title: Influence of heel height and shoe insert on comfort perception and biomechanical performance of young female adults during walking.
abstract: BACKGROUND
  The possible negative effects of high-heeled shoes on subjective comfort perception and objective biomechanical assessment have been noted. Although shoe inserts have been widely applied in footwear to increase comfort and to reduce the frequency of movement-related injury, no study has attempted to identify insert effectiveness in high heels. The purpose of this study was to determine the effects of heel height and shoe inserts on comfort and biomechanics as represented by plantar pressure and ground reaction force (GRF).
  
  
  METHODS
  Twenty young female adults performed the test conditions formed by the cross-matching of shoe inserts (shoe without insert and shoe with total contact insert [TCI]) and heel height (a flat, a low heel [3.8 cm] and a high heel [7.6 cm]). Two-way analyses of variance for repeated measures design were used to test condition effects on comfort rating, plantar pressure, and GRF during gait. To determine the biomechanical variables that can predict comfort, a multiple linear regression with stepwise method was done.
  
  
  RESULTS
  The results showed that discomfort increased with heel height. In high heels, the plantar pressure in the heel and midfoot shifted to the medial forefoot, and the vertical and anteroposterior GRF increased. Use of the TCI reduced the peak pressure in the medial forefoot. Interestingly, the effectiveness of the TCI was greater in the higher heels than in the lower heels and in flat heels. The peak pressure in the medial forefoot, impact force, and the first peak vertical GRF could explain 75.6% of the variance of comfort in high-heeled gait.
  
  
  CONCLUSIONS
  These findings suggest that higher heels result in decreased comfort, which can be reflected by both the subjective rating scale and biomechanical variables. Use of a TCI altered the biomechanics and therefore improved the comfort in high-heeled shoes.
authors.affiliation: School of Sports Medicine, China Medical University, Taiwan.
authors.forename: Wei-Hsien
authors.initials: WH
authors.lastname: Hong
authors.forename: Yung-Hui
authors.initials: YH
authors.lastname: Lee
authors.forename: Hsieh-Ching
authors.initials: HC
authors.lastname: Chen
authors.forename: Yu-Cheng
authors.initials: YC
authors.lastname: Pei
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Wu
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D005260:Female; D005545:Forefoot, Human / Q000503:physiopathology; D006365:Heel / Q000502:physiology*; D006801:Humans; D009989:Orthotic Devices; D010147:Pain Measurement; D011312:Pressure; D012044:Regression Analysis; D012775:Shoes; D016138:Walking / Q000502:physiology*