3D Weight-Bearing CT Imaging Analysis of Foot Mechanics: Bridging High Heels and Hallux Valgus
Introduction/Purpose: Evidence in the literature suggests the negative effects of using High Heels (HH), becoming a challenge for clinicians and researchers since they are welcomed by women worldwide, mainly due to the subjective power of attractiveness given to them. Although some people blame HH a...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2024-04-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011424S00040 |
| _version_ | 1827287063336058880 |
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| author | Kepler A.M. Carvalho MD Tania Szejnfeld Mann MD, PhD Aly Fayed MD Grayson M. Talaski BA Emily Joan Luo BS Antoine Acker MD Nacime Salomao Barbachan Mansur MD, PhD Jonathan Kaplan MD Bopha Chrea MD Cesar de Cesar Netto MD, PhD |
| author_facet | Kepler A.M. Carvalho MD Tania Szejnfeld Mann MD, PhD Aly Fayed MD Grayson M. Talaski BA Emily Joan Luo BS Antoine Acker MD Nacime Salomao Barbachan Mansur MD, PhD Jonathan Kaplan MD Bopha Chrea MD Cesar de Cesar Netto MD, PhD |
| author_sort | Kepler A.M. Carvalho MD |
| collection | DOAJ |
| description | Introduction/Purpose: Evidence in the literature suggests the negative effects of using High Heels (HH), becoming a challenge for clinicians and researchers since they are welcomed by women worldwide, mainly due to the subjective power of attractiveness given to them. Although some people blame HH as one of the causes of Hallux Valgus (HV), until now, there are no studies in the literature that effectively prove a cause-effect relationship between HH and HV. The objectives of this study are: (1) to analyze whether the increase in heel height can lead to HV and (2) to evaluate whether HV can increase in severity with increasing heels. We hypothesized that an increase in heel height could cause and increase the severity of HV deformity. Methods: Comparative cross-sectional study. Forty-one feet from twenty-one participants (11 males and 10 females, aged 30.8 ± 8.9 years, and with Body Mass Index 25.5 ± 2.0 m kg2) were recruited. HH shoes were designed for this study with three heights for each participant: 3, 6, and 9 cm. The inclusion criteria were: no regular wearing of heels. The exclusion criteria were: Hallux Valgus diagnosis and/or any orthopedic conditions that affect the Foot and Ankle joints. Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), First-Metatarsal Phalangeal Angle, 1st-to-5th Intermetatarsal Angle, First Tarsometatarsal Angle (axial), Second tarsometatarsal angle (axial), Hindfoot Moment Arm (HMA) (mm), Saltzman 45 angle and, Foot Ankle Offset (FAO) were measurement using semiautomated software analysis. Multiple comparisons were performed (Bonferroni's for normal distributions and Wilcoxon test for no normal distributions) when there was a main effect on an outcome (p < 0.05). Results: With the increase in HH, we noticed a progressive increase in HVA (p < 0.001), IMA (p < 0.001), First-Metatarsal Phalangeal Angle (p < 0.001), First Tarsometatarsal Angle (axial) (p < 0.001), and the Second tarsometatarsal angle (axial) (p < 0.001). The Hindfoot Moment Arm (HMA) (mm), Saltzman 45 angle, and Foot Ankle Offset (FAO) had hindfoot varization behavior. When we stratified the groups and compared them, we noticed that an increase of 3 cm in heels slightly increased HVA and IMA (p > 0.05). However, heel increases above 6 cm significantly increased HVA and IMA (p > 0.001). Based on Coughlin's classification, a 3 cm heel increase promoted a mild HV and increases above 6 cm caused a moderate HV. Conclusion: Based on data from our study with patients without Hallux Valgus through analysis with WBCT versus high heels, we conclude that increasing heel height can lead to Hallux Valgus and can progressively increase the severity with increasing high heels. High heels above 6 cm can lead to moderate Hallux Valgus. These findings may be an essential step toward a better understanding of the effects of increasing high heels on Hallux Valgus pathology. |
| first_indexed | 2024-04-24T10:51:36Z |
| format | Article |
| id | doaj.art-f940391ad59d4f109b7c89769eb02019 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-04-24T10:51:36Z |
| publishDate | 2024-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-f940391ad59d4f109b7c89769eb020192024-04-12T13:03:38ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142024-04-01910.1177/2473011424S000403D Weight-Bearing CT Imaging Analysis of Foot Mechanics: Bridging High Heels and Hallux ValgusKepler A.M. Carvalho MDTania Szejnfeld Mann MD, PhDAly Fayed MDGrayson M. Talaski BAEmily Joan Luo BSAntoine Acker MDNacime Salomao Barbachan Mansur MD, PhDJonathan Kaplan MDBopha Chrea MDCesar de Cesar Netto MD, PhDIntroduction/Purpose: Evidence in the literature suggests the negative effects of using High Heels (HH), becoming a challenge for clinicians and researchers since they are welcomed by women worldwide, mainly due to the subjective power of attractiveness given to them. Although some people blame HH as one of the causes of Hallux Valgus (HV), until now, there are no studies in the literature that effectively prove a cause-effect relationship between HH and HV. The objectives of this study are: (1) to analyze whether the increase in heel height can lead to HV and (2) to evaluate whether HV can increase in severity with increasing heels. We hypothesized that an increase in heel height could cause and increase the severity of HV deformity. Methods: Comparative cross-sectional study. Forty-one feet from twenty-one participants (11 males and 10 females, aged 30.8 ± 8.9 years, and with Body Mass Index 25.5 ± 2.0 m kg2) were recruited. HH shoes were designed for this study with three heights for each participant: 3, 6, and 9 cm. The inclusion criteria were: no regular wearing of heels. The exclusion criteria were: Hallux Valgus diagnosis and/or any orthopedic conditions that affect the Foot and Ankle joints. Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), First-Metatarsal Phalangeal Angle, 1st-to-5th Intermetatarsal Angle, First Tarsometatarsal Angle (axial), Second tarsometatarsal angle (axial), Hindfoot Moment Arm (HMA) (mm), Saltzman 45 angle and, Foot Ankle Offset (FAO) were measurement using semiautomated software analysis. Multiple comparisons were performed (Bonferroni's for normal distributions and Wilcoxon test for no normal distributions) when there was a main effect on an outcome (p < 0.05). Results: With the increase in HH, we noticed a progressive increase in HVA (p < 0.001), IMA (p < 0.001), First-Metatarsal Phalangeal Angle (p < 0.001), First Tarsometatarsal Angle (axial) (p < 0.001), and the Second tarsometatarsal angle (axial) (p < 0.001). The Hindfoot Moment Arm (HMA) (mm), Saltzman 45 angle, and Foot Ankle Offset (FAO) had hindfoot varization behavior. When we stratified the groups and compared them, we noticed that an increase of 3 cm in heels slightly increased HVA and IMA (p > 0.05). However, heel increases above 6 cm significantly increased HVA and IMA (p > 0.001). Based on Coughlin's classification, a 3 cm heel increase promoted a mild HV and increases above 6 cm caused a moderate HV. Conclusion: Based on data from our study with patients without Hallux Valgus through analysis with WBCT versus high heels, we conclude that increasing heel height can lead to Hallux Valgus and can progressively increase the severity with increasing high heels. High heels above 6 cm can lead to moderate Hallux Valgus. These findings may be an essential step toward a better understanding of the effects of increasing high heels on Hallux Valgus pathology.https://doi.org/10.1177/2473011424S00040 |
| spellingShingle | Kepler A.M. Carvalho MD Tania Szejnfeld Mann MD, PhD Aly Fayed MD Grayson M. Talaski BA Emily Joan Luo BS Antoine Acker MD Nacime Salomao Barbachan Mansur MD, PhD Jonathan Kaplan MD Bopha Chrea MD Cesar de Cesar Netto MD, PhD 3D Weight-Bearing CT Imaging Analysis of Foot Mechanics: Bridging High Heels and Hallux Valgus Foot & Ankle Orthopaedics |
| title | 3D Weight-Bearing CT Imaging Analysis of Foot Mechanics: Bridging High Heels and Hallux Valgus |
| title_full | 3D Weight-Bearing CT Imaging Analysis of Foot Mechanics: Bridging High Heels and Hallux Valgus |
| title_fullStr | 3D Weight-Bearing CT Imaging Analysis of Foot Mechanics: Bridging High Heels and Hallux Valgus |
| title_full_unstemmed | 3D Weight-Bearing CT Imaging Analysis of Foot Mechanics: Bridging High Heels and Hallux Valgus |
| title_short | 3D Weight-Bearing CT Imaging Analysis of Foot Mechanics: Bridging High Heels and Hallux Valgus |
| title_sort | 3d weight bearing ct imaging analysis of foot mechanics bridging high heels and hallux valgus |
| url | https://doi.org/10.1177/2473011424S00040 |
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