine changes in maximum ankle ROM caused by
HHS, active and passive ROM was measured using an incli-
nometer (Angle Finder AF200M, Dasco Pro Inc, Rockford,
IL). Maximal angular ranges of inversion, eversion, plan-
tarflexion, dorsiflexion with the knee at 90 degrees of flex-
ion (DF-KF), and dorsiflexion with the knee fully extended
(DF-KE) were measured. To measure the ROM of inver-
sion and eversion, the subjects were seated with their feet
off the floor to ensure that the anterior border of the tibia
was vertical and to prevent hip rotation. After fixation, the
angles of the movement of the metatarsal head in the fron-
tal plane were checked. To measure the ROM of plan-
tarflexion and dorsiflexion, subjects were asked to place
their ankles over the edge of a table while lying in a supine
position. Then, the maximal movement angle of the fifth
metatarsal bone was used to determine the ankle ROM on
the sagittal plane relative to the vertical. To examine the
effects on the soleus and gastrocnemius muscles, dorsiflex-
ion was checked with the knee at 90 degrees flexion and
fully extended. To measure DF-KF, the subject lay in a
supine position with hip and knee at 90 degrees flexion
with the tibia fixed in place horizontally. The angle of ankle
maximal dorsiflexion from the vertical was then measured.
All measurements were taken 3 times.
Measurement of Muscle Strength
Ankle muscle strength was measured using a multimodal
dynamometer (Primus RS, BTE Technologies Inc., Baltimore,
MD). To measure the maximal voluntary isometric force
(MVIF) in 4 directions (inversion, eversion, plantarflexion,
and dorsiflexion) of both ankles, an axis of dynamometer
was fixed in place. Concentric contraction power at the 25%
and 75% MVIF levels was measured for both ankles in the
same MVIF posture, and subjects were instructed to use
maximal effort to ensure concentrated speed as well as
force. Measurement postures were determined in the plan-
tarflexion, dorsiflexion, inversion, and eversion directions.
To measure dorsiflexion and plantarflexion, the subject lay in
a supine position with the pelvis and tibia fixed in position
up on a table (see Figure 1). Strength of ankle eversion and
inversion was then measured in a sitting position by fixing
the thigh in place to prevent movement of the hip joint (see
Figure 2). All measurements were repeated 3 times.
Statistical Analysis
Our purpose was to compare the ROM, MVIF, and concen-
tric contraction power at 25% and 75% MVIF between the
HHS and FS groups. We used an independent t test to com-
pare demographic characteristics and the period of wearing
HHS between groups. Levene’s test for equality of vari-
ances was used in relation to the underlying assumptions of
parametric statistics. The reproducibility of trials was tested
by intraclass correlation coefficients. Data from the
2 groups included the average of 3 trials for the left and
right ankles and were compared by repeated measures
analysis of variance in SPSS 12.0. Statistical significance
was accepted for P values less than .05.
Figure 1. The position used for the ankle strength
measurements (maximal voluntary isometric force and
concentric contraction power) of dorsiflexion and plantarflexion.
The axis of a multimodal dynamometer was located at the lateral
malleolus, and the distal part of the tibia was fixed in position.
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416 Foot & Ankle International 34(3)
Results
No significant differences between the HHS and FS groups
in mean age, height, weight, foot length, foot width, or
period of wearing HHS were observed. However, a signifi-
cant difference was observed in the frequency of wearing
HHS and walking while wearing HHS for a week (Table 1).
Moreover, the maximum ROM differed between the HHS
and FS groups. ROM measures were dichotomized as
active and passive ROM. Measurement of active ROM was
chiefly performed in the clinical field because most of the
tasks performed during daily life require active ROM.4
Passive ROM was measured to confirm the passive visco-
elastic properties of the involved muscles, pain, and neural
inhibition.27
Ankle ROM
The maximum active and passive ROM of plantarflexion
and inversion was approximately 25 degrees and 10
degrees higher, respectively, in the HHS group compared
with the FS group (P < .05). In contrast, maximum DF-KE
and eversion were 16 degrees and 9 to 4 degrees higher in
the FS group compared with the HHS group (P < .05). In
DF-KF, only passive ROM was significantly decreased by
6 degrees in the HHS group (P < .05). The active and pas-
sive ROM values are shown in Table 2. Based on 3 ROM
measurements, the minimum intraclass correlation coeffi-
cient value was 0.886.
Ankle Strength
Ankle strength was assessed on the basis of MVIF and
concentric contraction power. The MVIF in eversion was
higher in the HHS group than the FS group; however, there
was no statistical difference between the 2 groups in all
directions (P > .05). The concentric contraction power was
measured at 25% and 75% of MVIF in both the FS and
HHS groups. Except for eversion, no significant difference
in concentric power was observed between the 2 groups.
The HHS group had higher eversion power (range, around
2-3 W) than the FS group (P < .05) at both 25% and 75%
of MVIF. The mean values of ankle muscle strength are
shown in Table 3. Based on 3 trials, the intraclass correla-
tion coefficient for MVIF, with concentric contraction
power at 25% and 75% of MVIF, was over 0.871.
Discussion
To understand clinically the musculoskeletal effects of
wearing HHS, orthopaedic examination of habitual high-
heeled shoe wearers is important. The purpose of this study
was to compare ankle ROM and muscle strength between
habitual wearers of HHS and FS. We found that the physi-
cal ability of the ankles of wearers of HHS was signifi-
cantly different from that of the wearers of FS in terms of
kinematics and kinetics.
Regarding kinematic changes, the maximum ROM of
plantarflexion and inversion was higher in the HHS group
compared with the FS group; however, DF-KE and eversion
were lower. This indicates that the range of ankle joint
mobility in the HHS group was shifted to a supinated posi-
tion. These results lead to the speculation that tissues around
the ankle become lax on the anterolateral side and stiff on
the posteromedial side—that is, an elongated anterior talo-
fibular ligament and a stiff deltoid ligament and Achilles
tendon. We considered that changes in ankle ROM related
to the supinated position were caused by kinematic charac-
teristics during walking with HHS. Other studies have
reported increased maximum peak angles of plantarflexion
and inversion in the ankle during walking with HHS; how-
ever, their experimental data compared maximum peak
angles of the ankle in HHS and FS and were inconsis-
tent.7,17,29,30 Thus, it is possible that the gait pattern when
wearing HHS affects supinated deformation of the ankle
ROM in wearers of HHS.
In particular, the ankle plantarflexed position in HHS
would reduce the length of the gastrocnemius muscle relative
to the other calf muscles. We dichotomized dorsiflexion
ROM in the knee at full extension and at 90 degrees of flex-
ion because examinations of ankle dorsiflexion at different
knee positions are useful for discriminating posterior ankle
structure shortening between monoarticular and biarticular
Figure 2. The position used for the ankle strength
measurements (maximal voluntary isometric force and
concentric contraction power and concentric contraction
power) of inversion and eversion. The lever arm of a multimodal
dynamometer and the body of the femur were lined up, and the
distal part of the femur was fixed in position.
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Kim et al 417
Table 2. Comparisons of Active and Passive Range of Motion, in Degreesa
Active Passive
Direction FS HHS FS HHS
DF-KE 16.1 ± 9.4b0.1 ± 8.4 21.9 ± 9.6b4.0 ± 9.5
DF-KF 26.4 ± 6.2 24.4 ± 6.7 35.4 ± 6.3b29.5 ± 8.3
Plantarflexion 80.7 ± 16.9 100.8 ± 13.4c88.6 ± 22.7 106.8 ± 16.2c
Inversion 42.7 ± 9.8 53.0 ± 16.3c50.0 ± 8.9 60.5 ± 17.2c
Eversion 32.9 ± 12.9b21.2 ± 10.5 38.9 ± 13.4b24.6 ± 8.9
Abbreviations: FS, flat shoes group; HHS, high-heeled shoes group; DF-KE, dorsiflexion in knee full extension; DF-KF, dorsiflexion in knee 90 degrees of
flexion.
aMean ± standard deviation.
bAngle of maximum range of motion is significantly higher than HHS (P < .05).
cAngle of maximum range of motion is significantly higher than FS (P < .05).
Table 3. Comparisons of Ankle Isometric Force and Concentric Powera
Isometric Force (N)
Concentric Power
at 25% Load Level (W)
Concentric Power
at 75% Load Level (W)
Direction FS HHS FS HHS FS HHS
Dorsiflexion 28.4 ± 6.2 25.1 ± 8.3 5.6 ± 3.7 5.1 ± 2.1 9.2 ± 3.6 10.0 ± 4.4
Plantarflexion 27.1 ± 9.7 24.0 ± 9.3 6.4 ± 3.6 6.1 ± 3.7 13.5 ± 7.4 11.4 ± 9.5
Inversion 22.9 ± 11.2 26.6 ± 15.8 5.9 ± 3.3 7.7 ± 4.8 11.1 ± 8.8 13.7 ± 10.0
Eversion 13.8 ± 7.8 19.2 ± 9.2 2.9 ± 2.7 5.0 ± 4.0b5.1 ± 3.4 8.1 ± 5.2b
Abbreviations: FS, flat shoes group; HHS, high-heeled shoes group.
aMean ± standard deviation.
bConcentric power is significantly higher than HHS (P < .05).
Table 1. Anthropometric Characteristics of Participantsa
FS, n = 10 HHS, n = 10 t P
Mean age, y 23.8 ± 2.1 23.9 ± 2.7 –0.092 .928
Height, cm 165.0 ± 4.8 162.8 ± 4.6 1.071 .298
Weight, kg 54.2 ± 4.6 54.0 ± 4.8 0.096 .925
Foot length, mm 237.2 ± 11.5 239.7 ± 5.4 –0.592 .562
Foot width, mm 8.6 ± 0.6 8.8 ± 0.3 –0.578 .576
Total wearing period, yb3.8 ± 1.7 5.6 ± 1.2 –0.438 .667
Wearings for a week, nc1.1 ± 0.8 5.5 ± 1.3 –7.782 <.001
Wearing periods for a week, hd2.3 ± 1.7 4.6 ± 0.9 –4.347 <.001
Preferred heel height 5.6 ± 1.4 7.6 ± 2.3 –1.993 .062
Abbreviations: FS, flat shoes group; HHS, high-heeled shoes group.
aMean ± standard deviation.
bWearing period of the high-heeled shoes in participants’ lifetime.
cFrequency of wearing the high-heeled shoes for a week.
dWalking period with wearing the shoes per week.
muscles.19 The maximum ROM of DF-KE was about
16 degrees lower in the HHS group compared with the FS
group, whereas DF-KF was not different or was only slightly
different. This indicates that the gastrocnemius muscle fascia
of the HHS group was shorter than the other ankle structures,
such as the soleus muscle and the posterior joint capsule.
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418 Foot & Ankle International 34(3)
The supinated metamorphosis of the ankle in the HHS
group would lead to functional changes in the musculoskel-
etal system; that is, it would disturb efficient shock absorp-
tion of the deltoid and spring ligament7 and increase the risk
of anterior talofibular ligament sprains.21 In addition, lim-
ited ankle dorsiflexion ROM is associated with poor calf
muscle pump function in limbs with chronic venous insuf-
ficiency19 and could contribute to increased gait deviations,
such as decreased step length and walking speed.8 Thus, we
were able to establish that kinematic changes induced by
wearing HHS have a negative influence on the ankle and
that regular ankle stretching in the direction of dorsiflexion,
with the knee extended, and at eversion is essential for
habitual wearers of HHS.
We also found that the HHS group had a significantly
higher concentric contraction power in eversion than the FS
group. Muscle power is the ability of a muscle to produce
force rapidly, is defined as the product of force and time,
and is generated during activities that involve movement.28
We first considered that increased muscle power of eversion
would be induced as an adaption to mediolateral instability
induced by a narrow heel. A previous study also reported
that peroneus muscle activity was increased during walking
with heeled shoes owing to a decreased base of support.30
The enhanced eversion power observed in the HHS group
indicates that ankle instability while wearing HHS can
induce a rapidly generated force affecting the peroneus
muscle and that this is important for preventing ankle
sprains.3,5,16 Second, increased eversion power results from
shifting the center of the body mass laterally when women
walk in HHS.11 That is, the medial longitudinal arch and the
spring ligament complex are key structures for shock
absorption generally.26,30 During the stance phase of walk-
ing wearing HHS, however, the center of gravity shifts lat-
erally with increased hip adduction. The external moment
arm of the ankle axis is increased, and the peroneus muscle
requires more power to maintain balance. This process
emphasizes the role of the peroneus muscle as a shock
absorber. Thus, the increased mediolateral instability and
the lateral transfer of the center of gravity during walking in
HHS act as the main effectors increasing the concentric
power of ankle eversion.
Our results show that habitual wearers of HHS have to
increase dorsiflexion and eversion ROM. Thus far, several
studies have reported the effect of stretching exercises on
the calf muscles to increase the dorsiflexion ROM of nor-
mal subjects.9,10,13,31,32 Of these, a passive stretching exer-
cise with programmed long, frequent stretching times (more
than 150 seconds per day, 5 days per week for 6 to 8 weeks)
with a short resting period had a positive effect on increas-
ing ankle ROM.9,10,13 For habitual wearers of HHS, more
intensive stretching exercises are necessary. In addition, our
study suggests that the stretching exercises should be per-
formed in the direction of not only dorsiflexion but also
eversion. Further studies are required to determine whether
the intensity of the outlined stretching program is effective
for habitual wearers of HHS.
In conclusion, this study found that habitual wearers of
HHS have a significantly altered musculoskeletal system in
the ankle, resulting in supinated ROM and increased ever-
sion power. Moreover, ankle adaptations to maintain bal-
ance from a narrow base of support when wearing HHS
evoke kinematic and kinetic changes. However, the ankle
adaptations are known to have a clinically negative impact
by increasing the risk of inversion sprains,21 poor calf mus-
cle pumping,19 and unstable gait.8 Therefore, we recom-
mend that clinicians check the frequency of a patient’s
wearing of HHS and that they understand the physical char-
acteristics of the ankles of habitual wearers of HHS when
undertaking functional evaluations.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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... Kinematic parameters, including joint angles at the knee, and ankle, offer a detailed view of the movement dynamics during gait. High-heeled shoes typically increase the plantarflexion of the ankle, which in turn affects the alignment and movement of the entire lower limb [28]. This altered kinematic profile can lead to increased loading on specific joints, potentially contributing to discomfort or injury over time. ...
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The study of biomechanics during locomotion provides valuable insights into the effects of varying conditions on specific movement patterns. This research focuses on examining the influence of different shoe parameters on walking biomechanics, aiming to understand their impact on gait patterns. To achieve this, various methodologies are explored to estimate human body biomechanics, including computer vision techniques and wearable devices equipped with advanced sensors. Given privacy considerations and the need for robust, accurate measurements, this study employs wearable devices with Inertial Measurement Unit (IMU) sensors. These devices offer a non-invasive, precise, and high-resolution approach to capturing biomechanical data during locomotion. Raw sensor data collected from wearable devices is processed using an Extended Kalman Filter to reduce noise and extract meaningful information. This includes calculating joint angles throughout the gait cycle, enabling a detailed analysis of movement dynamics. The analysis identifies correlations between shoe parameters and key gait characteristics, such as stability, mobility, step time, and propulsion forces. The findings provide deeper insights into how footwear design influences walking efficiency and biomechanics. This study paves the way for advancements in footwear technology and contributes to the development of personalized solutions for enhancing gait performance and mobility.
... Perubahan ROM ankle dapat dipengaruhi oleh berbagai faktor, seperti kekakuan pada tendon achilles dan kekakuan muskulus gastroknemius (Kim et al, 2013;Wulan dan Rahayu 2016). Kekakuan tendon achilles dan muskulus gastroknemius dapat dipengaruhi oleh berbagai faktor, seperti macam gerakan yang sering dilakukan dan kebiasaan melakukan latih regang. ...
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ABSTRAK Sepatu high heel atau sering disebut high heels adalah jenis sepatu yang didesain dengan hak yang tinggi. Penggunaan high heels tidak berbanding lurus dengan pengetahuan masyarakat mengenai cara penggunaan sepatu ini dengan baik dan benar. Kasus cedera yang sering muncul karena penggunaan high heels adalah nyeri pada daerah calcaneus oleh karena plantar fasciitis dan achilles tendinitis. Selain menyebabkan nyeri, penggunaan high heels juga dapat menyebabkan perubahan range of motion ankle akibat adapatasi postural yang dilakukan oleh tubuh selama menggunakan high heels. Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara penggunaan high heels terhadap intensitas nyeri daerah calcaneus dan perubahan range of motion pada ankle. Jenis penelitian ini adalah penelitian survei analitik, dengan desain penelitian cross-sectional. Penelitian dilakukan kepada para karyawan wanita Matahari Departement Store Johar Plaza Jember dan Roxy Square Jember yang memenuhi kriteria inklusi dan eksklusi. Intensitas nyeri daerah calcaneus diketahui menggunakan kuesioner Visual Analog Scale (VAS) dan besar range of motion ankle diukur menggunakan goniometer. Hasil uji analisis Spearman antara penggunaan high heels terhadap intensitas nyeri daerah calcaneus posterior dan medial menghasilkan nilai p<0,05, hasil tersebut menunjukkan terdapat hubungan yang signifikan antara penggunaan high heels terhadap intensitas nyeri daerah calcaneus posterior dan medial. Sedangkan pada hubungan antara penggunaan high heels terhadap perubahan range of motion ankle didapakan nilai p>0,05 yang berarti tidak terdapat hubungan yang signifikan antara penggunaan high heels terhadap perubahan range of motion ankle Kata kunci: High heels, intensitas nyeri daerah calcaneus, perubahan range of motion ankle ABSTRACT High heeled shoes or commonly called high heels, is a type of shoe with high sole designed. Wearing high heels can cause so many musculosceletal injury. Injury cases that mostly appear is pain on calcaneus area as a result of plantar fasciitis and achilles tendinitis. Besides causing injury, the use of high heels also can cause the range of motion ankle become changed due to body postural adaptation during wearing high heels. The aim of this study is to determine the correlation between wearing high heels and pain Intensity on calcaneus area and range of motion ankle changes. This is an analytical survey study with cross sectional study design. This study using women workers in Matahari Departement Store Johar Plaza Jember and Roxy Square Jember who met inclusion and exclusion criteria. Pain intensity on calcaneus area was measured with visual analog scale (VAS) questionnaire and the large of range of motion ankle was measured with goniometer. Spearman correlation test result between wearing high heels and pain intensity on posterior and medial calcaneus area is p<0,05, this result indicates that there is significant correlation between wearing high heels and pain intensity on posterior and medial calcaneus area. While correlation between wearing high heels and range of motion ankle changes has result>0,05, this result indicates that there is no significant correlation between wearing high heels and range of motion ankle canges.
... Beyond 3.5 h of wearing, there appears to be mild pain when considering the whole body. The reasons may be related to the time of adaptation and musclefatigue related time as reported in the literature where individuals alter their center of mass (COM) in relation to the center of pressure (COP) 33,34 through structural adjustments such as trunk and pelvis rotations 10,35,36 to modifications in muscle-tendon architecture [36][37][38] . According to the data, mild pain starts in the back after about 2 h followed by pain in the calcaneus, metatarsals and the toes (Fig. 4). ...
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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.
... 5,6 Numerous researches have warned females who wear HHS for prolong period of time that HHS can result into the development of changes in musculoskeletal system within the kinetics and kinematics of lower extremity and trunk. 7 It was found that HH may lead to foot-pain and deformities 2 and foot pain is aggravated by walking, prolong standing and stair climbing. 8 Many studies shows that high heels are responsible for hallux valgus, deformity, plantar calluses and reduced venous function in lower extremity. ...
... As a consequence, expert and clinical recommendations are made to alleviate the implications such as to avoid aggravation in spinal disks and knee joints associated with high impact activities, stretch calf to prevent calf shortening and aid in pain relief, and stretch ankle to increase eversion range of motion for stability [18]. Products marketed to address symptoms include but are not limited to adjustable stretch boards, resistant bands, and metatarsal pad insoles. ...
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The process of product design and development can be complex, especially in transdisciplinary practice. A design framework is often adopted to better govern this process. In recent years, there is a growing trend for domestic devices promoting health enhancement. However, due to its specific functionality and a strong need for safety emphasis, domestic health enhancement devices need to be distinguished from other domestic consumer products from the initial stages of designing. Therefore, this study aims to explore the influence of design principles on the artefacts by developing a framework for the design and development of domestic health enhancement devices. It adopts the approach of targeting a selected lifestyle or demography and tailoring a set of device functionalities to its needs. Throughout the process, the proposed framework provides disciplined guidelines to achieve its three design objectives – safety, effectiveness, and user receptiveness. A case study is performed to demonstrate the application of the proposed framework in the context of high heel wearers. The sensor-based real-time feedback is integrated into the user involved design process. The first design iteration in accordance to the framework is completed and evaluated.
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Background Many women enjoy wearing high heels despite knowing they can be harmful to the feet. There are many uncomfortable conditions that can originate from wearing this type of shoe leading to biomechanical changes in ankle joints. Hence the study is aimed to identify the effects of massage therapy in improving muscular flexibility among women wearing high heels Methodology Forty female participants with chronic heel pain were included in the single-blinded randomized controlled trial. Participants were divided into Group-A (Stretching and deep heat) and Group-B (petrissage and deep heat) group. The treatment was performed for four weeks, 3 sessions/ week in both groups. Foot function index and ankle dorsiflexion were recorded at baseline and after 4 weeks of intervention. Results Forty female participants with a mean age of 28.23±6.24 were recruited in the study. Both groups showed significant improvement in all three variables i.e. pain, disability, and ankle dorsiflexion. However, group B showed more significant results with mean differences of 1.80±2.22 and 4.1±6.7 (p-value <0.05) for pain and disability respectively. A similar result was observed for ankle dorsiflexion in which a mean difference of 0.95±1.08 in the left ankle and 1.25±1.12 in the right ankle was observed. Conclusion Both treatment programs are highly effective in reducing pain, reducing disability, and improving the ankle joint ROM, but petrissage massage along with deep heating was found to be superior as compared to superficial heat with static stretching for females with chronic heel pain. Keywords Ankle joint, Disability, Massage, Pain, Range of motion
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Introduction: Ginger is one of the herbal plants that has been known for a long time. However, most people did not know further about the benefits of ginger for pregnant women. Therefore, this study aimed to analyze the ginger effect to compress the lower back in third-trimester pregnant women. Methods: The data were used in this study obtained from the intensity of pain felt by pregnant women in the third trimester. This study involved 10 respondents who were collected by purposive sampling technique. The analysis used in this study was to determine the difference in the level of the back before the ginger compress and after the ginger compress in the third trimester of pregnant women using the Wilcoxon test. Results: This study shows that the significant value of ρ=0.005<0.05, from these results, it was shown that there is an effect of ginger compresses on reducing back pain in third-trimester pregnant women. Conclusion: This study was conducted to analyze the effect of ginger compress on the lower back in third-trimester pregnant women. Furthermore, this study proves that ginger compress can significantly reduce back pain in the third-trimester pregnant women
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Introduction: High heels are still the top choice of women's footwear and have an aesthetic function. A previous study showed that high heels were the potential to give musculoskeletal disorders. This study aimed to find the presence of musculoskeletal disorders and the factors influencing the routine and long-term use of high heels amongst bank employees. Methods: This is an observational study with a cross-sectional design. The research study participant collection was carried out in November - December 2020 in several Bank branches; 233 participants were obtained. Each participant was given a questionnaire about musculoskeletal disorders and the factors influencing high heels used. Results: It was found that there is a relationship between body mass index (BMI), shoe height, and the length of time used per week for the pain Visual Analogue Scale (VAS) in the use of high heels. However, it was found that there is no relationship between the type of shoes and the pain VAS using high heels. Conclusion: The higher BMI, shoe height, and the longer time using high heels per week contribute to the increasing pain VAS amongst high heel users.
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No one discipline or person can encompass all the knowledge necessary to solve complex, ill-defined problems, or problems for which a solution is not immediately obvious. The concept of Concurrent Engineering (CE) – interdisciplinary, but with an engineering focus – was developed to increase the efficiency and effectiveness of the Product Creation Process (PCP) by conducting different phases of a product’s life concurrently. Transdisciplinary Engineering has transcended CE, emphasizing the crucial importance of interdisciplinary openness and collaboration. This book presents the proceedings of the 28th ISTE International Conference on Transdisciplinary Engineering (TE2021). Held online from 5 – 9 July 2021 and entitled ‘Transdisciplinary Engineering for Resilience: Responding to System Disruptions’, this is the second conference in the series held virtually due to the COVID-19 pandemic. The annual TE conference constitutes an important forum for international scientific exchange on transdisciplinary engineering research, advances, and applications, and is attended by researchers, industry experts and students, as well as government representatives. The book contains 58 peer-reviewed papers, selected from more than 80 submissions and ranging from the theoretical and conceptual to strongly pragmatic and addressing industrial best practice. The papers are grouped under 6 headings covering theory; education and training; PD methods and digital TE; industry and society; product systems; and individuals and teams. Providing an overview of the latest research results and knowledge of product creation processes and related methodologies, the book will be of interest to all researchers, design practitioners, and educators working in the field of Transdisciplinary Engineering.
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OBJETIVO: O propósito deste estudo foi avaliar a amplitude e o tempo de ativação elétrica do vasto medial oblíquo (VMO), vasto lateral longo (VLL) e vasto lateral oblíquo (VLO) durante atividades funcionais em portadoras da síndrome da dor patelofemural (SDPF). MÉTODOS: Participaram do estudo 20 mulheres, sendo dez do grupo controle e dez do grupo com SDPF. O sinal eletromiográfico do quadríceps foi detectado por eletrodos ativos diferenciais simples de superfície e um eletromiógrafo de quatro canais, durante atividades em cadeia cinética aberta (em um dinamômetro isocinético) e fechada (através de um step e durante o agachamento). Na análise estatística foram utilizados o teste t de student e uma análise de variância (ANOVA), com método pos-hoc de Tukey, com nível de significância de p<0,05. RESULTADOS: Os resultados sugerem uma menor intensidade na atividade elétrica do VMO em relação ao VLO (p=0,04) e maior retardo no tempo de ativação do VMO (p=0,0023) no grupo com SDPF considerando todas as atividades avaliadas. Houve diferença significativa do VMO em relação ao VLO nas atividades de extensão isocinética à 30º/s (p=0,042) e descida do step com 75º de flexão de joelho (p=0,038) no grupo com SDPF, e nas atividades de levantar-se de um banco (p=0,041), salto unipodal (p=0,046) e elevação dos calcanhares (p=0,004) no grupo controle. CONCLUSÕES: Nas condições experimentais realizadas, o estudo sugere um desequilíbrio na atividade elétrica e um padrão de recrutamento anormal entre os músculos VMO, VLL e VLO em sujeitos com SDPF, com maior retardo e menor amplitude de ativação do VMO neste grupo de sujeitos.
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OBJETIVO: O propósito deste estudo foi avaliar a amplitude e o tempo de ativação elétrica do vasto medial oblíquo (VMO), vasto lateral longo (VLL) e vasto lateral oblíquo (VLO) durante atividades funcionais em portadoras da síndrome da dor patelofemural (SDPF). MÉTODOS: Participaram do estudo 20 mulheres, sendo dez do grupo controle e dez do grupo com SDPF. O sinal eletromiográfico do quadríceps foi detectado por eletrodos ativos diferenciais simples de superfície e um eletromiógrafo de quatro canais, durante atividades em cadeia cinética aberta (em um dinamômetro isocinético) e fechada (através de um step e durante o agachamento). Na análise estatística foram utilizados o teste t de student e uma análise de variância (ANOVA), com método pos-hoc de Tukey, com nível de significância de p<0,05. RESULTADOS: Os resultados sugerem uma menor intensidade na atividade elétrica do VMO em relação ao VLO (p=0,04) e maior retardo no tempo de ativação do VMO (p=0,0023) no grupo com SDPF considerando todas as atividades avaliadas. Houve diferença significativa do VMO em relação ao VLO nas atividades de extensão isocinética à 30º/s (p=0,042) e descida do step com 75º de flexão de joelho (p=0,038) no grupo com SDPF, e nas atividades de levantar-se de um banco (p=0,041), salto unipodal (p=0,046) e elevação dos calcanhares (p=0,004) no grupo controle. CONCLUSÕES: Nas condições experimentais realizadas, o estudo sugere um desequilíbrio na atividade elétrica e um padrão de recrutamento anormal entre os músculos VMO, VLL e VLO em sujeitos com SDPF, com maior retardo e menor amplitude de ativação do VMO neste grupo de sujeitos.
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The purpose of this study was to assess the acute effects of vibration and stretching on passive and active forward split range of motion in elite adult female synchronized swimmers. Eleven athletes performed a passive forward split test measuring the height of the anterior superior iliac spine on both sides and an active split test on both sides by adopting an inverted split position. Then athletes were assigned randomly by right or left leg to receive vibration on one leg while stretching. The contralateral leg was stretched but did not receive vibration and served as the control. The treatment involved a 40-s exposure to vibration of the forward leg in a split and 40 s of vibration to the rear leg in a split. The athletes were then post-tested using the same protocols. The results indicated that the vibration had a statistically significant influence on passive forward split flexibility, but not active split flexibility. The results of this study confirm earlier work and further demonstrate the efficacy of vibration in enhancing range of motion in a passive split position. Given that it is often difficult to achieve large changes in range of motion with already highly trained elite athletes, this methodology shows considerable promise. Vibration may not be powerful enough to evoke changes in active range of motion in spite of the changes in passive range of motion.
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To analyze the electrical activity of the vastus medialis obliquus (VMO), vastus lateralis longus (VLL) and vastus lateralis obliquus (VLO) muscles of individuals with patellofemoral pain syndrome (PFPS) during maximum voluntary isometric contraction (MVIC) of lower leg extension with the knee at 30 degrees; to assess pain using a visual analogue scale (VAS); and to assess patellar positioning using magnetic resonance imaging (MRI). Twelve women with PFPS and 12 clinically normal women were evaluated. They performed five MVICs of lower leg extension at 30 degrees for electromyographic (EMG) analysis. Using MRI, the sulcus angle (SA), congruence angle (CA), patellar tilt angle (PTA) and patellar displacement (PD) were obtained. The following statistical tests were used: analysis of variance (ANOVA) for repeated measurements to assess EMGs; Mann-Whitney U test to analyze MRIs; Pearson's (r) correlation test between EMGs and MRIs; and one-way ANOVA to evaluate pain (p < or = 0.05). In the PFPS group, there was greater electrical activity in the VLL than in the VMO. In both groups, there was greater electrical activity in the VMO and VLL than in the VLO. In the PFPS group, the MRI showed higher SA and lower CA values, and there was a negative correlation between the VMO and the PTA. The data suggest that, in individuals with PFPS, greater electrical activity in the VLL combined with an increased SA and a decreased CA may contribute to patellar instability.
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Wearing high heels (HH) places the calf muscle-tendon unit (MTU) in a shortened position. As muscles and tendons are highly malleable tissues, chronic use of HH might induce structural and functional changes in the calf MTU. To test this hypothesis, 11 women regularly wearing HH and a control group of 9 women were recruited. Gastrocnemius medialis (GM) fascicle length, pennation angle and physiological cross-sectional area (PCSA), the Achilles' tendon (AT) length, cross-sectional area (CSA) and mechanical properties, and the plantarflexion torque-angle and torque-velocity relationships were assessed in both groups. Shorter GM fascicle lengths were observed in the HH group (49.6+/-5.7 mm vs 56.0+/-7.7 mm), resulting in greater tendon-to-fascicle length ratios. Also, because of greater AT CSA, AT stiffness was higher in the HH group (136.2+/-26.5 N mm(-1) vs 111.3+/-20.2 N mm(-1)). However, no differences in the GM PCSA to AT CSA ratio, torque-angle and torque-velocity relationships were found. We conclude that long-term use of high-heeled shoes induces shortening of the GM muscle fascicles and increases AT stiffness, reducing the ankle's active range of motion. Functionally, these two phenomena seem to counteract each other since no significant differences in static or dynamic torques were observed.
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The purpose of this investigation was to determine whether a graded response in gait kinematics, kinetics, and EMG occurs as shoe heel height increases. Four different shoes, including one flat shoe and three shoes with high heels, were tested in this investigation. The average heel heights of the four shoes were 1.4 cm, 3.7 cm, 5.4 cm, and 8.5 cm. Kinematics, kinetics, and muscle EMG were measured during the stance phase of gait on 13 healthy female subjects while wearing each of these 4 shoes. Systematic increases in the active vertical, propulsive, and braking forces were found as shoe height increased. Ankle and knee flexion and soleus and rectus femoris activity showed a graded response as heel height increased. One surprising result was the behavior of the maximal vertical impact force peak and the maximal loading rate during heel impact. The vertical impact force peaks and the maximal vertical loading rates were highest for the shoe with 3.7 cm heel height and lowest for the flat shoe and the shoe with heel height of 8.5 cm.
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A survey of 200 young women wearing high-heeled shoes indicated frequent complaints of leg and low back pain. Consequently, an empirical study examined the biomechanical effects of three heel heights (0, 4.5, and 8 cm), while standing stationary and while walking in five, healthy, young women. Four major biomechanical effects were observed. As heel heights increased, the trunk flexion angle decreased significantly. Similarly, tibialis anterior EMG, low back EMG and the vertical movement of the body center of mass increased significantly while walking with high-heeled shoes. Due to these added stresses, wearing of high heels should be avoided.Relevance to industryIn addition to the normal physical job stresses, women workers may experience additional biomechanical stresses placed on them by fashion demands such as high heels. All these effects can significantly increase discomfort levels in those wearing high heels.
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Exercises for the ankle are often used to improve sport performance through balance and stability or to prevent or recover from ankle injury. Ankle training programs often include exercises for the primary muscle of the lateral ankle, the peroneus longus (PL). However, many exercises for the PL are non-weight bearing and unidirectional. However, data from biomechanical studies show that peak activity of the PL occurs neither in non-weight-bearing nor during uniplanar movements. This lack of congruency may limit the effectiveness of PL training. Exercises more consistent with the biomechanical function of the PL may increase the efficacy of ankle training. This study examined and compared the electromyographic (EMG) activity of the PL during 2 exercises that specifically address the known biomechanical function of the PL and a traditional non-weight-bearing unidirectional PL exercise. Twenty healthy college-aged men and women (age 24.8 +/- 2.7 years) without history of ankle injury were examined in a single-session repeated measures design. The average root means square (RMS) values of the PL during each of the 3 exercises were measured and compared to assess for differences in magnitude of muscular activity. The RMS activity of the PL was significantly greater (p < 0.05) in each of the biomechanically correct exercises when compared with the conventional exercise. However, no significant difference was noted in EMG activity between the 2 biomechanical exercises. This study provides evidence for increased activity from the PL during 2 exercises that more accurately reflect its biomechanical function. Use of these exercises when training the PL for sports performance or rehabilitation may increase the effectiveness of ankle training programs that include PL activity.
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Cryotherapy and ankle bracing are often used in conjunction as a treatment for ankle injury. No studies have evaluated the combined effect of these treatments on reflex responses during inversion perturbation. This study examined the combined influence of ankle bracing and joint cooling on peroneus longus (PL) muscle response during ankle inversion. A 2x2 RM factorial design guided this study; the independent variables were: ankle brace condition (lace-up brace, control), and treatment (ice, control), and the dependent variables studied were PL stretch reflex latency (ms), and PL stretch reflex amplitude (% of max). Twenty-four healthy participants completed 5 trials of a sudden inversion perturbation to the ankle/foot complex under each ankle brace and cryotherapy treatment condition. No two-way interaction was observed between ankle brace and treatment conditions on PL latency (P=0.283) and amplitude (P=0.884). The ankle brace condition did not differ from control on PL latency and amplitude. Cooling the ankle joint did not alter PL latency or amplitude compared to the no-ice treatment. Ankle bracing combined with joint cooling does not have a deleterious effect on dynamic ankle joint stabilization during an inversion perturbation in normal subjects.