Pandemic-related decline in injuries related to women wearing high-heeled shoes: Analysis of U.S. data for 2016-2020

Background Wearing high-heeled shoes is associated with injury risk. During the COVID-19 pandemic, changes in work and social behavior may have reduced women's use of such footwear. Methods This study assessed the trend in high-heel related injuries among U.S. women, using 2016-2020 data from the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS). Results In 2020 there were an estimated 6,290 high-heel related emergency department visits involving women ages 15-69, down from 16,000 per year in 2016-2019. The 2020 decline began after the start of the COVID-19 shutdowns on March 15. There was no significant change in the percentage of fractures or hospital admissions. Conclusions The COVID-19 pandemic was associated with a decline in reported injuries related to high-heeled shoes among US women. If this resulted from fewer women wearing such shoes, and such habits influence future behavior, the result may be fewer injuries in the future.

The Influence of Heel Height on Strain Variation of Plantar Fascia During High Heel Shoes Walking-Combined Musculoskeletal Modeling and Finite Element Analysis

The therapeutic benefit of high heel shoes (HHS) for plantar fasciitis treatment is controversial. It has been suggested that plantar fascia strain can be decreased by heel elevation of shoes which helps in body weight redistribution throughout the length of the foot. Yet it is a fact that the repetitive tension caused by HHS wearing resulting in plantar fasciitis is a high-risk disease in HHS individuals who suffer heel and plantar pain. To explore the biomechanical function on plantar fascia under HHS conditions, in this study, musculoskeletal modeling (MsM) and finite element method (FEM) were used to investigate the effect of heel height on strain distribution of plantar fascia. Three-dimensional (3D) and one-dimensional (1D) finite element models of plantar fascia were generated to analyze the computed strain variation in 3-, 5-, and 7-cm heel heights. For validation, the computed foot contact pressure was compared with experimental measurement, and the strain value on 1D fascia was compared with previous studies. Results showed that the peak strain of plantar fascia was progressively increased on both 3D and 1D plantar fascia as heel elevated from 3 to 7 cm, and the maximum strain of plantar fascia occurs near the heel pain site at second peak stance. The 3D fascia model predicted a higher strain magnitude than that of 1D and provided a more reliable strain distribution on the plantar fascia. It is concluded that HHS with narrow heel support could pose a high risk on plantar fasciitis development, rather than reducing symptoms. Therefore, the heel elevation as a treatment recommendation for plantar fasciitis is questionable. Further studies of different heel support structures of shoes to quantify the effectiveness of heel elevation on the load-bearing mechanism of plantar fascia are recommended.

A Comparative Clinical Study to Evaluate the Effect of Shamana Sweda Followed by Nirgundi Guggulu in Vaatakantaka with Special Reference to Calcaneal Spur Amongst Female Population

Vatakantaka is characterized by the pain in the heel region and included in the vatavyadhi by Acharya Sushruta. It is common in about 10% of general population. Women are twice more prevalent than men. Vatakantaka is mainly caused due to vitiation of Vatadosha and continuous pressure on the heel region. It can be co-related with Calcaneal spur. It is more prevalent in female due to life style postures like standing for longer period, wearing high heel shoes. Various treatment measures for the management of Vatakantaka are given in the classics of Ayurveda. Siravyadha,Agnikarma and Eranda taila pana are the main chikitsa of Vatakantaka. Achrya Charaka said Vatakantaka is Sweda sadhya Vyadhi. So in this present study, treatment is given with swedana followed by Shamanoushadhi. Here 40 cases of Vatatakantaka vis- a -vis Calcaneal spur were devided in to two groups and subjected to Dashamula churna pinda sweda and valuka sweda for 7 days, followed by Nirgundi Guggulu for 30 days. Patients showed significant results in subjective and objective parameters. The present clinical study has been registered as a Prospective study in clinical trials registry- India (CTRI). Register number – CTRI/2019/11/022132

The “Shiny and Thick High Heel Sign”

Purpose Together with the foramen ovale, the middle meningeal artery (MMA) looks like a high heel shoe print on axial time-of-flight magnetic resonance angiography (TOF-MRA) images, with the MMA resembling the heel. Cranial dural arteriovenous fistulas (DAVF) are often fed by the MMA, which can lead to an increase of signal intensity and diameter of this vessel, resulting in a more “shiny” and “thick” high heel print appearance than on the contralateral side. We describe this finding as a novel radiologic sign and provide cut-off values for the ratios of MMA signal intensities and diameters for predicting the presence of a DAVF. Methods A total of 84 TOF-MRA examinations of 44 patients with DAVFs (40 with unilateral MMA feeders, 4 with bilateral feeders) and of 40 patients without DAVFs were included. Diameters and signal intensities of both MMAs were measured by two raters and evaluated using receiver operating characteristic analysis. Results The diameters of feeding and non-feeding MMAs differed significantly, as did the ratios of signal intensities and of diameters of DAVF and control patients (P < 0.0001). Cut-off values were 1.25 for average signal intensity ratio (shiny high heel sign) and 1.21 for diameter ratio (thick high heel sign). The combination of the “shiny” and the “thick” high heel sign resulted in the highest sensitivity (92.5%) and positive predictive value (95%). Conclusion The described sign seems promising for the detection of DAVFs with noncontrast-enhanced MRI. The TOF-MRA source images should be reviewed with special attention to the MMA.

Effects of Wearing High Heels on Ankle Plantarflexion

Wearing High Heels (HH) for prolong period may cause kinetics and kinematics changes of lower extremity. It may lead to musculoskeletal deformities.Objective:To determine the effects of wearing different high heel shoes on ankle joint plantar flexion range.Methadology: 120 healthy university students who habitually wore shoes of different heel heights from 1cm to 10cm for at least 1 academic year, more than 5 days a week were selectively recruited. Participants were grouped according to their heel heights: flat, low, mid and high heels. Ankle plantarflexion was measured using universal goniometer in all 4 groups.Results:Overall plantarflexion range was significantly affected by heel height (p-value <0.001). Wearing high heel s s ignificantly inc reased the plantar flexion range as compared to flat shoe wearers (p-value <0.001). There was statistically significant difference in plantarflexion range according to heel height (p<0.001).Conclusion: Wearing high heels shoes for 1 year enhanced the plantarflexion range of motion in all heel groups and the change was most significant in HH group. Habitually wearing of high heels increases the plantarflexion range of motion in heel wearing groups but it was not seen in flat shoes group (FSG). Increase in range depends on heel height; increasing the heel height results into increase plantarflexion range. Keywords: High heels; Heel height; Plantarflexion ; Range of motion

Influences of heel height on human postural stability and functional mobility between inexperienced and experienced high heel shoe wearers

Background High heel shoes (HHS) can affect human postural control because elevated heel height (HH) may result in plantar flexed foot and limit ankle joint range of motion during walking. Effects of HH and HHS wearing experience on postural stability during self-initiated and externally triggered perturbations are less examined in the literature. Hence, the objective of the present study is to investigate the influences of HH on human postural stability during dynamic perturbations, perceived stability, and functional mobility between inexperienced and experienced HHS wearers. Methods A total of 41 female participants were recruited (21 inexperienced HHS wearers and 20 experienced HHS wearers). Sensory organization test (SOT), motor control test (MCT), and limits of stability (LOS) were conducted to measure participant’s postural stability by using computerized dynamic posturography. Functional reach test and timed up and go test were performed to measure functional mobility. The participants’ self-perceived stability was assessed by visual analog scale. Four pairs of shoes with different HH (i.e., 0.8, 3.9, 7.0, and 10.1 cm) were applied to participants randomly. Repeated measures analysis of variance was conducted to detect the effects of HH and HHS wearing experience on each variable. Results During self-initiated perturbations, equilibrium score remarkably decreased when wearing 10.1 cm compared with flat shoes and 3.9 cm HHS. The contribution of vision to postural stability was larger in 10.1 cm HHS than in flat shoes. The use of ankle strategy worsened when HH increased to 7 cm. Similarly, the directional control of the center of gravity (COG) decreased for 7 cm HHS in LOS. Experienced wearers showed significantly higher percentage of ankle strategy and COG directional control than novices. Under externally triggered perturbations, postural stability was substantially decreased when HH reached 3.9 cm in MCT. No significant difference was found in experienced wearers compared with novices in MCT. Experienced wearers exhibited considerably better functional mobility and perceived stability with increased HH. Conclusions The use of HHS may worsen dynamic postural control and functional mobility when HH increases to 3.9 cm. Although experienced HHS wearers exhibit higher proportion of ankle strategy and COG directional control, the experience may not influence overall human postural control. Sensory organization ability, ankle strategy and COG directional control might provide useful information in developing a safety system and prevent HHS wearers from falling.