High-heeled shoes increase motion of the talocrural joint while limiting the subtalar joint

Background: Foot issues caused by High-heeled shoes (HHS) may be related to changed kinematics. This study aimed to use novel dynamic biplane radiography (DBR) to investigate the effect of HHS on the in vivo six degrees of freedom (6DOF) kinematics of the talocrural and subtalar joints. Methods: Fourteen healthy female participants were recruited. Magnetic Resonance Imaging (MRI) scan images of each participant's ankle were used to create three-dimensional (3D) bone models. Two-dimensional (2D) motion perspective views of the foot were captured by DBR while walking with and without HHS. The 2D perspective views and 3D bone models are imported into a customized program for alignment. 6DOF kinematic data were extracted for the talocrural and subtalar joints during the stance phase of gait. Results: Compared to barefoot, the maximum plantarflexion angle of the talocrural joint increased (6.5 +/- 2.4(degrees) vs. 28.8 +/- 6.0(degrees), P < 0.001) when walking with HHS; minimum inversion angle increased (-1.8 +/- 1.7(degrees) vs. -4.9 +/- 2.3(degrees), P < 0.001). The range of motion (ROM) of the talocrural joint was increased in plantarflexion (13.8 +/- 3.2(degrees) vs. 20.3 +/- 7.4(degrees), P = 0.002). The maximum internal rotation angle of the subtalar joint increased during HHS (-0.4 +/- 1.8(degrees) vs. -3.2 +/- 2.7(degrees) P = 0.02). The ROM of external rotation (7.6 +/- 2.5(degrees) vs. -5.9 +/- 2.3(degrees), P = 0.03) and eversion (10.4 +/- 3.5(degrees) vs. 8.2 +/- 2.6(degrees), P = 0.041) decreased. Conclusion: During the stance phase, HHS increased peak plantarflexion, inversion angle, and plantarflexion ROM of the talocrural joint. HHS decreased external rotation and eversion ROM of the subtalar joint. These results may provide a basis for developing prevention and treatment strategies for HHS injuries.