The influence of heel height on patellofemoral joint kinetics during walking

Although wearing high-heeled shoes has long been considered a risk factor for the development for patellofemoral pain (PFP) in women, patellofemoral joint kinetics during high-heeled gait has not been examined. The purpose of this study was to determine if heel height increases patellofemoral joint loading during walking. Eleven healthy women (mean age 25.0±3.1 yrs) participated. Lower extremity kinematics and kinetics were obtained under 3 different shoe conditions: low heel (1.27 cm), medium heel (6.35 cm), and high heel (9.53 cm). Patellofemoral joint stress was estimated using a previously described biomechanical model. Model outputs included patellofemoral joint reaction force, patellofemoral joint stress and utilized contact area as a function of the gait cycle. One-way ANOVAs with repeated measures were used to compare the model outputs and knee joint angles among the 3 shoe conditions. Peak patellofemoral joint stress was found to increase significantly (p=0.002) with increasing heel height (low heel: 1.9±0.7 MPa, medium heel: 2.6±1.2 MPa, and high heel: 3.6±1.5 MPa). The increased patellofemoral joint stress was mainly driven by an increase in joint reaction force owing to higher knee extensor moments and knee flexion angles. Our findings support the premise that wearing high-heeled shoes may be a contributing factor with respect to the development of PFP.