Heeled Shoes Increase Knee Work Demand During Repeated Hopping in Dancers

Dancers have high injury rates of the lower extremity. External factors such as footwear likely alter the work demands placed on the lower extremity joints when performing dance-style movements. Research on pedestrians shows an increase in knee work demand when wearing heels, which may occur in dancers as well. The purpose of this study was to assess the effect of heeled shoes on lower extremity joint work demand during a basic dance-specific jump (sauté) in dancers when compared to barefoot.

Ten healthy, female dancers (age 25.6±4.7 yrs; height 1.7±0.1 m; weight 64.9±9.2 kg; mean years of dance training 17.6±6.4) performed repetitive vertical bipedal dance jumps (sautés) barefoot as well as wearing heeled dance shoes. Sagittal plane hip, knee, and ankle kinetics were calculated. Percentages of work done by these joints were calculated in comparison to the work done by the leg as a whole and compared between the two conditions.

During a dance-specific jump, the percent contribution of energy absorption was significantly different at the ankle and knee between the two conditions. The ankle contribution decreased from 50.7±6.1% in the bare condition to 34.9±5.3% in the shod condition (p=0.002), and the knee contribution increased from 38.6±3.9% barefoot to 55.1±2.8% shod (p=0.002). The same pattern was seen for energy generation, with the ankle contribution decreasing from 48.1±7.3% to 35.6±6.9% and the knee contribution increasing from 43.3±5.6% to 56.4±6.1% in the bare vs shod condition (both p=0.002). There was no significant difference in the percent contribution from the hip.

With heeled shoes, there is a shift in work demand from the ankle to the knee with no change at the hip as compared to barefoot.