Increased knee flexion and varus moments during gait with high-heeled shoes: A systematic review and meta-analysis |
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| Institution: | 1. Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK;2. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK;3. Amsterdam University Medical Centers, Amsterdam Movement Science, Dept Rehabilitation Medicine, Netherlands;4. Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK;5. Delft University of Technology, Dept of Biomechanical Engineering, Netherlands;1. Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology, Chiba, Japan;2. Shikoku Center, National Institute of Advanced Industrial Science and Technology, Kagawa, Japan;1. Catherine McAuley School of Nursing and Midwifery, University College Cork, Co. Cork, Ireland;2. Faculty of Biological Sciences, School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom;1. KITE, Toronto Rehab – University Health Network, 520 Sutherland Dr., M4G 3V9, Canada;2. Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada;3. Institute of Biomaterials & Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada;4. Department of Physical Therapy, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada;1. Department of Physical Therapy, West Coast University, 590 N Vssermont Ave, Los Angeles, CA, 90004, USA;2. Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA;3. Department of Health and Rehabilitation Sciences, School of Health Technology and Management, Stony Brook University, 101 Nicolls Road, Health Sciences Center, Stony Brook, 11794, USA;4. Department of Bioengineering, Temple University 1801 N Broad St., Philadelphia, PA, 19122, USA |
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| Abstract: | BackgroundHigh-heeled shoes have been thought to alter lower extremity joint mechanics during gait, however its effects on the knee remain unclear.Research questionThis systematic review and meta-analysis aimed to determine the effects of high-heeled shoes on the sagittal- and frontal-plane knee kinetics/kinematics during gait.Methods1449 studies from 6 databases were screened for the following criteria: 1) healthy adult females, 2) knee joint kinematics/kinetics reported for the early stance phase during gait under varying shoe heel heights (including barefoot). Excluded studies included those mixing different shoe styles in addition to altering the heel heights. A total of 14 studies (203 subjects) met the selection criteria, resulting in 51 and 21 Cohen’s d effect sizes (ESs) comparing the differences in knee sagittal- (flexion) and frontal-plane (varus) moment/angle, respectively, between shoes with higher heels and shoes with lower heels/barefoot.ResultsMeta-analyses yielded a significant medium-to-large effect of higher heels compared to lower heels on increasing knee flexion moment (overall ES = 0.83; P < 0.01), flexion angle (overall ES=0.46; P < 0.01), and varus moment (overall ES=0.52; P < 0.01) during the early stance phase of gait. The results of meta-regressions used to explore factors explaining the heterogeneity among study ESs revealed that a greater ES in the knee flexion moment was associated with an elevated heel height of the high-heeled shoes (P = 0.02) and greater body mass of the individuals (P = 0.012). A greater ES in the knee varus moment during high-heeled gait was associated with a greater body height (P = 0.003) and mass (P = 0.006).SignificanceGiven the association between increased knee flexion/varus moments and risk of developing knee osteoarthritis (OA), women who wear high-heel shoes frequently and for a long period may be more susceptible to knee OA. Preventive treatments, such as lower extremity muscle strengthening, may help improve shock absorption to decrease knee loading in high-heel users. |
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| Keywords: | High heels Gait Kinematics Kinetics Knee Meta-analysis |
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