title: Self-reported adult footwear and the risks of lower limb osteoarthritis: the GOAL case control study.
abstract: BACKGROUND
  Biomechanical factors may play a role in osteoarthritis (OA) development and progression. Previous biomechanical studies have indicated that types of footwear may modulate forces across the knee joint, and high heeled womens' shoes in particular are hypothesised to be detrimental to lower limb joint health. This analysis of data from a case control study investigated persistent users of different adult footwear for risks of knee and hip OA. Our underlying hypotheses were that high heeled, narrow heeled, and hard soled shoe types were putative risk factors for lower limb OA.
  
  
  METHODS
  Data on footwear were initially obtained from participants during the Genetics of Osteoarthritis and Lifestyle (GOAL) hospital-based, case control study using standardised interview-delivered questionnaires. An additional questionnaire was later sent to GOAL study participants to verify findings and to further investigate specific shoe use per decade of life. Persistent users of footwear types (high or narrow heel; sole thickness or hardness) were identified from early adulthood. Participants were grouped into single sex knee OA, hip OA or control groups. Adjusted odds ratios (aOR) and 95% confidence interval (CI) were calculated.
  
  
  RESULTS
  Univariate analysis of persistent users of women's high heeled and narrow heeled shoes during early adulthood showed negative associations with knee OA and hip OA. After logistic regression, persistent narrow heel users were associated with less risk of OA (knee OA aOR 0.59, 95% CI 0.35 - 1.00 and hip aOR: 0.50, 95% CI 0.30 - 0.85), and other analyses were not statistically significant. Further analysis suggested that women with hip OA may have stopped wearing high and narrow heeled footwear to attenuate hip pain in early adulthood. Consistent associations between shoe soles and OA were not found.
  
  
  CONCLUSIONS
  In general, persistent users of high and narrow heeled shoes during early adulthood had a negative association with knee or hip OA. This does not necessarily imply a causal relationship, as changing footwear during early adulthood to modulate index joint pain may provide a possible explanation. Despite the findings of previous biomechanical studies of high heels, we did not find a positive association between women's shoes and lower limb osteoarthritis.
authors.affiliation: Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK. dan.mcwilliams@nottingham.ac.uk.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: McWilliams
authors.forename: Stella
authors.initials: S
authors.lastname: Muthuri
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Muir
authors.forename: Rose A
authors.initials: RA
authors.lastname: Maciewicz
authors.forename: Weiya
authors.initials: W
authors.lastname: Zhang
authors.forename: Michael
authors.initials: M
authors.lastname: Doherty
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis* / Q000209:etiology*; D012307:Risk Factors; D057566:Self Report; D012775:Shoes / Q000009:adverse effects*