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Document Title: Kerrigan-TL-May98.shtml
Article Title: Knee osteoarthritis and high-heeled shoes
Authors: D Casey Kerrigan MD, Mary K Todd MA and Patrick O Riley PhD
Publication: The Lancet
Date: May 1998
Volume 351, Issue 9113, Pages 1399-1401
Keywords: High-heeled footwear, knee injury, osteoarthritis, varus torque at knee, increased compression and shear forces at knee
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: This article shows that the use of high-heeled footwear predisposes the person to knee osteoarthritis. Kerrigan et al. found that the torque (twisting force) at the knee, in particular varus-directed (i.e. outwards in the coronal/frontal plane), increases when high heels are worn. So, the forces across the knee are higher when the fashion-minded person is teetering around on high heels. Additionally, note that the use of high heels tends to disable the arch of the foot; and the arch serves to absorb the shock of each footfall. The result is that the shock of each step is transmitted directly to the knee. (The strident "clop-clop-clop" sound of walking around in high heels is mechanically very similar to the "bang-bang-bang" of a carpenter's hammer. A person walking around in high heels is literally pounding on her knees in much the same way as a carpenter pounds in a nail.) These concerns are in addition to all the other biomechanical concerns generated by high-heeled footwear use, including the medial-compartment pressure increase resulting from the aforementioned varus torquing of the knee. Additionally, if the knee harbours any existing ligament-injury or cartilage-injury history, for example acute sports injuries or acute work injuries, then the concerns will be even greater.
Abstract
Background
Little is known about the effects of walking in high heels on joints in the legs. Since osteoarthritis of the knee is twice as common in women as in men, we investigated torques (forces applied about the leg joints) of women who wore high-heeled shoes.
Methods
We studied 20 healthy women who were comfortable wearing high-heeled shoes. The women walked with their own high-heeled shoes and barefoot. Data were plotted and qualitatively compared; major peak values for high-heeled and barefoot walking were statistically compared. Bonferroni adjustment was made for multiple comparisons.
Findings
Measurement showed increased force across the patellofemoral joint and a greater compressive force on the medial compartment of the knee (average 23% greater forces) during walking in high heels than barefoot.
Interpretation
The altered forces at the knee caused by walking in high heels may predispose to degenerative changes in the joint.
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