Background

High-heeled shoes have been thought to alter lower extremity joint mechanics during gait, however its effects on the knee remain unclear.

Research question

This 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.

Methods

1449 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.

Results

Meta-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).

Significance

Given 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.

中文翻译：

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高跟鞋在步态中膝部屈曲和内翻力矩增加：系统评价和荟萃分析

背景

高跟鞋被认为可以改变步态下肢的关节力学，但是对膝盖的影响尚不清楚。

研究问题

这项系统的回顾和荟萃分析旨在确定高跟鞋对步态中矢状和额面膝关节动力学/运动学的影响。

方法

筛选了来自6个数据库的1449个研究，其标准如下：1）健康的成年女性，2）报告了在脚跟高度不同（包括赤脚）的步态中步态早期站立阶段的膝关节运动学/运动学。排除的研究包括那些除了改变鞋跟高度以外还混合了不同鞋款的鞋子。共有14项研究（203名受试者）符合选择标准，得出51项和21项Cohen d效应大小（ESs），分别比较了两者之间的矢状位（屈曲）和额面（内翻）力矩/角度的差异高跟鞋和低跟/赤脚鞋。

结果

荟萃分析显示，高跟鞋相比低跟鞋对膝关节屈曲力矩增加（总体ES = 0.83；P  <0.01），屈曲角度（总体ES = 0.46；P  <0.01）和内翻有明显的中到大效果。 步态的早期站立阶段（总ES = 0.52; P <0.01）。用于探索解释研究ES之间异质性的因素的元回归结果表明，膝盖屈曲力矩中较大的ES与高跟鞋的脚跟高度升高有关（P  = 0.02），而高跟鞋的体重更大。个人（P  = 0.012）。高跟步态时膝内翻力矩中较大的ES与更大的身高相关（P = 0.003）和质量（P  = 0.006）。

意义

考虑到膝关节屈曲/内翻力矩增加与患膝骨关节炎（OA）的风险之间的相关性，经常且长时间穿高跟鞋的女性可能更容易患膝OA。下肢肌肉的加强等预防性治疗可能有助于改善减震效果，以减少高跟鞋使用者的膝盖负担。