CHAPTER 5. CONCLUSIONS
5.2 Summary of main findings
When maintaining postural control, increasing heel height impaired human balance in terms of strategy score: which shifted from the ankle to the hip; somatosensory ratio: which demonstrated an inability to organize the sense of position, movement and balance; and maximum distance reached during functional reach test: which has decreased as the heel height increased. However, participants’
overall coordination of the visual, vestibular, and somatosensory systems to maintain standing posture remained the same, even with the highest heels in this study. To achieve this performance, participants wearing higher heels shifted their force and pressure distributed on the heel and mid foot regions to the forefoot and toe regions, and they also shifted their center of pressure (COP) towards the ball of the foot. They also put more effort on the lower limb and low back muscles to support them in maintaining standing balance. In a more dynamic conditions, their limits of stability and functional mobility got worsened. Participants had their center of mass (COM) elevated and more fluctuated when they walked on higher shoes. Since the heel elevation made the knee movement restricted, they started to use upper body control strategy in maintaining balance, with more flexible movements on the hips and elbow. Same with static condition, they put more effort especially on their calf muscles to support them in maintaining balance during gait. They also had shorter COP path length, indicating an altered motion of the foot during walking, not a natural heel to toe motion. They had lower confidence in balancing their body and higher rank of discomfort, especially on the lower leg and foot. Even though experienced wearers did not show significantly better balance performance, shoe wearing experience provided certain advantages on the wearers’ stability limits, with better excursion and control of direction. They also provided advantages in plantar pressure measures, with smaller loads and lower pressure under the forefoot region, and shifted their COP back to the heel as if they wore shoes lower than they actually were. They used different muscle utilization and movement patterns in maintaining balance during gait. These adaptation effects shown by experienced wearers may provide them with better stability. Heel contact area did not affect the balance performance significantly.
The study has gone some way towards enhancing our understanding of the biomechanical challenges imposed on the human balance with higher heeled shoes and the experience effect to
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evaluate the regular high heeled shoes wearer populations more accurately. A further study could assess the long-term effects of wearing high heeled shoes found in this study in real work environments with a longer experiment duration, for example the changes in gait pattern and fatigue at the end of working day. Another possible area of future research would be to investigate the effects of heel contact area using shoes with heels that have larger difference in contact area to understand the effect of heel contact area on human balance.
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APPENDICES
APPENDIX A
Demographic questionnaire (Experiment 1)
Demographic Data Sheet
Subject ID:
Name:
Birthdate:
Frequency of wearing high-heeled shoes:
a. <2 times a week b. 2 or more times a week
Experience of wearing high-heeled shoes:
a. <1 year
b. 1 or more years
Height of high-heeled shoes:
a. Less than 7 cm b. 7 cm or more