Mezian Kamal, Ata Ayşe M, Kara Murat, Şahin Onat Şule, Gürçay Eda, Çalışkan Aslı, Simoes Maria I T, Akıncı Ayşen, Özçakar Levent, Franchignoni Franco
Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University, Albertov 7, Prague 12800, Czech Republic.
Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Turkey.
PM R. 2019 Jun;11(6):613-618. doi: 10.1016/j.pmrj.2018.09.023. Epub 2019 Mar 7.
Specific attention on the musculoskeletal impact of wearing high-heeled shoes (HHS) has mainly focused on knee osteoarthritis and the literature is limited to biomechanical changes. The distal femoral cartilage has not been morphologically studied. Additionally, although heel elevation is coupled with a shear stress at the heel and overloaded calf muscles, Achilles tendon (AT) and plantar fascia (PF) thicknesses have not been assessed either.
To investigate whether the distal femoral cartilage, AT, and PF were different in women wearing HHS and flat-heeled shoes (FHS) and specifically, different in terms of AT/PF and distal femoral cartilage thicknesses.
Cross-sectional observational study.
Tertiary care center.
There were 34 women (mean age; 31.1 ± 6.4, body mass index [BMI]; 21.6 ± 2.4 kg/m ) in the HHS group and 54 women (mean age; 29.5 ± 7.2 years, BMI 22.5 ± 2.9 kg/m ) in the FHS group (P = .271, P = .102, respectively). Women wearing shoes with a heel height of >5 cm were enrolled in the HHS group, and those wearing shoes with a heel height of <1.4 cm were included in the FHS group.
Distal femoral cartilage from the lateral condyle, intercondylar area and medial condyle (MFC), AT and PF thicknesses, and any abnormalities were evaluated bilaterally by ultrasound.
Within-group comparisons yielded thicker right MFC (P = .022) and left AT (P = .028) only in the HHS group. Between-group comparisons yielded thicker left AT in the HHS group (P = .040). PF thicknesses were similar both within and between group comparisons (all P > .05). Right AT thickness was positively correlated with right (r = .469, P = .005) and left (r = .402, P = .018) PF thicknesses only within the HHS group. Only calcaneal irregularity/spur was found to be common in the HHS group (P = .038).
We found thickening of the right MFC and left AT in those wearing HHS, whereas PF thickness was not significantly different between those wearing HHS and those wearing FHS.
III.
对穿高跟鞋（HHS）的肌肉骨骼影响的具体关注主要集中在膝关节骨关节炎，且相关文献仅限于生物力学变化。股骨远端软骨尚未进行形态学研究。此外，尽管足跟抬高会导致足跟处的剪切应力以及小腿肌肉、跟腱（AT）和足底筋膜（PF）负荷过重，但也未对AT和PF的厚度进行评估。
研究穿HHS和平底鞋（FHS）的女性的股骨远端软骨、AT和PF是否存在差异，特别是在AT/PF和股骨远端软骨厚度方面的差异。
横断面观察性研究。
三级医疗中心。
HHS组有34名女性（平均年龄；31.1±6.4岁，体重指数[BMI]；21.6±2.4kg/m²），FHS组有54名女性（平均年龄；29.5±7.2岁，BMI 22.5±2.9kg/m²）（P分别为0.271和0.102）。足跟高度>5cm的女性被纳入HHS组，足跟高度<1.4cm的女性被纳入FHS组。
通过超声双侧评估外侧髁、髁间区和内侧髁（MFC）的股骨远端软骨、AT和PF厚度以及任何异常情况。
组内比较仅在HHS组中发现右侧MFC（P = 0.022）和左侧AT（P = 0.028）增厚。组间比较发现HHS组左侧AT更厚（P = 0.040）。PF厚度在组内和组间比较中均相似（所有P>0.05）。仅在HHS组中，右侧AT厚度与右侧（r = 0.469，P = 0.005）和左侧（r = 0.402，P = 0.018）PF厚度呈正相关。仅发现跟骨不规则/骨刺在HHS组中常见（P = 0.038）。
我们发现穿HHS的人右侧MFC和左侧AT增厚，而穿HHS的人和穿FHS的人之间PF厚度无显著差异。
III级。
