Journal of Electromyography and Kinesiology 19 (2009) 1071–1078

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Journal of Electromyography and Kinesiology
journal homepage: www.elsevier.com/locate/jelekin

Kinematics and kinetics of the lower extremities of young and elder women during stairs ascent while wearing low and high-heeled shoes
Bih-Jen Hsue, Fong-Chin Su *
Institute of Biomedical Engineering, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan

a r t i c l e

i n f o

a b s t r a c t
The effect of the heel height on the temporal, kinematic and kinetic parameters was investigated in 16 young and 11 elderly females. Kinematic and kinetic data were collected when the subjects ascended stairs with their preferred speed in two conditions: wearing low-heeled shoes (LHS), and high-heeled shoes (HHS). The younger adults showed more adjustments in forces and moments at the knee and hip in frontal and transverse planes. Besides a few significantly changes in joint forces and moments, the elder group demonstrated longer cycle duration and double stance phase, larger trunk sideflexion and hip internal rotation, less hip adduction while wearing HHS. Most differences in joint motions between two groups were found at the hip and knee either in LHS or HHS condition. Instead, the differences in moment occurred at the hip joint and only in HHS. The interaction of the heel height and age showed the influences of heel height on trunk rotation, hip abduction/adduction, and knee and hip force and moment at the frontal plane depended on age. These phenomena suggest that younger and elderly women adapt their gait and postural control differently during stair ascent (SA) while wearing HHS. Crown Copyright Ó 2008 Published by Elsevier Ltd. All rights reserved.

Article history: Received 30 January 2008 Received in revised form 17 August 2008 Accepted 14 September 2008

Keywords: Stairs Gait Biomechanics Age Shoe

1. Introduction Stairs negotiation is a common and important activity of daily living and challenging task for elder people, since the demand for greater muscle activities and joint range of motion of lower extremities increases compared to level walking (Andriacchi et al., 1980; Livingston et al., 1991; McFadyen and Winter, 1988). Yet, most of the studies in stairs have been restricted to young adults, or the individuals with certain joint pathologies at the lower extremities; biomechanical information about how the elderly negotiate stairs is still lacking. Due to age-related declines in the sensory, vestibular, and musculoskeletal functions, slowing of compensatory behavioral responses and the subsequent injuries are suggestive for the older person, especially when there are external factors impairing the recovery from instability. Numerous studies have compared the differences in gait kinematics and kinetics between young and elder populations during level walking (Judge and Davis, 1996; Kerrigan et al., 1998; Winter et al., 1990; Hageman and Blanke, 1986; Ostrosky et al., 1994). It is documented that elderly people tend to walk slowly with reduced step length, increased step width, and decreased range of motion at the hip, knee, and ankle joints as compared with younger population. The deviations in gait for the elder people may be directly related to the decreased muscle
* Corresponding author. Tel.: +886 6 276 0665; fax.: +886 6 234 3270. E-mail address: fcsu@mail.ncku.edu.tw (F.-C. Su).

strength and power generation at the lower extremities, particular around the distal joints (Judge and Davis, 1996; Thelen et al., 1996; DeVita and Hortobagyi, 2000). However, the differences in walking biomechanics may not exist between young and elder adults when the walking speeds were matched (Kerrigan et al., 1998; Williams and Bird, 1992). Just then, a redistribution of joint torques and powers, e.g. using more hip extensors and less knee extensor and ankle plantarflexor, would be needed for the elderly (Kerrigan et al., 1998; DeVita and Hortobagyi, 2000; Riley et al., 2001a). Based on these observations, it is reasonable to assume that the elder adults need to make more adjustments in order to successfully negotiate stairs. Thus a thorough quantitative investigation of the gait, kinematics and kinetics in stairs is needed for the elderly population. The largest numbers of falls in the elderly occur on stairs, but only few studies have been conducted to evaluate the specific factors that contribute to falls on stairs. The finding of Simoneau et al. (1991) suggested that inappropriate foot-stair spatial relationship between foot and stair was the main reason resulting in falls. It may account for the report that foot wear is a predictor for falls in stairways (Templer et al., 1985). Besides the findings of above studies initiated the idea of choosing heel height as an intervening factor out of many footwear characters, this study intended to investigate biomechanical adaptations of the young and elder women in SA and while wearing shoes with different heel height owing to two clinical needs. First, elderly females appear to be at higher risk of stair injury than males based on the high incidence

1050-6411/$34.00 Crown Copyright Ó 2008 Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jelekin.2008.09.005

The mean weight and height of the older and young groups was 54. No interactions between age and heel height were significant on temporal parameters.60 ± 2. 1992). the hip and knee joints (Table 2). the assessment and identifying risk factors become increasingly more important (Pauls 1985. the ankle position in static standing ranged from neutral position to 5° of plantarflexion. None of the subjects had any orthopedic problem.1.4 years old. respectively. Cycle (sec) LHS HHS a ST (%)a 61.3 ± 6. and a step height. more than three hours each time. 3.005 as comparing old group with young group in same shoe condition. Both types of shoes were not ‘slip on’.65* 12. and (3) casual HHS wearers who wear HHS at least one day per week. in today’s society..80 63.0 ± 3. Testing consisted of at least five trials for each condition.48 ± 1.7 ± 5. Su / Journal of Electromyography and Kinesiology 19 (2009) 1071–1078 of stair accidents in this population and. One investigator was standing close to the staircase for protection. and stance phase was further divided into three substance phases: early stance. Temporal parameters The temporal phases for SA in shoe conditions are presented in Table 1. and 7th cervical spine was used.6–6.§ Y E Y E 1.64 ± 1.4 ± 6. C. dizziness or major visual deficits. the HHS wearers must adopt necessary compensatory mechanisms or ability to maintain appropriate relationship between body segments and between the body and the environment. 28 cm and 90 cm. The gait of the elder group is characterized by a significant larger proportion of stance and terminal double support phases. many women wear shoes with high heel in both professional and social settings. Results 3. the markers at the lateral and medial malleolus were not affected. and cycle duration for the young group. Therefore. The walking speed of elder group is significantly slower. ** p < 0.13§ 1.4 Kg and 159. USA) was used to capture the threedimensional trajectory data of the twenty five markers affixed to the subject’s bilateral anatomical landmarks. Women who were interested in participating in this study were interviewed about the health and medical history and given a physical activity questionnaire (Voorrips et al. (2) to determine whether heel height influences temporal gait parameters. especially while wearing HHS.87 ± 1. In other words.05 was used to test for significance.15***.2. Each subject had read and signed an approved letter of informed consent. A modified Helen Hayes marker set with additional markers at the greater trochanter of the femur. The level of 0. One gait cycle was divided into swing phase and stance phase. While wearing LHS. Kinematic findings In both shoe conditions. An eight-camera Eagle Motion Analysis System (Motion Analysis Corporation. The order of wearing HHS or LHS was randomized. A five-step wood staircase with a slope of 32.94* SW (%)b 38.0 ± 9.26 ± 0. J. F. and 52. All data were analyzed using the SPSS statistical analysis software.. significant differences are found in cycle duration and double support phase for the elderly group. The early and late stance phases were phases of double support.22 13.1072 B.. the major differences in peak joint angle between the young and elderly occur at proximal parts.5 cm (range 5. * p < 0.4 cm.05 as comparing old group with young group in same shoe condition.31 ± 0.5 cm) and having a base area of 6 cm  6 cm. kinematics and kinetics. As comparing the temporal parameters between shoe conditions.55 14. Inverse dynamics using linear and angular Newtonian equations of motion and methods described by Vaughan et al was used to calculate the joint angles and joint forces and internal moments in three dimensions (Vaughan et al. (2) able to ascend and descend stairs without using a handrail. § p < 0. 1991). it may be absorbed directly by soft tissue and accelerate degenerative changes. and kinematics and kinetics of the ankle. knee and hip joints in the young and elderly adults during SA. The elder females seem to gain stability by increasing the stance phase. The subjects walked at their preferred speeds from a start point about five steps away from the staircase to the top platform reciprocally under two conditions: wearing casual LHS with heel height less than 2 cm (range 1.0 Kg and 153. kinematics and kinetics depends on age. Switzerland) were secured on the second and third tread to collect ground reaction forces. The data was normalized to a stride period of 100% to determine the percentage of stance and swing phases in one gait cycle. and eleven elder females above 70.19 ± 1. Subjects included sixteen healthy young females aged 28. The fifth step was created by a 120 cm  90 cm platform.67 ± 0. and the average of the five trials was used for comparisons. As measured by goniometer.79 36.02** 38. 3.94* DS (%)c 12.3–1.02** 61. and longer cycle duration than the young group either in LHS or HHS condition. SW: swing phase. 1996). 2. All force and moment data were normalized by body weight and presented as 100% of the stance phase. One stride began with heel contact on the second step and ended with subsequent heel contact of same foot on the fourth step. therefore. A mediolateral force took place along the mediolateral axis of the proximal segment.7. was used. Two portable force plates (Kistler Inc.59 ± 0.6 years old. proximal/distal force took place along the longitudinal axis of the distal segment.81 ± 1. Methods Inclusion criteria for the elderly group were (1) above 65 years of age. neurological disease.8 cm) and HHS with a block heel higher than 5.79 63.11 ± 2. c DS: terminal double support.§ ST: stance phase. Hsue. if the increased loads from wearing HHS cannot be attenuated by changes in kinematics and kinetics of the body. respectively.80 36.0 cm. Second. The participants were asked to wear shorts and tight-fitting vest with dark color during testing. kinematics and kinetics.. Rantanen et al. The markers which were supposed to be placed at the calcaneus and metacarpal between 2nd and 3rd toes were attached at the shoe surface covering these two landmarks. The interaction effect of age and heel height on each parameter was tested by two-way ANOVA. and 20°–23° of plantarflexion while wearing LHS and HHS. Santa Rosa. the elderly ascend Table 1 Stance and swing phases in percentages and the cycle duration in seconds. single limb support and late stance phases. *** p < 0.40 ± 2. Descriptive statistics were calculated for the time-distance parameters and peak values of kinematic and kinetic data. CA. The specific aims of this study were (1) to investigate and compare temporal gait parameters. (3) to determine whether the age influences gait. and an anterior/posterior force took place along a floating axis that is perpendicular to the mediolateral and longitudinal axes.4 ± 4. b . there is also a clinical need to identify the biomechanics caused by HHS.16*. (4) to determine whether the influence of heel height on gait parameters.21*** 1.16 ± 1.36± 1.12 1. xiphoid process.05 as comparing HHS with LHS condition in each group.01 as comparing old group with young group in same shoe condition. tread depth and width of 18 cm.35 ± 1.12 ± 1.

94*** 64.49 5. the elder group 100 80 60 40 20 20 40 60 80 stance swing 0 -10 -20 100 Hip flex(+)/extension(-) Knee flex(+)/extension(-) 20 10 Ankle plantar(+)/dorsiflexion(-) stance swing Degrees 20 40 60 80 100 Trunk side-flexion (+:right.26 6.41 8.91 ± 4.41 0. middle and bottom plots show the angular displacement in sagittal.49 7. they tend to walk with larger trunk sideflexion (p < 0.59 6.89 ± 5.17 4.49 ± 7.91 ± 2.16 ± 3.66* 17.00 ± 3. the changes at the proximal joints mainly in the elderly group take place in the frontal and transverse Trunk flex(+)/extension(-) 6 80 5 stance swing 60 4 40 3 20 2 20 40 60 80 100 20 40 60 80 100 stance swing planes. d Side flexion to the right for the trunk.10 15. and varus for the ankle.46 À11.73 ± 5. * p < 0. valgus for the ankle. knee and ankle angles for young and elder groups in three planes are presented.50 6.05).34 ± 4.65 ± 3.96 ± 4. While wearing HHS.94 ± 5.48 ± 4.20 ± 6.61 4.08 14.00*** 66.63 ± 3.11 ± 8.81 À15. knee and ankle.05 3.01 as comparing HHS with LHS condition in each group. The thick line represents young subjects wear LHS. .80 ± 7.00 ± 2.48 ± 5.§ 7. 1.12 ± 7. -:left) 5 stance swing 0 -5 0 -10 -5 20 40 60 80 -15 100 Hip abd(+)/adduction(-) stance swing 5 Knee abd(+)/add(-) stance swing 5 0 Ankle varus(+)/valgus(-) stance swing Degrees 0 -5 -5 -10 -10 100 -15 100 20 40 60 80 20 40 60 80 20 40 60 80 100 Trunk rotation (+:right.96 Plantarflexion for the ankle.25 ± 6.53§ 0.15 ± 1.06 21. f Rotation to the left side for the trunk.005 as comparing old group with young group in same shoe condition.68 ± 7.43 À10.10 6.00*** 34.69 ± 6.88 3.28 4. §§§ p < 0. Su / Journal of Electromyography and Kinesiology 19 (2009) 1071–1078 Table 2 Mean maximum peak angle (degrees) of the hip.07 ± 3.36§ 2.59 ± 3.89 ± 9.60 ± 5. *** p < 0.17 À26.52 5.B.33 ± 5.05 7.91 ± 3.77§§ E Y E Y E Y E Y E Y E Y E Y E Y 4.53 10.44 ± 5. J.§§ 3.12 ± 2. e Rotation to right side for the trunk.83 82.50*** 13.60§§ 13.11 ± 5.25 3.05 as comparing HHS with LHS condition in each group.31 ± 4.41 ± 1.42 11.45***.12 5.73 À2.12 6.69 ± 3. The vertical solid.87 ± 5. C.56 ± 7. respectively.07§§ 9.69 ± 4.75 2.005) and knee flexion and adduction (p < 0. §§ p < 0. dotted line represents elder subjects wear HHS.10§ 5.80** À1.49 ± 4. -:left) 10 2 5 0 stance 20 40 60 swing 80 100 -5 Hip int(+)/ext(-) rotation -10 -15 -20 Knee int(-)/ext(+) rotation 10 5 0 -25 -30 -35 100 stance swing 20 40 60 80 -10 100 -5 Ankle inv(+)/eversion(-) stance Degrees 0 -2 stance 20 40 60 swing 80 swing 20 40 60 80 100 % of gait cycle % of gait cycle % of gait cycle % of gait cycle Fig.93 9.9310.87§ Ext Rotf 1.24 ± 6.25±3.19 14.35 6.01 as comparing old group with young group in same shoe condition.08 20.00 ± 2.73 ± 3.01). and dotted lines separate the stance and swing phase of the young and elder groups.52 ± 6.37 ± 6.19 1.76 0.35 ± 7.98 ± 7. eversion for the ankle.35 87.05).56 0.61 ± 2.08§ 5.24 ± 4.13* 88.44§§§ 16.47±2.05 as comparing old group with young group in same shoe condition.78§§ À1.96* 34.005) than the young subjects.06*** 5.05).03 ± 2.56 À15. respectively.96 2.72 ± 7.43 ± 8.61§ 9. Shoe Joint Age Sagittal plane Flex LHS Trunk Hip Knee Ankle HHS Trunk Hip Knee Ankle a a 1073 Frontal plane Extend b Transverse plane Add d Abd c Int Rote 3.37 ± 14.31 À2.46 26.19 ± 7.87 À16.96 ± 5.02 20.07* 13.61 ± 6. inversion for the ankle.33 ± 4. thin line represents young subjects wear HHS.33 À1. hip. gray line represents elder subjects wear LHS.43 ± 5.82 À2.80 ± 4. Hsue. less hip adduction (p < 0.10 À0.91 À12.98 ± 7.36 ± 6.78 25.63 6.76 ± 2.00 ± 2. The top.16 10.46 ± 7.01 2.12 6.12 ± 9. As compared with the young group.53 ± 2.04 7.71 5.96 ± 8.27 À1. Trunk.31 ± 7.05 ± 6.16§ 0.62 À13.81*** À12.55 ± 1.83* À1.66 12.20 ± 3. but less knee extension (p < 0.31 ± 5.79 ± 7.6 ± 46.52 8.66 6.61§ 92. frontal and transverse planes. ** p < 0. F.12 ± 2. § p < 0.08 ± 8.65 ± 10. b stairs with larger hip (p < 0.32§§ 19.005 as comparing HHS with LHS condition in each group.81 ± 9.27**.82*.79 ± 3.74 ± 7.49 ± 9.93 ± 6. c Side flexion to the left for the trunk.86 ± 8. and larger hip internal rotation and less external rotation (p < 0.99 ± 3.23 ± 3.53 ± 2.64 82.66 ± 7.21 À26.59 ± 2.81 ± 2.97 93.70 ± 4.34 ± 5.06 À13.05*** À12.40 ± 2.06 ± 7. and larger knee adduction (p < 0.05).03 ± 5.§ 17.31§ 6. Dorsiflexion for the ankle.

62 1.08 0.50 ± 0.06 ± 0.01 ± 0.24 ± 0. Dorsiflexion for the ankle.48 ± 3.03§§ Addd 0.96 ± 0.19§ 1.22*** 1.31§§ 0.07 ± 0.05 ± 0.14 0.17 0.06 0.87 ± 0.04 0.16 ± 0.07 0.56*** 1.24* 0.03§ 0.00 ± 0.51 ± 0.93 ± 1.23 ± 0.20 ± 1.55 ± 0.15 10.§§ 0.02 0.59 ± 0.02§ 11.08 0.83§§ 0. * p < 0.03 ± 0.14 0.05 Transverse plane Int Rote 0.25 ± 0.22 ± 0.11 ± 1.12 ± 0.21 ± 0.16 ± 0.23 ± 0.13 À0.36*** 1.22 0.10 0.13* 0.34 ± 0.84 ± 0.04 Ext Rotf 0. *** p < 0.01 0.86 ± 0.76 ± 2. knee and ankle.05 ± 0.04 0.84*** 1.52 ± 0.05 0.09 ± 0.24 0.24 À1.00 ± 0.10* 0.87 ± 0.19 0.05 ± 0.28 ± 0.03 0.40 ± 0.24 À0. c Varus for the ankle.54 ± 0.13 ± 0.83 ± 0.72 ± 0.21 0.07 0.67 ± 0.13 ± 0.11 ± 0.96 ± 0.04 ± 0.00 ± 0.41 0.08 ± 0.22 ± 0.06 ± 1.25 ± 0. f Eversion for the ankle. d Valgus for the ankle.05 as comparing old group with young group in same shoe condition.02 ± 0.13 12.59 6.24 ± 0.04 0.55 0.99 ± 0.68 4. §§ p < 0.65 ± 0. b .13§§ 0.22 ± 0. e Inversion for the ankle.02 ± 0.54 3.08±0.30 ± 0.52 0.005 as comparing old group with young group in same shoe condition.09 ± 0.40 0.02 1.13 0.14 ± 0.97 ± 0.11 ± 0.01 as comparing old group with young group in same shoe condition.63 ± 3.30 ± 0.96 1.24**.44 1.90 0.04* 0.65 1.13 Lat 1.39 ± 0.04 12.05 ± 0.41 ± 0.06 0.06 ± 0.06 0.50 ± 0.50 ± 0.87 ± 0.14 0.13 0.01 13.61§ 0.1074 Table 3 Mean maximum peak forces (Newton/Kg) and peak moments (Newton-meter/Kg) of the hip.26 ± 0.77 ± 0.16 ± 0. F.75 ± 3.24 0.45§§ 3.85 ± 0.05 ± 0.01 ± 0.07§§ 0.20 À0.20 ± 0.21 0.59 0.06 0.20§ Extendb 1.03 ± 0.12 ± 0.13 0.41 ± 0. ** p < 0.19 ± 0.06 ± 0.04*** 0.16 ± 0.26 ± 0.01 4.56 ± 0.24 ± 0.14 ± 0.89 10.75 1.56§ À0.18 ± 0.06 ± 0.29 ± 0.07 ± 0.82 À0.05 0. J.03 0.18 0.08 E Y E Y E Y E Y E Y E Y 5.12 1.91 1.50 ± 0.11§ Dist 11.03 0.58 ± 1.93 ± 0.13 1.20 ± 0.32 ± 0.15 À0.81 13.74 ± 1. § p < 0.05 0.23 0.03 0. Hsue.69 ± 0.07 ± 0.00 ± 0.81 ± 0.23§§ 0.56§ Med 0.02 13.14 À0.17 ± 0.49 ± 0.14 1.005 as comparing HHS with LHS condition in each group.58 ± 0.93 ± 0.33 0.11 ± 0.01 ± 0.05 as comparing HHS with LHS condition in each group.69 ± 1.16 ± 0.00 ± 0.11 ± 0.30***.03* 0.07** 0.04 ± 0.90 ± 0.06 3.03 0.03 0.15 ± 0.06 0.06 0.06 ± 0.04 ± 0.26 ± 1.53* 12.55 ± 0.06 ± 0.95 4.12 0.20 0.75 ± 0.09 ± 0.76 ± 0.99 À0.13 0.71 12.68§§ Sagittal plane Flexa 0.62 0.07 11.17 0.§ 0.12 1.57 ± 0.10 6.40 ± 0.28 ± 0.80 ± 1.22§ À0. Su / Journal of Electromyography and Kinesiology 19 (2009) 1071–1078 Moments Frontal plane Post 0.16 À0.93 6.02 ± 0.17 0.15 À0.07 0.08±0.10 ± 0.06 ± 0.66 0.87 2.49 ± 0.93 ± 0.05 0.07 0.04 Plantarflexion for the ankle.06 ± 0.30 ± 0.66 ± 0.02 ± 0.27* 0.13§§ 0.02* 0.20 À0.88 ± 0.05 ± 0.15*** 1.15 ± 0.15§§ 0.38 1.83 ± 0.39 *** Transverse plane Prox À0.30 ± 0.02 Frontal plane Abdc 0.14 0. C.35 0. Shoe Joint Age Forces Sagitta plane Ant LHS Hip Knee Ankle HHS Hip Knee Ankle a B.12 0.

01) and ankle valgus (p < 0. The young group demonstrates more trunk forward flexion in particular as wearing HHS. J. The magnitudes and profiles of the LM knee and ankle forces are quite different between two groups.5 -0. thin line represents young subjects wear HHS. In LHS.B. The peak DP forces at the ankle also significantly change while wearing HHS (p < 0.01). HHS increases the hip abduction moment (p < 0. DP: distal to proximal.005) forces in ML direction between groups in both shoe conditions. 2. heel height has greater effect on the forces and moments in young group.05).005) and adduction (p < 0. dotted line represents elder subjects wear HHS. and the young group has higher knee extension moment. are found for three joints in the sagittal and transverse planes between groups and shoe conditions (Fig. and ankle eversion moment throughout the stance phase. gray line represents elder subjects wear LHS.01).5 0 -0. .005) and hip (p < 0.005).05) and knee abduction moment (p < 0. Su / Journal of Electromyography and Kinesiology 19 (2009) 1071–1078 1075 demonstrates significantly less hip extension (p < 0. The elder group has larger hip flexion of 20° than the young group. Most of peak angles occur at transiting from stance to swing phase.5 100 4 3 2 -4 1 -6 0 20 -2 -4 N/ Kg -6 -8 -8 -10 -10 -12 20 40 60 80 -12 100 20 40 60 80 100 -2 -4 -6 20 20 -1 0 Knee forces 0. The ankle plantarflexion moment is positive throughout the stance phase. and reaches peak at the end of the stance phase. ankle valgus (p < 0. the young group shows significantly larger knee extension (p < 0.01). LM: lateral to medial. Similar curve profiles. No further interactions were significant on other kinematic variables. Hsue. The differences in motion profiles are more apparent between groups than between shoe conditions.5 1 N/ Kg 0. the elderly demonstrates significantly greater hip extension moment (p < 0. hip abduction/adduction. the maxima of lateral-medial (LM) and distal-proximal (DP) forces of the ankle. except knee force in LM direction (Fig.5 -1 20 0 40 60 80 -1. and decreases plantarflexion moment (p < 0. The young group has greater Hip forces 1.01) moments than the elderly group. and hip external rotation (p < 0. Significant differences are noted in the ankle (p < 0. and the hip forces in three directions are different between shoe conditions (Table 3).005). all moments in frontal plane at the hip. 3. except the ankle motions (Fig. While wearing HHS. but less hip abduction moment (p < 0. For the younger group. Kinetic findings Overall. F.05) for the elder group. knee and ankle. PA: posterior to anterior.01) than the young group. it was from the toe to the heel) at the ankle. 3).05). The force profiles are quite similar in shoe conditions and two groups at the hip and knee. posterior-anterior (PA) force of the knee. and remains positive for most of the stance phase. which apparently results from the different heel height that HHS cause greater force in DP direction (for the foot. For the elder group. The thick line represents young subjects wear LHS. A positive force is in the direction of the specified axis. It is noticeable that the elder group demonstrated greater hip extension moment either in HHS or LHS throughout the stance phase. but different peak moment values. Regarding the internal joint moments. the maximum of LM force at the knee in HHS is 4 times the force in LHS (p < 0. Hip. knee and ankle forces about LM (top profiles).005).5 40 60 80 100 -2 -4 -6 -8 -10 40 60 80 -12 100 0 20 40 60 80 100 20 40 60 80 100 -2 N/ Kg -1 -2 -3 40 60 80 100 20 40 60 80 100 % of stance phase % of stance phase % of stance phase Fig. The hip and knee extension moments reach peaks around 20–25% of the stance phase (weight acceptance or loading response) when the body is pulled up to the next step.5 0 Ankle forces -0. 1).3. less knee adduction (p < 0. the elder group demonstrates smaller LM forces at these two joints. The trunk motions are computed in relation to pelvis coordinate instead of room coordinate. which may account for the smaller magnitude of trunk motions as compared with the findings of others’. The magnitude of DP force at the ankle between shoe conditions is different.005). C. PA (middle profiles) and DP (bottom profiles) axes during SA. Statistically significant interaction between age and heel height were only shown on peak magnitude of trunk rotation. hip internal rotation moment and ankle plantarflexion and varus moments are significantly different between shoe conditions (Table 3). Both groups have hip and knee internal rotation moments. knee (p < 0. 2). In the young group.

05 0 Ext.33 ± 0. In fast walking.2. and ankle varus moment at the end of the stance phase for the young group. Discussion The objective of this study is to provide a detailed and thorough description of temporal. age and body figure of the subjects. though the average cycle duration is shorter for the young group and longer for the elder group in both shoe conditions in present study. 153.rot 80 100 0 -0. In level walking. kinematic and kinetic parameters of the gait during SA for the young adults aged below 40 years and elderly aged over 65 years. 2001b).8 0. Peak moments are observed also around 20– 25% of the stance phase. ankle valgus moment for the elder group.6 0. Riley agrees with Kerrigan’s findings that kinematic factors (e. Since the average body height of the young group was taller than the elder group (159.3 vs.8 40 60 Abd 80 100 0. particularly at the hip and knee joint. Hageman and Blanke. 4. 3.2 20 Varus 40 60 80 100 100 0. The temporal parameters The time proportion of the stance or swing phase for the two groups is close to the findings of previous studies (McFadyen and Winter.0 cm). the joint moments in the frontal plane has more variation. the taller subjects have longer stance phase and lower cadence than the shorter ones. 4.15 s) on elder population (1989). Riley et al. 1986). The young group has two peaks in abduction moment at the hip. Zachazewski et al. 2003. (2002).1 Eversion 60 80 100 20 40 Inversion 0.05 0 % of stance phase % of stance phase % of stance phase Fig. gender. reduced maximal hip extension) would limit gait speed. F. frontal (middle) and transverse (bottom) planes during SA..2 0 20 0. The kinetic findings of several studies are presented along with ours in Table 4. we reviewed the previous literature about the effect of height on temporal parameters and compared with our findings.1. and methods of data reduction.5 -1 Extension 20 0. In contrast to the findings in the sagittal plane. thin line represents young subjects wear HHS. Riener et al. magnitude than the elder group in these three moments in the transverse plane. unobvious peak at 85% of the stance phase. 4. 1993. 1988. 1996). gray line represents elder subjects wear LHS.rot 20 40 60 80 -0.05 60 Valgus 80 100 Add 20 Nm/ Kg 0. DeVita reveals that the elderly used more hip extensors to compensate for the strength loss at the ankle (DeVita and Hortobagyi.2 Int. 2000). we suggest that the differences in time proportion and cycle duration are due to age difference.. Kerrigan et al. Significant interaction between age and heel height were found on peak magnitude of knee force in medial direction. The cycle duration for the elder group is also longer than James and Parker’s findings (1. The thick line represents young subjects wear LHS. 1998. The results of this study agree most closely with those of Costigan et al.g. one around 25–30% of the stance phase and the other at 85–90%.5 -0. and determine the changes in these parameters when the balance is challenged by wearing HHS.15 100 20 40 -0. Peak hip and knee abduction moments show more variations across all studies. The effect of age The literature regarding joint forces and moments in three dimension during SA are limited.1 0 100 -0.2 1 Ankle moments Plantarflex Nm/ Kg -0. not body height.1076 B. 1998.05 100 Ext. and different walking speed would induce different contributions of hip and knee moment to propulsion power in the elderly (Kerrigan .. Judge et al suggest that elderly people increase hip flexor power to compensate for the lower ankle plantarflexor power (Judge and Davis. The variations may come from the dissimilarities in staircase configuration. HHS increases the abduction moment at the hip and knee for both groups.. while the elder group has only one peak at around 60–65% of the stance phase and one much lower.4 0. Su / Journal of Electromyography and Kinesiology 19 (2009) 1071–1078 Hip moments 0 Flex 0 Knee moments Flex 1.05 40 60 Int. C. In the study of Livingston and colleagues (1991)..15 0.3 0. the elderly people demonstrate a decrease of step length associated with reduced ankle joint power in latestance (Kerrigan et al.rot 20 40 60 80 -0. knee and ankle moments about sagittal (top). A second peak moment of the knee and ankle is small and observed at 80% of the stance phase when the body weight starts to shift to the opposite leg. marker placement. Hsue.25 0. dotted line represents elder subjects wear HHS.1 0. So.. signal management.05 Nm/ Kg 0. Hip.2 -1 20 40 60 Abd Extension 80 0. Nadeau et al. and hip abduction/adduction and knee adduction moments.6 0.4 0. particularly in elder population. J.rot 40 60 80 0 0. 2002). the elderly people either are not able to generate ankle plantarflexion power or have limited hip extension (Judge and Davis 1996.

For elder group. but the major changes occurred in transverse and frontal planes instead of sagittal plane.80 0. no difference in knee angular displacement between groups is found while the young group has greater knee extension moment.78/$0c 0. the height of the subject increased when wearing HHS.b).67/$0c 0. The information about the kinetics of HHS gait is very limited even in level walking. For the young group. and the increased loads need to be attenuated either by changes in kinematics or by direct absorption by the soft tissues.30c NA Hsue 0. 1991. Most studies investigating kinematics in SA focus on motions in the sagittal plane.06/0. 1991). It illustrates that the leg has been consciously or unconsciously moved back and forth to make accommodations.07 0.31/$0c 0. (1996)a NA NA NA 0..12 0.21/0.10 NA NA NA NA NA NA Riener et al.86 vs. the influences of HHS on the elder group are less than its influences on the young group in terms of the peak magnitude changes in kinetics and kinematics. Parameters Researchers Costigan et al.11c/0.42/$0c $0c/1.. 1. the vertical projection of center of mass shifts anteriorly.77 to 0. 1.29/0. the present study converted the values to Nm/kg. Wu et al. Instead. Schwartz et al. An increase in heel height is also associated with an increase in inversion and a decrease in maximum eversion during gait. 4. The findings partially agree with the previous report that the forces encountered by the forefoot increase with an increased force concentration at the first metatarsal head and a reduction in force over the fifth metatarsal head in HHS wearing (McBride et al. is preferable (Opila-Correia. the joint forces increase in DP direction when wearing HHS as expected. e..41 Nm/Kg) and hip (from 0.16 0.23 Nm/Kg). and ankle eversion moment are required in HHS. J.25/1. This ‘back and forth’ motion at the knee joint exerts a force on the force plate. In present study.12 Nm/Kg in LHS.1/$0c NA NA NA The data was originally reported in (% body weight/leg length). (2002) NA $0c/0. and the base of support during single limb standing is decreased. it may be one of the strategies for the elderly adults to maintain balance in SA. the elder group rotates the trunk and hip to compensate for the possible functional loss at the foot. When wearing HHS. older women have worst performance in balance tests. 2004). The results show the influence of heel height on investigated parameters does not depend on age. increased body sway during static standing and decreased maximal balance range.50 vs.30 0. particularly at foot strike (Fig. the elder group remain in significantly larger hip flexion (26°–82°) throughout the gait cycle in both shoe conditions. et al.17 NA Kirkwood et al. As well. (2003) 0. 1996). Hsue. Therefore. the adjustments made by the elder group when wearing HHS may be more crucial than those made by the young group in order to advance to the upper step. F. The results of this study support the previous findings of DeVita on level walking that aging cause a redistribution of joint torques at the lower extremity. The subjects aged over 55 years.09/0. predominantly at the first half of the stance phase (0. the shift of joint forces at the ankle and the knee in ML axis is prominent when wearing HHS for both groups. Su / Journal of Electromyography and Kinesiology 19 (2009) 1071–1078 Table 4 Comparison of peak moments of the young group in this study with other researcher’s findings. and consequently it produces a second peak in the knee and hip moment in sagittal plane (bottom row in Fig. 1. In present study.53 NA 0.80/$0c $0c/0. e. 1990).3. therefore. Riley et al. 1). 1994.98 NA NA NA/1. as compared with barefoot and wearing LHS (Lord and Bashford.. 1. 1964).77/0. and hip kinematics and kinetics in frontal plane. greater hip and knee abduction moments. with the former most significant at late stance and the latter two throughout the .g. Besides reducing walking velocity. To prevent the acceleration of tissue degeneration.24 vs. the locomotor control system using sensory input may change. in present study.10c NA NA $0c/1. stair climbing has some invariant features that cannot be compromised. and more adjustments need to be made at the proximal joints in the elders when confronting a more demanding activity.22 0. and consequently. C.g. 1998. 1990a.15/1. The effect of heel height and its interaction with age It has been reported that when wearing HHS. 3). This can be one explanation why the young group has larger trunk and hip flexion throughout the whole cycle when wearing HHS. which is not observed in the young group.00 0.04/0.24/0. knee force in transverse plane.16 0. 1). On the contrary.. and may indicate a state of ‘unsteadiness’ or ‘instability’ that the elderly subjects are not certain whether the opposite leg is ready to bear the body weight.08 0. respectively. the strategy is associated with greater internal hip extension moment meaning requiring more work of hip extensors than the young group (1.99 Nm/Kg) which occur at the ‘pull-up’ phase and late stance phase. the elder group exhibits a ‘bump’ before the leg swings through to the next step (Fig. As stepping forward to catch balance on stairs is not feasible.16 0.B.53c NA NA $0c/1..05 0. more adjustments are made for the young group than the elder group when wearing HHS. Unlike level walking in which elder adults can change step length to compensate for inefficient musculoskeletal and neuromuscular functions.26/0. However. and the subjects seem to adjust to different stair dimensions by varying the flexion/extension at the knee rather than that at the ankle or hip (Livingston et al.13 Nm/Kg in HHS). As a result. It is reported the range of motion of the lower extremity is highly related to the subject’s height and stair dimensions. the force distribution under the foot changes.00/1.06 0.92 NA NA NA NA Nadeau et al. larger movements in transverse and frontal planes as compared with level walking to compensate for the altered foot mechanism is very likely.28/1. (1999)b 0.29 to 0. the compensation by altered kinematics. (2002) Hip Abd/add Flex/extend Int/ext rot Knee Abd/add Flex/extend Int/ext rot Ankle Varus/valgus Dorsi/planta Inv/eversion a b c 1077 Kowalk et al. Nevertheless. The values were estimated from the profiles.99/$0c 0.22 0.77/0. except trunk rotation. increasing flexion at proximal joints. In present study.28/0. HHS is less stable than LHS (Snow and Williams. From the results of the peak moments and moment profiles. the major changes caused by HHS are the increases of peak abduction moment at the knee (from 0. HHS places the ankle in plantarflexion which is an open-pack position allowing more joint movements in ML and diagonal directions. some of the shock absorbing function of eversion is lost. An interesting but easily neglected feature in the knee flex/ extension angle profile is that in late stance phase. From the view point of biomechanics.

Phys Ther 1990. and has published 125 journal papers. Foot Ankle 1991. J Am Geriatr 1996. Hsue.28:89–93. McFadyen BJ. Rantanen T. He is Distinguished Professor and Associate Dean of Engineering. Electromyogr Clin Neurophysiol 1989. Riener R. Inc. Illinois.88:1804–11. J. gait analysis and rehabilitation engineering. Comparison of gait of young women and elderly women. Dognelmans PC. Conflict of Interest Statement This study did not receive any funding from commercial firms. . and exercise in individuals aged 55 years or older. Della Croce U. Ulbrecht JS. Int J Aging Hum Develop 1992.21(9):733–44.16:83–196.79:317–22.26:639–46. Williams K. M. James B. Malouin F. Costigan P. His major research interests are in the field of biomechanics. Mann RW. Stevenson JM. 1992. Phys Ther 1994. Patla AE. Heikkinen E. Propulsive adaptation to changing gait speed. rearfoot motion. He is Deputy Editorin-Chief of the Journal of Medical and Biological Engineering and an editorial board member for Clinical Biomechanics. Voorrips LE. Kowalk DL. Hodge WA. Costigan PA. Duncan JA. Cooke TD. First metatarsophalangeal joint reaction forces during high-heel gait.34:241–55.11(5):282–8. USA in 1989. Ounpuu S. Abduction-adduction moments at the knee during stair ascent and descent.S. Effect of age on lower extremities joint moment contributions to gait speed. J Bone Joint Surg 1964. Collins JJ. Vaughan CL. Bashford GM. Deurenberg P. A study of lower-limb mechanics during stair-climbing. J Biomech 1988. and New York University. Her research interests are in the field of biomechanics of human motion and balance control. She is a pediatric physical therapist and adjunct lecturer at the Physical Therapy Department of FooYin Technology University. Fermier RW. A comparison of gait characteristics in young and old subjects. Todd MK. given the potential problems caused by HHS and possible occurrence of balance loss and joint degeneration with a fail in making these adjustments. Lord SR.A degree in Physical Therapy from National Taiwan University. Blanke DJ. Leibowitz HW. However. Davis III RB. Heath AL. stair climbing. O’Connor JC. VanSwearingen JM. Kinematics of high-heeled gait with consideration for age and experience of wearers. A physical activity questionnaire for the elderly.28(7):999–1010. or government. Biomechanical walking pattern changes in the fit and healthy elderly. Tyrrell RA. Gait Posture 2002. Kinematics of high-heeled gait. Deluzio KJ.74: 637–46. Williams KR. Bird M. These adjustments are of concern. Riley PO. Zachazewski JE. Schultz AB. J Bone Joint Surg 1980:749–57. Hip moments during level walking.51:M226–32. Wyss UP. Della Croce U. Su FC. Cohen HH. Phys Ther 1986. McFadyen BJ. J Appl Physiol 2000. J Rehabil Res Develop 1993. Pauls JL. References Andriacchi TP.66:1382–7. 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There were not any financial and personal relationships with other people or organization that could influence this.29:161–8.23:974–9. National Cheng Kung University (NCKU). Maximal isometric knee extension strength and stair-mounting ability in 75. posture. Murphy L. Winter DA. Med Eng Physics 2004. 331 conference papers and 69 other publications and edited a conference proceedings and a book. Andersson BJ. Phillips J. Arch Phys Med Rehabil 1990b. Step length reduction in advanced age: the role of ankle and hip kinetics. Galante JO.46A:324–44. Ravelli AC. and ground reaction forces. Livingston LA. Cavanagh PR. Biomechanical gait alterations independent of speed in the healthy elderly: evidence for specific limiting impairments. Morgan DW. Towns RC. Kerrigan DC.29(3):383–8. High-heel shoes: their effect on center of mass position. Age causes a redistribution of joint torques. McBride ID. Frigo C. Van Straveren WA. Biomechanical analysis of body mass transfer during stair ascent and descent of healthy subjects. Archea J. Winter DA.year-old men and women.70:340–7. Bih-Jen Hsue received her B. more subjects with different gender should be included to improve the generalization of the study. private foundations. Electromyography of stair locomotion in elderly men and women. Olney SJ. Review of stair-safety research with an emphasis on Canadian studies. Fong-Chin Su received his Ph. Della Croce U. Opila-Correia KA. The effects of rocker sole and SACH heel on kinematics in gait. J Biomechanics 1990. Opila-Correia KA. Parker AW.24:412–22.44(4):429–33. The baseline kinematic and kinetic data and possible compensatory strategies of healthy elderly women may also enable the therapists and clinicians to make comparisons with aging patients with pathological locomotion characteristics. Walt SE. J Biomech 2001a. Kerrigan DC. The aging mover: a preliminary report on constraints to action.16:31–7. Thelen DG. Knee and hip kinetics during normal stair climbing. Olney SJ. J Biomech 1996. Su / Journal of Electromyography and Kinesiology 19 (2009) 1071–1078 Ostrosky KM. Vaughan CL. Med Sci Sports Exerc 1991.15:32–44. J Gerontol A Biol Sci Med Sci 1996.75(5):568–76. Schwartz RP. Frank JS. Riley PO. Study of factors associated with risk of work-related stairway falls. Modeling of the biomechanics of posture and balance. Both findings suggest that more work of abductor and rotator muscles at the lower extremities are required to successfully complete the task of SA when wearing HHS. Dynamics of human gait. and aid health care professionals in evaluating and training elderly individuals in stair negotiation and increasing their functional mobility for independent living. J Gerontol A Biol Sci Med Sci 1996:M303–12.and 80. Conclusion In the current study it was found the younger and elder women developed different gait adjustments during stair ascent while wearing HHS. Gait Posture 2001b. 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