title: The impact of high-heeled shoes on ankle complex during walking in young women-In vivo kinematic study based on 3D to 2D registration technique.
abstract: OBJECTIVE
  To explore the accurate in vivo kinematic changes in the ankle complex when wearing low- and high-heel shoes (LHS and HHS, respectively).
  
  
  METHODS
  Twelve young women were tested unilaterally. Three-dimensional models of the tibia, talus, and calcaneus were first created based on CT scan results. The subjects walked at a self-controlled speed in barefoot, LHS (4cm), and HHS (10cm) conditions. A fluoroscopy system captured the lateral fluoroscopic images of the ankle complex. The images of seven key positions in the stance phase were selected, and 3D to 2D bone model registrations were performed to determine the joint positions. The mean of 6 degree of freedom (DOF) range of motions (ROM), joint positions, and angular displacements of the ankle complex during the gait were then obtained.
  
  
  RESULTS
  For the talocrural joint, the rotational ROMs of the subjects either in LHS or HHS condition displayed no significant difference from those in barefoot condition. For the subtalar joint, all the rotational ROMs in the HHS condition and the internal/external rotations in the LHS condition significantly decreased compared with those in the barefoot condition. The talocrural joint was positioned significantly more plantarflexed, inverted, internally rotated, and posteriorly seated in all seven poses in HHS condition, compared with those in barefoot condition.
  
  
  CONCLUSIONS
  HHS mainly affected the rotational motion of the ankle complex during walking. The talocrural joint position was abnormal, and the subtalar joint ROM decreased during the gait in HHS condition. Only a few kinematic changes occurred in LHS condition relative to the barefoot condition.
authors.affiliation: Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Geng
authors.affiliation: Harvard Medical School, Boston, MA, USA; Key Laboratory of Exercise and Health Science, Ministry of Education, Shanghai University of Sport, Shanghai, China.
authors.forename: Shaobai
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China. Electronic address: maxin@sh163.net.
authors.forename: Xin
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Jiazhang
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Junsheng
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Jiabei
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Kan
authors.initials: K
authors.lastname: Wang
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000000981:diagnostic imaging* / Q000502:physiology*; D001696:Biomechanical Phenomena / Q000502:physiology; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D018482:Muscle, Skeletal; D016059:Range of Motion, Articular / Q000502:physiology; D012775:Shoes / Q000009:adverse effects*; D013977:Tibia / Q000502:physiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016138:Walking / Q000502:physiology*; D055815:Young Adult
keywords: 3D–2D registration; Ankle complex; High-heel shoes; In vivo kinematics