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Acta of Bioengineering and Biomechanics Original paper
Vol. 21, No. 4, 2019 DOI: 10.37190/ABB-01435-2019-03
Temporal and dynamic changes
in plantar pressure distribution, as well as in posture
during slow walking in flat and high-heel shoes
SONA JANDOVA1*, MILOSLAV GAJDOŠ2,
KATARÍNA URBANOVÁ2,3, WIOLETTA MIKUĽÁKOVÁ2
1 Technical University of Liberec, Faculty of Mechanical Engineering,
Department of Applied Mechanics, Liberec, Czech Republic.
2 University of Prešov in Prešov, Faculty of Health Care, Department of Physiotherapy, Prešov, Slovakia.
3 St. Elizabeth College of Health and Social Work, Bratislava, Slovakia.
Purpose: The aim of the study was to assess the differences in plantar pressure distribution and in posture during slow and very slow
walking on the treadmill in flat and high-heeled shoes. Methods: The Pedar-X® (Novel, Munich, Germany) measuring insoles were used to
measure the plantar pressure distribution and to assess temporal parameters during walking on the treadmill with the speed v1 = 0.97 ms–1
and v2 = 0.56 ms–1 in flat shoes (FS) and HH. For postural measurement, the SonoSens Monitor Analyzer (Gefremed, Chemnitz, Ger-
many) was used. Thirty healthy females who only occasionally wear HH volunteered to participate in the study (age: 21.8 ± 2.09 years,
weight: 55.7 ± 4.05 kg, height: 1.66 ± 0.03 m). For statistical analysis the ANOVA, and paired t-test were used. Results: Significant
differences in walking in HH were detected in temporal and plantar pressure variables, compared to FS. The walking speed influenced
the temporal variables, but not the measured dynamic parameters, in either shoes. In the sagittal plane, significant differences in all sec-
tions of the spine were identified for v1 and v2. While walking in HH, lordosis at lumbar spine decreased significantly as well as at cervi-
cal spine, and kyphosis increased in the thoracic spine. In HH statistically significant differences between the walking speeds were ob-
served particularly in the thoracic spine. Conclusions: Walking in high heels caused a plantar pressure changes and curvature of the
spine, and the slowing of walking speed did not prevent these changes.
Key words: gait cycle, stance, swing, frontal plane, sagittal plane
1. Introduction
Gait is the basic movement stereotype and motor
expression of an individual, and one of the basic
features of the human form. In terms of natural hu-
man movement, the choice of footwear is very im-
portant. In our modern society, women often wear
high-heeled shoes (HH) which cause significant
changes in both the dynamics and kinematics of gait,
power profile, and motor control [5]. HH are defined
as shoes whose heel is located higher than its tip; the
difference can be more than 10 cm [6]. In compari-
son, flat shoes (FS) enable the full range of take-off
and longer strides are, therefore, possible when in-
creasing walking speed. The Centre of Mass (CoM)
places the load of the foot at the Chopart’s joint area,
which makes upright walking easier in FS. Similarly
to tiptoeing, while walking in HH, the CoM shifts
forward to the Lisfranc joint area. It increases the
pressure on the metatarsal area, and the load is re-
moved from the heel [3], [18]. The kinetic effects of
HH also depend upon the habit of their wearer, their
age and walking speed [19], [24].
During the observation of changes in the plantar
area caused by wearing different types of shoes, the
plantar pressure distribution and Centre of Pressure
(CoP) are evaluated. Besides other factors, the CoP
______________________________
* Corresponding author: Sona Jandova, Applied Mechanics, Technical University of Liberec, Faculty of Mechanical Engineering,
Studentská 2, 46008, Liberec, Czech Republic. Tel: +420 485353656, e-mail: sona.jandova@tul.cz
Received: August 7th, 2019
Accepted for publication: October 22nd, 2019
S. JANDOVA et al.132
also depends on the profile and tilt of the supporting
surface as well as the friction properties of both the
surface and the shoes [10]. While walking, the CoP
usually shifts from the centre of the heel, along the
external side of the foot towards the fifth metatarsal,
and from the tips of the toes towards the big toe. HH
prevent the wearer from stepping on their heel properly
and landing on the ground gradually because the foot is
in plantar flexion. The higher the heel, the more the
frontal part of the foot is overloaded [3], [4], [30],
increasing the pressure and duration of pressure under
the medial forefoot during walking [30], [3]. In HH,
the stance phase is extended, which increases the dura-
tion of the contact between the foot and the surface [2].
HH influence the walking speed and shorten the steps
[2], [7], [9], [16]. The main characteristics of gait in-
clude the gait cycle duration, rhythm, stride, and speed
[28], [13], [14]. Walking speed is limited by frequency
and stride; the latter depends upon the extent of the
lower limb range of motion during the swing phase.
Walking speed changes during the gait cycle and it is
influenced by the position of the stance of the lower
limb. When the foot is in front of the body, the walking
speed decreases. When the foot is behind the body, the
walking speed increases. The average walking speed of
an adult is 1.33 ms–1 – 1.53 ms–1 [18].
HH contribute to slower self-selected walking
speeds and shorter strides, whereas cadence is generally
unchanged [2], [7], [9]. Studies examining various
attributes of walking in HH most often used a walking
speed of 1.3–1.4 m s–1 [2], [26]. A slow speed is con-
sidered to be approx. 1.12 m s–1 [17]. This values
seem to be still relatively high for those who have
little experience with wearing HH.
HH also influence the overall postural stability. The
foot position causes a chain effect influencing the posi-
tion of the lower limbs, pelvis, and spine [6]. Walking in
HH also depends upon the wearer’s experience with HH
[19], [5], experienced wearers (wearing HH approxima-
tely 4 hours/day, 4 days/week or more) exhibited better
control during the contact phase of one-limb support as
well as a faster transfer of weight during double-limb
support. The previous study [19] showed that, while
walking in HH, the lumbar area lordosis straightened in
women who do not wear HH or do so rarely, however, it
was more pronounced in experienced HH wearers.
The postural and locomotion motor skills interact
to ensure coordination and fluent movement; they are
activated automatically. However, the discrepancy
caused between the new type of movement and pos-
tural motor skills in inexperienced wearers causes
them to decrease their walking speed. Therefore, it
seems important to focus on very slow walking speed
in HH (at <1 m s–1), typical for the inexperienced HH
wearers. No study on very slow walking seems to be
available. The main aim of presented study is to find out
whether very slow walking (v < 1 m s
–1) observed in
a group of inexperienced HH wearers significantly
changes the dynamic characteristics and whether it
causes postural changes as occur during higher walking
speeds (as discovered in previous studies). It is assumed
that slow walking in HH will increase the % duration of
the STANCE phase, while the SWING phase will be
relatively shorter than while walking in FS. It is expected
that ground reaction forces (GRF) in the forefoot while
walking in HH will occur as well as postural changes in
the sagittal plane represented by straightening of cervical
and lumbar lordosis, and thoracic kyphosis.
2. Materials and methods
Participants
Thirty healthy females who wear HH only occa-
sionally volunteered to participate in the study (age: 21.8
± 2.09 years, weight: 55.7 ± 4.05 kg, height: 1.66
± 0.03 m, BMI: 20.34 ± 1.41, shoe size: EU 36–38). The
exclusion criteria included previous musculoskeletal
injury within 1 year and experiencing musculoskeletal
pain; none of the participants experienced any injuries
that could limit their range of motion of their body and
extremities. The study was approved by the Institutional
Review Board for testing of human subjects (protocols
were obtained under the license granted by this board)
and the research was performed in accordance with the
ethical standards of the Helsinki Declaration.
Data collection
The Pedar-X® (Novel, Munich, Germany) insole
measuring system was used to measure the plantar
pressure distribution and to assess temporal and dy-
namic parameters during the gait cycle: 30-s walk in
flat shoes (FS) and 30-s walk in high heel shoes (HH).
This measuring system enables data to be recorded with
a frequency of 100 Hz. The data collected were ana-
lysed with the Pedar-X® (Novel, Munich, Germany)
software after the measurements were finished. The
subjects walked on a treadmill (inSPORTline Genesis,
Slovakia) at the pre-set walking speeds of v1 = 0.97 ms–1
(slow speed) and v2 = 0.56 ms–1 (very slow speed).
From the participants’ point of view, these speeds were
perceived as the safest and most comfortable. Speed v1
was perceived as comfortable slow speed, v2 – as very
slow. Shoes and speeds were selected randomly.
Temporal and dynamic changes in plantar pressure distribution, as well as in posture... 133
For postural measurement, the SonoSens Monitor
Analyzer system (Gefremed, Chemnitz, Germany) was
used to observe the movements in individual sections
of the subjects’ spines as well as their posture when
walking. In a comparative experiment, the correlation
between the variables recorded when walking in two
types of shoes were identified.
Protocol
Data pertaining to each subject during walking
were obtained during a single session. The partici-
pants were first familiarized with the experimental
protocol and subsequently signed an informed consent
form. At the beginning of the data collection, anthro-
pometric data were recorded. The participants’ height
was measured using a portable Antropometer A 213
(Trystom, Olomouc, Czech Republic), their weight was
measured using an electronic scale (Amboss, New
York, USA), and their age in years was recorded.
At the beginning of each trial, the measuring in-
soles were calibrated by standing on one leg sepa-
rately for each shoe, in accordance with the manufac-
turer’s recommendations.
Two types of shoes (Fig. 1) were used (FS and HH
shoes with a 7 cm heel and 1.4 1.2 cm heel thickness)
for the measurement and subjects chose their respective
shoe size. Subjects were asked to walk on the treadmill
in both types of shoes for 3 minutes before the test
started. At first, all participants walked in randomly cho-
sen shoes at the pre-set walking speed (v1 = 0.97 ms–1
and v2 = 0.56 ms–1). The measurement for the other
type of shoes (identical v1 and v2) continued after
a 5-minute rest during which the recalibration of the
system was performed. All subjects were tested in the
same type of shoes of the respective size.
Fig. 1. Flat shoes (left) and high heel shoes (HH) used in the study
During the postural measurement, the measuring
system was first calibrated during upright standing,
forward bending and backward bending of the
spine, side bending and rotation in both directions
as recommended by the Sonosens Monitor Analyzer
manufacturer. The movements of the axial skeleton
during gait analysis are represented by % deviations
from the default data measured during the calibra-
tion.
Plantar pressure analysis
In the analysis of the gait cycle, temporal and dy-
namic variables were measured and calculated (Fig. 2).
From the measured maximal peak pressure values
(PPmax) and maximal vertical force (Fmax) functions,
the following temporal and dynamic variables for each
step were observed: The STANCE [s] phase – which
represents the contact time with the ground, SWING
[s] phase and duration of the STRIDE [s], frequency
(FRE) [steps/min], maximal peak pressure per body
weight (PPmaxBW = PPmax/mg) and maximal vertical
force per body weight (FmaxBW = Fmax/mg).
Thirty steps from the central part of the 30-s meas-
urement section were evaluated. The first 6–8 and the
last 6–8 steps were recorded, but not evaluated due to
the necessity to evaluate only the fluent walking cy-
cle. The resulting data pertaining to left and right feet
are the mean values calculated based on 15 steps us-
ing each leg. The number of steps for the analysis was
based on the individual length of the step on the
measured section. The coefficients of variation (CVs)
pertaining to the calculated mean values were 1–3%.
Fig. 2. An example of maximal vertical force component
during the gait-cycle phases
Posture analysis
The results pertained to the posture in the sagittal
and frontal planes, and the following values were
compared: median sagittal bending index (mSBI),
median frontal bending index (mFBI), sagittal bending
amplitude (SBA), and the frontal bending amplitude
(FBA) (Fig. 3) in all sections of the spine – lumbar
(LSC), thoracic (TSC) and cervical (CSC). In the sagittal
S. JANDOVA et al.134
plane, the positive deviation represents flexion, while the
negative one represents extension (Fig. 3). In the frontal
plane, the positive values represent movement to the
right, while negative ones represent movement to the
left. These variables were compared for both types of
shoes and subsequently statistically evaluated.
Fig. 3. Bodygram in the sagittal and frontal planes
during walking in HH (The values outside the field of reference
– the standard is determined based on the calibration
during upright posture – are provided in red)
Statistical analysis
The ANOVA statistical test with repeated meas-
ures (
= 0.05) was used to evaluate the effect of HH
on PPmaxBW, FmaxBW and temporal variables of the gait
cycle by comparing walking in HH and FS in v1, v2. The
measured values were evaluated by comparing the cal-
culated testing criterion of critical value F – division
(4.006873), where F > F critical means that the hypothe-
sis cannot be rejected. In the case of posture and for
comparing differences in measured values depending on
walking speed, a paired t-test was used as the statistical
processing method to evaluate the interval data between
the two dependent variables (i.e., paired data). The re-
sults are statistically significant if the t value exceeds the
critical table value of 1.669. The measured values are
considered statistically significant at ( p ≤ .05).
3. Results
Temporal and plantar pressure characteristics
of the gait cycle in HH and FS
Significant differences in slow walking in HH and
FS were detected in temporal variables (Table 1).
For v1, the STANCE duration was significantly shorter
(p = 0.009) than in FS. The same trend was observed
for v2 ( p = 0.005). The SWING phase was significantly
shorter while walking at v1 ( p = 0.001). A difference in
the SWING phase duration between FS and HH was not
observed in v2. In addition, STRIDE was significantly
Table 1. Differences in the plantar pressure distribution and the phases of the gait-cycle
while walking slowly (v1) and very slowly (v2) in HH and FS
Temporal and Dynamic
Parameters in Plantar
Pressure Distribution
FS
Mean SD
HH
Mean SD
FS vs. HH
p-value
v1Ratio [%] Ratio [%]
STANCE 0.828 ± 0.077 64 0.780 ± 0.058 64 0.009
SWING 0.476 ± 0.046 36 0.438 ± 0.040 36 0.001
STRIDE 1.304 ± 0.115 100 1.217 ± 0.084 100 0.002
FRE 92.468 ± 8.392 99.004 ± 6.597 0.002
PPmaxBW 0.565 ± 0.151 0.801 ± 0.2 <0.001
FmaxBW 1.099 ± 0.066 1.279 ± 0.162 <0.001
v2Ratio [%] Ratio [%]
STANCE 1.215 ± 0.115 66 1.124 ± 0.121 66 0.005
SWING 0.613 ± 0.082 34 0.580 ± 0.064 34 0.101
STRIDE 1.829 ± 0.179 100 1.700 ± 0.154 100 0.005
FRE 66.303 ± 6.547 70.878 ± 7.352 0.015
PPmaxBW 0.535 ± 0.142 0.762 ± 0.192 <0.001
FmaxBW 1.080 ± 0.062 1.231 ± 0.135 <0.001
Legend: PPmaxBW – maximal peak pressure per body weight, FmaxBW – maximal vertical force per body weight,
HH – high-heeled shoes, FS – flat shoes, SD – standard deviation, FRE – frequency per minute, v1 – walking
speed of 0.97 ms–1 and v2 – walking speed of 0.56 ms–1
Temporal and dynamic changes in plantar pressure distribution, as well as in posture... 135
shorter in HH at v1 (p = 0.002) and also at v2 (p =
0.005). The percentage ratio of the average duration
pertaining to individual gait phases (STANCE,
SWING) was equal in both types of shoes. At v1, the
ratio was 64% of STANCE versus 36% of SWING in
HH and FS. For v2 the STANCE phase was longer
(66%) and the SWING shorter (34%) in both types of
shoes. FRE was significantly higher in HH at v1 (p =
0.002) and also at v2 ( p = 0.015).
Significant differences between HH and FS were
detected also in dynamic parameters PPmaxBW and
FmaxBW (Table 1), when the values of PPmaxBW and
FmaxBW were significantly higher in HH ( p ≤ .001).
Posture and spine changes
influenced by walking in HH and in FS
The evaluation of the overall results showed sig-
nificant differences between walking in HH and FS in
some of the measured parameters (Table 2). In the
sagittal plane, significant differences in all sections
of the spine at both measured walking speeds were
identified. In the case of SBA, only at v2 were sig-
nificant differences found in LSC ( p = 0.019), TSC
(p = 0.003) and CSC ( p = 0.002) (Table 2). Based on
the overall results in the sagittal plane, it can be
stated that HH affect the spine curvature, unlike FS.
While walking in HH, at v1 and v2 lordosis at LSC
decreases significantly ( p < 0.001) as well as CSC
(p < 0.001), and kyphosis increases in TSC ( p < 0.001)
(Table 2).
In the frontal plane, statistically significant differ-
ences were observed only at v1 in LSC (p = 0.013). In
the frontal plane, the v2 speed caused significant dif-
ferences between HH and FS in CSC ( p = 0.044) and
movement amplitudes (FBA), in CSC ( p = 0.002) and
LSC ( p = 0.002).
Table 2. Differences in the individual spine section during walking in HH and FS
Parameters of Individual
Spine Section
FS
Mean SD
HH
Mean SD
FS vs. HH
p-value
v1
mSBI – LSC [mm] –0.487 ± 7.229 0.550 ± 6.962 <0.001
SBA – LSC [mm] 2.503 ± 1.075 2.947 ± 1.174 0.112
mSBI – TSC [mm] –3.403 ± 2.586 –3.000 ± 2.673 <0.001
SBA – TSC [mm] 1.590 ± 0.762 1.687 ± 0.850 0.620
mSBI – CSC [mm] –4.120 ± 5.019 –2.240 ± 4.392 <0.001
SBA – CSC [mm] 4.850 ± 1.994 4.720 ± 1.841 0.606
mFBI – LSC [mm] –2.023 ± 4.129 –2.98 ± 4.621 0.013
FBA – LSC [mm] 3.890 ± 1.757 4.410 ± 1.555 0.083
mFBI – TSC [mm] –1.686 ± 3.417 –1.376 ± 3.716 0.461
FBA – TSC [mm] 1.843 ± 1.160 2.336 ± 2.085 0.792
mFBI – CSC [mm] –0.44 ± 2.917 –0.173 ± 2.810 0.067
FBA – CSC [mm] 3.656 ± 1.635 3.770 ± 1.905 0.264
v2
mSBI – LSC [mm] 0.003 ± 6.626 3.337 ± 7.549 <0.001
SBA – LSC [mm] 3.303 ± 1.075 4.140 ± 2.247 0.019
mSBI – TSC [mm] –2.147 ± 2.134 –0.770 ± 2.169 <0.001
SBA – TSC [mm] 1.733 ± 0.727 2.520 ± 1.285 0.003
mSBI – CSC [mm] –3.123 ± 3.148 –0.240 ± 3.887 <0.001
SBA – CSC [mm] 4.627 ± 2.064 5.853 ± 2.391 0.002
mFBI – LSC [mm] –2.893 ± 3.811 –2.76 ± 3.845 0.687
FBA – LSC [mm] 4.277 ± 2.039 4.833 ± 2.191 0.002
mFBI – TSC [mm] –1.513 ± 3.531 –1.036 ± 3.193 0.086
FBA – TSC [mm] 2.283 ± 1.190 3.140 ± 1.434 0.834
mFBI – CSC [mm] –0.35 ± 2.436 0.203 ± 3.291 0.044
FBA – CSC [mm] 3.640 ± 1.809 3.590 ± 1.654 0.002
Legend: LSC – lumbar spine, TSC – thoracic spine, CSC – cervical spine, mSBI – median Sagittal
Bending Index, mFBI – median Frontal Bending Index, SBA – Sagittal Bending Amplitude, FBA – Frontal
Bending Amplitude, HH – high-heeled shoes, FS – flat shoes, SD – standard deviation, v1 – walking speed
of 0.97 ms–1 and v2 – walking speed of 0.56 ms–1
S. JANDOVA et al.136
Effect of walking speed
The walking speed affected all measured temporal
variables – STANCE, STRIDE, SWING, frequency
per minute in both FS and HH ( p < 0.001) (Table 3).
In terms of posture, the walking speed affected the
movement amplitudes of LSC in the sagittal plane (SBA)
in FS ( p = 0.006) and HH ( p = 0.013). In HH, a statis-
tically significant differences between the walking speeds
in TSC – mSBI ( p = 0.001) and SBA (p = 0.004) were
observed (Table 3).
Table 3. Differences in the measured values
depending on the walking speed
Measured
parameters
FS (v1) vs. FS (v2)
p-value
HH (v1) vs. HH (v2)
p-value
STANCE <0.001 <0.001
STRIDE <0.001 <0.001
SWING <0.001 <0.001
FRE <0.001 <0.001
PPmaxBW 0.441 0.441
FmaxBW 0.275 0.215
mSBI – LSC [mm] 0.788 0.143
SBA – LSC [mm] 0.006 0.013
mSBI – TSC [mm] 0.045 0.001
SBA – TSC [mm] 0.459 0.004
mSBI – CSC [mm] 0.302 0.061
mFBI – LSC [mm] 0.400 0.842
FBA – LSC [mm] 0.435 0.392
mFBI – TSC [mm] 0.847 0.705
FBA – TSC [mm] 0.152 0.087
mFBI – CSC [mm] 0.897 0.635
FBA – CSC [mm] 0.970 0.697
Legend: PPmaxBW – maximal peak pressure per body weight,
FmaxBW – maximal vertical force per body weight, HH – high-
-heeled shoes, FS – flat shoes, LSC – lumbar spine, TSC – thoracic
spine, CSC – cervical spine, mSBI – median Sagittal Bending In-
dex, mFBI – median Frontal Bending Index, SBA – Sagittal Bend-
ing Amplitude, FBA – Frontal Bending Amplitude, SD – standard
deviation, v1 – walking speed of 0.97 ms–1 and v2 – walking speed
of 0.56 ms–1
4. Discussion
Wearing high-heeled shoes is a wide-spread model
of behaviour among women in developed countries
all over the world. The presented study enhances the
knowledge pertaining to the effects of slow and very
slow walking in HH observed in a group of inexpe-
rienced HH wearers; the walking speed was set to
0.97 ms–1 and to 0.56 ms–1, respectively. Both speeds
were chosen intentionally based on the fact that higher
speeds used in previous studies [2], [26] were per-
ceived as too fast by the inexperienced HH wearers
(subjects). Our subjects perceived the speeds selected
for this study as comfortable.
According to the previous study, [10] the
STANCE phase takes up about 60% of a single gait-
cycle, while the remaining 40% pertain to the SWING
phase. This study discovered that this ratio is influ-
enced by the walking speed rather than by the type of
shoes. At v1, the STANCE phase amounted to 64%
and SWING to 36% of the gait cycle in both HH and
FS. At the very slow speed v2, STANCE amounted to
66% and SWING to 34% of the gait cycle and it was
identical in both types of shoes. This contradicts the
previous study [16] which found that HH prolongs
STANCE and shortens SWING, generally shortening
the STRIDE in comparison with walking in FS, how-
ever, the cadence remained unaffected. While at com-
fortable and fast speeds the swinging leg moves along
a largely ballistic trajectory under passive gravita-
tional control, at significantly reduced walking speeds,
a more active mode of control may be necessary to
counteract gravity and provide sufficient ‘air time’ for
the swinging leg [22]. Besides, the study showed that
HH shortened both phases, which corresponds with
previous studies [2], [7], [16]; cadence in HH in-
creased in comparison with FS, which resulted from
the fact that the treadmill was set to a constant speed.
The observation of plantar pressure distribution
showed that HH increase the pressure variables
(PPmaxBW, FmaxBW) at both speeds, in comparison with
FS. This also corresponds with previous studies [3],
[4], [30]. At the slower speed, the duration of pressure
is prolonged [31]; at the very slow speed v2, no differ-
ences in pressure values were recorded in comparison
with v1 in either shoes. In HH, the pressure force was
shifted forward and increased the forefoot pressure,
which corresponds with other studies [4], [11], [30]. It
indicates that a weight transfer mechanism is triggered
by HH [1].
In accordance with previous studies [1], [15], sig-
nificant differences were observed as a result of HH
wearing – lumbar lordosis was straightened. Lumbar
as well as cervical lordosis were decreased with sta-
tistical significance in HH. However, there are also
studies that discovered no significant differences in
lordosis in HH [25]. The studies [20], [16] that report
increased lordosis in HH were based on very small
subject groups, for which they were criticised [6],
[24]. Decreased lordosis in the lumbar area in inexpe-
rienced wearers and increased lordosis in experienced
HH wearers were also reported [19]. There are even
studies describing increased lordosis in inexperienced
Temporal and dynamic changes in plantar pressure distribution, as well as in posture... 137
wearers [8], [21]. A study that measured the radio-
logical parameters of the spine in the sagittal plane in
HH and barefoot [27] claims that the differences in C7
and meatus vertical axis, cervical and lumbar lordosis,
thoracic kyphosis, spino-sacral angle, pelvic tilt, sac-
ral slope, and spinal tilt were not significant. Individu-
als adapting with less-than-average knee flexion re-
sponded to high heels by an additional increase in
cervical lordosis. It may be explained by the fact that
some subjects responded to high heels through their
lower limbs, while some compensated the changed
CoG by increased cervical lordosis. However, our
study confirmed significant differences in all meas-
ured spine sections in the sagittal plane in HH, since
at both slow walking speeds both lumbar and cervical
lordosis straightened. In the thoracic area, the kypho-
sis was increased in HH. Moreover, at v2 significant
differences in amplitude values in HH were observed,
which indicates major deviations in gait and instabil-
ity caused by very slow walking speed. Different re-
sults in comparison with the previous study [27] can
be ascribed to a different protocol (walking on the
treadmill, constant walking speed, heel size). During
walking, individual body segments move as well as
the centre of gravity in response to the lower limb
mechanics. As a result, a sinusoidal curve is created
with a characteristic course in the given plane, best
approximating the correct gait stereotype [30]. HH
disrupt the stereotype causing the gait in HH to lose
fluency [26]. Multiple authors claim that HH effects
depend upon the individual’s experience with this
type of footwear [27], [19], [24], [29]. The results of
this study indicate that the walking speed in HH can
play an important role in the chain reaction of differ-
ent kinematic effects influencing the posture.
However, this study also had several limitations,
e.g., the subjects walked on a treadmill, which might
have influenced their gait cycle. In addition, it should
be noted that the walking speeds were constant for all
subjects without respect to their individual anthropo-
metric characteristics, although this setting allowed
for recording of data under homogeneous conditions.
5. Conclusions
HH cause changes in the temporal and dynamic
parameters of the gait cycle at slow walking speed.
HH shorten both STANCE and STRIDE phases at
speeds v1 = 0.97 ms–1 and v2 = 0.56 ms–1. The
SWING phase was shortened only at v1. HH also con-
tribute to specific postural changes while walking. In
HH, the lumbar and cervical spine lordosis were de-
creased in the sagittal plane, while kyphosis was in-
creased in thoracic spine at both speeds. In the frontal
plane, left lateral flexion in lumbar spine was ob-
served in HH at v1. At the slower speed v2, the move-
ment amplitude in lumbar spine increased in the fron-
tal plane, while in cervical spine, the movement
amplitude decreased and right lateral flexion occurred.
At the slower walking speed in HH, major movement
amplitude changes occurred in the thoracic section of
the spine.
Based on these results, it is recommended for in-
experienced HH wearers to focus on the correct spine
position while walking in HH and in situations that
require a very slow walking speed, to consider not
wearing HH.
Acknowledgement
This work was supported by SGS 21290, Specific University
Research Grant provided by the Ministry of Education, Youth and
Sports of the Czech Republic.
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