Full length articleEffects of high-heeled footwear on static and dynamic pelvis position and lumbar lordosis in experienced younger and middle-aged women
Introduction
While commonly used in the female population, high-heeled footwear affects posture and gait and is generally thought to be associated with back complains [1]. High-heeled footwear has been shown to have various effects on foot pathologies like hallux valgus and musculoskeletal pain [2]. It seems obvious that there are alterations in alignment and motion patterns in the foot-ankle complex. Additionally, other authors have discussed various other 'chain reaction' kinematic effects superior to the ankle [3]. A popular hypothesized compensating strategy, and probably the one most frequently investigated, is that of increased lumbar lordosis [1].
There have been conflicting findings and scientific perspectives on the lumbar lordosis and it was shown that the effects of high-heeled footwear are dependent on the habituation to this footwear and the age of the participants [4], [5], [6], [7], [8], [9], [10], [11], [12]. Cowley et al. [13] concluded in their review that increased lumbar lordosis angles were found predominantly in inexperienced users.
Furthermore, there have been different methodological confounders leading to difficulties in comparing the published results. While some authors investigate static outcome parameters [3], [4], [5], [6], [7], [9], [11], [12], some report dynamic outcomes [6], [12], [14], [15]. In addition, the assessment tools differ between studies using low-dose whole body x-ray [3], [5], inclinometers for indirect back surface reconstruction [11], lateral photogrammetry [7] or electromyography [15]. While radiographic assessments have the advantage of direct measurement of the spinal bones it has its disadvantages and ethical limitations due to the ionizing radiation [16]. The rasterstereographic assessment provides a safe and valid alternative that has been used for example in pregnancy [17] and in scoliosis progress-monitoring investigations [18]. Additionally, rasterstereography offers the opportunity for a dynamic spine shape assessment during gait [19], [20].
Due to the persistent research gap concerning assessment tools, age and habituation, the aim of this study was to investigate the effects of high-heeled footwear by means of video rasterstereography on static and dynamic pelvis position and lumbar lordosis parameters in young and middle-aged females experienced in wearing high-heeled shoes. Despite conflicting evidence, we hypothesized high-heel associated increased lumbar lordosis angles accompanied by corresponding pelvis position adaptations compared to a standard shoe condition.
Section snippets
Study design
The present investigation had a randomized crossover design. After a preliminary familiarization, the participants went through three repeated measures: a baseline test followed by two measurements in a randomized order (control: standard shoe condition; experimental: high-heeled shoe condition). The baseline and the control condition were the same, and were performed twice to determine the repeatability. All measures were separated by ten minutes for shoe habituation (standing, walking, and
Results
Outcomes were normally distributed in all dependent variables (p > 0.10). Age sub-samples differed significantly in high-heeled shod walking years (p < 0.001) and use per week (p = 0.001) (Table 1). Reliability of the parameters resulting from the dynamic assessment could be demonstrated as ICCs ranging from 0.826 (LA_ROM°), and 0.915 (P_ROT°) to 0.992 (MLA°).
Under static conditions, the pelvic tilt (PT°) showed a significant shoe effect (p = 0.003), but no effect for age (p = 0.564) or an interaction (p =
Discussion
The purpose of this study was to investigate the effects of high-heeled footwear on static and dynamic pelvic position and lumbar lordosis in young and middle-aged females with experiences in using high-heeled footwear. Our findings showed a small to moderate effect of high-heeled shoes on static (d = 0.24) and dynamic (d = 0.63) pelvic positions (sagittal pelvic tilt and axial pelvic rotation) in females habituated to the use of high-heeled footwear. In this study cohort no effects of footwear
Conclusions
In women, habituated to high-heeled footwear, a primary compensation mechanism during the use of high-heels seems to be pelvis position and movement adaptations rather than lumbar lordosis shape adaptations. The impact of these findings on back complaints should be revisited carefully, because muscular overuse as well as postural load relieving may contribute to complain reporting. Negative as well as positive effects on back pain due to heel elevation are conceivable. Further research would be
Conflict of interest
The authors declare no conflict of interests.
Acknowledgement
The authors did not receive financial support for this study.
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