Ramya Rough Draft 1

PREVALENCE OF FOOT DISORDERS IN COLLEGE
POPULATION REGULARLY WEARING HIGH

HEELS
STUDENT: Ms. Ramya Ramakrishnan
GUIDE: Mr. N. Ashok, Senior Physiotherapist
In partial fulfillment of the

requirement for the degree of
BACHELOR OF PHYSIOTHERAPY
- June 2023
A Project submitted to
SRM COLLEGE OF PHYSIOTHERAPY

SRM INSTITUTE OF SCIENCE AND TECHNOLOGY
(Deemed to be University u/s of UGC Act, 1956)

SRM Nagar, Kattankulathur,
Chengalpattu District, Tamil Nadu, India – 603203
PREVALENCE OF FOOT DISORDERS IN COLLEGE
POPULATION REGULARLY WEARING HIGH
HEELS
INTERNAL EXAMINER:
Name -_________________________________________________
Signature with date- ______________________________________
EXTERNAL EXAMINER:
Name- __________________________________________________
Signature with date- _______________________________________
In partial fulfilment of the
requirement for the fulfilment of
BACHELOR OF PHYSIOTHERAPY
-June 2023
A Project submitted to
SRM INSTITUTE OF SCIENCE AND TECHNOLOGY

2
SRM INSTITUTE OF SCIENCE AND
TECHNOLOGY
044- 27456729/ www.srmuniv.ac.in
CERTIFICATE
This is to certify that Ms. Ramya Ramakrishnan has satisfactorily
completed her project on the topic “PREVALENCE OF FOOT
DISORDERS IN COLLEGE POPULATION REGULARLY WEARING
HIGH HEELS”. This project is submitted towards partial fulfillment of
Degree of Bachelor of Physiotherapy Examination, – 2023.
OFFICIAL SEAL WITH DATE DEAN
3
SRM INSTITUTE OF SCIENCE AND
TECHNOLOGY
044- 27456729/ www.srmuniv.ac.in
DECLARATION BY THE STUDENT

I hereby declare that this project entitled “PREVALENCE OF FOOT
HIGH HEELS” is a bonafide and genuine research work carried out by me
under the guidance of Mr .N. ASHOK, SENIOR PHYSIOTHERAPIST
SIGNATURE OF THE STUDENT
CERTIFICATE BY THE GUIDE

This is to certify that the project entitled “PREVALENCE OF FOOT
HIGH HEELS” is a bonafide research work done by Ms. RAMYA
RAMAKRISHNAN towards partial fulfillment of the requirement for the
Degree of BACHELOR OF PHYSIOTHERAPY.
DATE:
PLACE: SIGNATURE OF THE GUIDE:
ACKNOWLEDGEMENT
4
First and foremost, I would like to thank the almighty, who showed his
blessings in all walks of my life.
I submit my Heartful thanks to Prof. T.S. VEERAGOUDHAMAN, M.P.T.,

DEAN, for the valuable advice and guidance towards this work.
I would like to thank Mr. T.N. SURESH, M.P.T., VICE-PRINCIPAL, for

helping me with my project work.
I am highly indebted to my guide, Mr. N. ASHOK, SENIOR

PHYSIOTHERAPIST who took his real personal interest in providing me
proper guidance, encouragement and support at all levels.
I thank my Coordinator Mr. AYYAPAN, ASSISTANT PROFESSOR

and all my Assistant Professors who with all patience gave me helping
hands whenever I needed.
My grateful thanks to all my subject Staff, and master’s students who contributed
their time and energy in this project.
I also thank the subjects who have given their consent for participating in
my study and co- operating to fill my form and contribute to the study.
My entire effort stand credited at this moment only because of my family

and friends who wholeheartedly stood beside me always in each step of my
career.
Last but not least, I would like to thank D305 group and Yamin Khursheed
for their valuable suggestions and support in the completion of my project.
I DEDICATE THIS PROJECT TO MY PARENTS
ABSTRACT
BACKGROUND: The foot is one of the most complex parts of the body that is placed under
multiple stresses at every point of everyday due to which people tend to develop foot
disorders like foot pain, injuries, etc. Between 63-72% of people experiencing foot disorders
were found to be wearing unfit or wrongly fitting shoes that didn’t accommodate the foot
freely. The occurrence was slightly higher in late teenage to young adult females, and
5
significantly in those women wearing high heels on a regular basis. Women regularly
wearing heels are reported to experience lesser toe deformity, corns, calluses, etc. and
regular users (2”+) face shape change of Achilles tendon, increasing pressure and shortening
tendon, reshaping and stiffening muscles where women in general are reported to have
plantar heel pain (9.6%) and disabling pain (7.9%) since strides will be shorter and more
forceful, making the woman take more strides than with no footwear or flat footwear on and
all the steps will have more force than usual too. OBJECTIVE: Prevalence of foot disorders
in college population regularly wearing high heels. OUTCOME MEASURE: Foot and
ankle disability index, Foot function index. METHODOLOGY: 150 subjects were chosen
based on inclusion and exclusion criteria. After informed consent was obtained, the subjects
filled the questionnaire provided. RESULTS: There is significant prevalence of foot
disorders in college population regularly wearing high heels. CONCLUSION: This study
concludes that women of age group 18- 30 years regularly wearing high heels in college
setting are highly prone to foot disorders.
6
INDEX
S.NO CONTENTS PAGE NO.
1. INTRODUCTION 1
2. REVIEW OF LITERATURE 5
3. METHODOLOGY 7
4. STATISTICAL ANALYSIS 15
5. RESULTS 26
6. DISCUSSION 29
7. CONCLUSION 31
8. LIMITATIONS AND RECOMMENDATIONS 32
9. REFERENCES 33
10. ANNEXURES 35
7
INTRODUCTION
The foot is one of the most complex parts of the body, made of 26 bones, that are
almost 25% of the bones of the body, and are connected and held together by joints,
muscles, tendons, and ligaments. [1][2] It is the part of the body susceptible to many
stresses as full impact of the weight of the whole body is congregated on two
comparatively small surfaces, which are the feet. [3]
Due to this intense pressure on the foot, individuals tend to experience pain, aching,
and sometimes tenderness during or after prolonged and intense physical activity or
movement. Since the foot is such an important organ, and is susceptible to wear and
tear, we need to discuss the causes of foot disorders.
Foot disorders are quite commonly self diagnosed by the individual by the reason of
pain. Between 63 and 72% of participants were wearing shoes that did not
accommodate either width or length dimensions of their feet.
There’s also evidence that wrongly footwear fitting was associated with foot pain and
foot disorders such as lesser toe deformity, corns, calluses, etc.. [4] The population
prevalence of plantar heel pain was 9.6% and 7.9% for disabling plantar heel pain. [5]
Occurrence was slightly higher in females, comparable across age-groups, and

significantly higher in those with physical and mental impairment, more anxiety and
depression, being overweight, a low previous use of high-heeled footwear. [9]
Women of late teenage and young adult age groups have displayed a widespread of
high heels. At this age, the individuals are at the age where they wish to look at the
other sex for mating or making themselves look appealing for the opposite sex.
And multiple studies suggested that there is a relationship between the attractiveness
factor and the usage of high heels by the reason that lumbar curvature increases and
the buttocks look emphasized which is ‘an act of presenting themselves’ to the
opposite sex. [6]
There is also the reason of making themselves look taller and slimmer, in this age of
supermodels on social media and young women being strongly influenced, the usage
of high heels and tilted or steeped shoes is increasing in both developing and
developed countries. And most significantly, the fad of fashion which holds high
heels as a staple in every woman’s closet.
High heels change the wearer’s pattern of gait, making the wearer take shorter and
more forceful strides than someone wearing flat soled footwear. These types of steps
can put excessive pressure on the knee joint and may cause degeneration of the knee
joint in the future. High heels change the centre of gravity or COG and overall weight
to compensate for the shoe’s heel and hence, we understand, the higher the heel,
higher the risk if causing disorders in the lower back, hip, knee and most importantly,
the foot. Regular users (2”+) face shape change of Achilles tendon, increasing
pressure and shortening tendon, reshaping and stiffening muscles. [7]
8
This can cause discomfort and pain and prolonged use for many years can even cause
discomfort wearing flat soled shoes as the foot will have adapted causing irritation on
usage of other types of footwear.
9
AIM OF THE STUDY
The aim of the project is to study the prevalence of foot disorders caused in college
going individuals due to the regular usage of high heels.
NEED OF THE STUDY

The purpose of the study is to analyse the prevalence of foot disorders in young
college population wearing high heels on a regular basis. As, after going through
multiple studies, the idea that high heels cause postural disorders and changes has
been suggested but none specifically on the foot have been done so far, and I wish to
explore this topic further.
10
REVIEW OF LITERATURE
Puszczałowska-Lizis et al. (2019) concluded in their study that the feet of women wearing
high heeled shoes were significantly more transverse, with more laterally flexed hallux as
compared to those wearing flat soled shoes.
Hylton B Menz and Meg E Morris (2005) concluded in their study that incorrectly fitting
footwear is common in older people and is strongly associated with forefoot pathology and
foot pain.
Dawson et al. (2002) concluded foot pain and deformities are widespread in women wearing
high heels and the relationship between footwear and occupational activities and foot
problems should be explored further.
Yan Cong et al. (2011) concluded there is a medial shift of plantar pressures and shear
stresses over the forefoot and a smaller peak anterior shear during push-off as heel height
increased. These changes agree with the increase in forefoot pronation and ankle
plantarflexion wearing high-heeled shoes.
Csapo et al. (2010) observed shortened gastrocnemius Lf and increased AT stiffness in

habitual high heel wearers, which might reduce the ankle active range of motion and thus
explain the discomfort these women experience when walking in flat shoes. These results
strongly support the hypothesis that muscle structure may adapt to a chronic change in
functional demand.
Cronin (2014) stated that HH generally cause qualitatively consistent changes in the
neuromechanics of walking. These changes are widespread, affecting structures from the toes
to the spine, and mostly disadvantageous in terms of movement economy or increased risk of
tissue damage.
Alsancak et al. (2020) concluded through their study that it may not be advisable for young
people to wear shoes with high heels and negative heel height by taking into account the risk
factors in the body and ankle postural compensation while carrying a backpack.
Fengqin Fu et al. (2016) stated that moderate high-heel shoes placed IEW at a greater risk of
joint and soft tissue injury with generally larger peak angles during stance phase.
Social and fashion customs encourage the continued use of high-heel shoes (Hong, Lee,
Chen, Pei, & Wu, 2005) despite of detrimental effects on the musculoskeletal system, such
as lower back pain, ankle sprains, foot pain, hallux valgus and increased predisposition
toward degenerative knee osteoarthritis (Barkema et al., 2012, Chien et al., 2014a, Chien et
al., 2014b, Dawson et al., 2002, Gu et al., 2014, Lee et al., 2001).
11
Unanimous results revealed that increase of heel height contributed to slower self-selected
walking speeds and shorter strides with generally unchanged cadence (Barkema et al., 2012,
Cronin et al., 2012, Esenyel et al., 2003, Lee et al., 2001, Opila-Correia, 1990a).
Blanchette et al. (2011) concluded increasing heel height increases the friction demand
during walking. This finding suggests that wearing high heel shoes may increase the
probability of a slip event when a floor surface with a reduced available friction is
encountered.
Cha Yu Jin (2020) concluded through his study that the wearers of high-heeled shoes (Group
A) showed significantly high peak pressure in the masks of hallux and midfoot, a
significantly high contact area in the mask of midfoot, high maximum peak EMG in GM, and
more active muscle activation in plantar flexor. In addition, they showed the highest muscle
tone of RF and GM, the largest lumbosacral angle, and the most stable static balance ability
(COP) in 7 cm heels with eyes open.
Yolanda A (2020) concluded in her study where middle aged women were studied for their
everyday usage of high heels that The effect of wearing high heels on foot pain is not
statistically significant (p = 0.248), yet clinically the racial odds were 1.87. This result shows
that woman who wears high heels has a risk of 1.87 times more likely to have foot pain.
Wang M et al. (2018) concluded through his study that the findings complement existing
kinematic evidence that wearing high heels can lead to foot deformities and injuries.
Soemarko D et al. (2019) concluded that the incidence of hallux valgus is higher among
sales promotion women who wear high heel shoes than flat shoes. Age and working
experience are also related to the development of HV.
Meir Nyska et al. (1996) have shown that high-heel shoes increased the load on the forefoot
and relieved it on the hindfoot. The load passed toward the medial forefoot and the hallux.
The lateral side of the forefoot showed a decrease in contact area, reduced forces, and peak
pressures. The medial side of the forefoot had a higher force-time and pressure-time integral.
It is suggested that these higher loads on the medial forefoot may aggravate symptoms in
patients with hallux valgus deformity.
Amir Ahmady et al. (2014) concluded that the result of this study on the shoes with heel
height 1.5 inches, 2.5 inches, and 3.5 inches shows that an increase in shoe heel height
12
resulted in a decrease in arch deformation (Figure 1). There was a common rise in a peak
Von-Mises stress of foot bones with increasing shoe heel height
13
METHODS
• STUDY DESIGN: Non-experimental type
• STUDY TYPE: Observational type
• SAMPLING METHOD: Convenience sampling
• SAMPLING SIZE: 150
• SAMPLING DURATION: 8 weeks
• STUDY SETTING: In SRM
14
INCLUSION CRITERIA
• College going students

• Age group:18 to 30 years
• Must be wearing high heels regularly
• Heel must be of 2 inches or more
• Must be willing to participate in the study
EXCLUSION CRITERIA
• Not wearing high heels
• With pre-existing foot disorders or pain
• Not in selected age group
• Not willing to participate in study
15
PROCEDURE
• The participants will be selected based on inclusion and exclusion criteria.

• The selected participants will be given an informed consent after detailed explanation
of procedure.
• Here we selected the college going population of 18-30 years wearing high heels on a
regular basis and use the outcome measure to analyse and quantify the foot pain and
discomfort they face, if any.
• The subject will fill the form and answer questions, if any, regarding the topic.
• We also observe the foot with the footwear, the direction of pressure placed on
footwear, the foot without the footwear.
• Patient position: Standing.
16
OUTCOME MEASURE
Foot and ankle disability index (FADI) with a ICC reliability score of 0.89 and foot function
index (FFI) has an ICC reliability score of 0.99
17
STATISTICAL ANALYSIS
The statistical package for social science (SPSS) version 20 was used to perform all
statistical calculations results with an alpha level below 0.05 were considered
statistically significant.
18
TABLE 1
N Minimum Maximum Mean Std. Deviation
Age 154 18 30 23.44 2.921

How often do you wear
154 1 4 2.90 .864
heels?
Following questions (4 to
19) pertain to discomfort
during or after usage of
154 1 4 2.74 .712
footwear:
4. Any feeling of discomfort
during or after use of heels?
Discomfort: Standing with
154 0 4 2.45 .817
footwear on?
Discomfort: Walking on
even ground without 154 0 4 3.36 .988
footwear on?
even ground with footwear 154 0 4 2.44 .766
on?
uneven ground with 154 0 4 2.02 .671
footwear on?
Discomfort: Stepping up
and down on curves with 154 0 4 1.62 .809
footwear on?
Discomfort: Walking initially
after wearing footwear? 154 0 4 2.55 .943
(First few steps)
Discomfort: Walking uphill
154 0 3 1.65 .805
wearing heels?
Discomfort: Walking
154 0 3 1.55 .785
downhill wearing heels?
Discomfort: Walking upstairs
154 0 4 1.73 .873
wearing heels?
Discomfort:
Squatting/Bending to pick
153 0 4 1.96 .768
up object from ground
wearing heels?
Discomfort: Wearing heels
154 0 4 1.76 .848
and going down the stairs?
19
TABLE 2
N Minimum Maximum Mean Std. Deviation
Discomfort: Wearing heels

154 0 4 1.94 .786
for 15+ minutes?
Discomfort: Daily life
activities with heels on?
154 0 3 1.66 .669
(Going to work/college,
Driving, etc.)
Discomfort: Recreational
activities with heels on? 154 0 3 1.66 .716
(Going out with friends, etc.)
The following questions (19
to 24) pertain to the pain felt
during or after usage of
heels: 154 0 3 1.82 .562
19. General pain level with
footwear on?
(Overall/Average pain level)
Pain: Sleeping after
154 0 4 2.37 .832
removing footwear?
Pain during normal activity
154 0 3 1.91 .620
with footwear on?
Pain at rest while wearing
154 0 4 2.61 .803
footwear?
Pain first thing in the
154 1 4 3.11 .947
morning without footwear?
After removing heels at the
154 0 3 1.29 .920
end of your day?
Valid N (listwise) 153
20
TABLE 3
MINIMUM MAXIMUM MEAN STD.

DEVIATION
AGE 18 30 23.44 2.921
According to table 1, demographic data information shows that the minimum age is 18 years,
maximum age is 30 years, mean age is 23.44 years and standard deviation is 2.921.
21
GRAPHICAL REPRESENTATIONS
Age
Frequency Percent Valid Percent Cumulative

Percent
18 3 1.9 1.9 1.9
19 7 4.5 4.5 6.5
20 11 7.1 7.1 13.6
21 23 14.9 14.9 28.6
22 24 15.6 15.6 44.2
23 17 11.0 11.0 55.2

24 21 13.6 13.6 68.8
Valid
25 13 8.4 8.4 77.3
26 10 6.5 6.5 83.8
27 6 3.9 3.9 87.7
28 8 5.2 5.2 92.9
29 5 3.2 3.2 96.1
30 6 3.9 3.9 100.0
Total 154 100.0 100.0
22
How often do you wear heels?

Percent
ONCE 9 5.8 5.8 5.8
2-3 TIMES 39 25.3 25.3 31.2
Valid 3-4 TIMES 65 42.2 42.2 73.4
EVERYDAY 41 26.6 26.6 100.0
Total 154 100.0 100.0
23
Following questions (4 to 19) pertain to discomfort during or after usage of

footwear:
4. Any feeling of discomfort during or after use of heels?

Percent
RARELY 5 3.2 3.2 3.2
SOMETIMES 49 31.8 31.8 35.1
Valid MOST TIMES 81 52.6 52.6 87.7
ALWAYS 19 12.3 12.3 100.0
Total 154 100.0 100.0
24
Discomfort: Standing with footwear on?

Percent
UNABLE TO DO 4 2.6 2.6 2.6
EXTREMELY DIFFICULT 11 7.1 7.1 9.7
MODERATE DIFFICULT 59 38.3 38.3 48.1

Valid
SLIGHT DIFFICULT 71 46.1 46.1 94.2
NO DIFFICULT 9 5.8 5.8 100.0
Total 154 100.0 100.0
25
Discomfort: Walking on even ground without footwear on?

Percent
UNABLE TO DO 3 1.9 1.9 1.9

Valid
NO DIFFICULT 94 61.0 61.0 100.0
Total 154 100.0 100.0
26
Discomfort: Walking on even ground with footwear on?

Percent
UNABLE TO DO 2 1.3 1.3 1.3

Valid
NO DIFFICULT 13 8.4 8.4 100.0
Total 154 100.0 100.0
27
Discomfort: Walking on uneven ground with footwear on?

Percent
UNABLE TO DO 2 1.3 1.3 1.3

Valid
NO DIFFICULT 2 1.3 1.3 100.0
Total 154 100.0 100.0
28
Discomfort: Stepping up and down on curves with footwear on?

Percent
UNABLE TO DO 12 7.8 7.8 7.8

Valid
NO DIFFICULT 1 .6 .6 100.0
Total 154 100.0 100.0
29
Discomfort: Walking initially after wearing footwear? (First few steps)

Percent
UNABLE TO DO 2 1.3 1.3 1.3

Valid
NO DIFFICULT 28 18.2 18.2 100.0
Total 154 100.0 100.0
30
Discomfort: Walking uphill wearing heels?

Percent
UNABLE TO DO 11 7.1 7.1 7.1
Valid MODERATE DIFFICULT 69 44.8 44.8 86.4
Total 154 100.0 100.0
31
Discomfort: Walking downhill wearing heels?

Percent
UNABLE TO DO 14 9.1 9.1 9.1
Total 154 100.0 100.0
32
Discomfort: Walking upstairs wearing heels?

Percent
UNABLE TO DO 8 5.2 5.2 5.2

Valid
NO DIFFICULT 5 3.2 3.2 100.0
Total 154 100.0 100.0
33
Discomfort: Squatting/Bending to pick up object from ground wearing heels?

Percent
UNABLE TO DO 2 1.3 1.3 1.3

Valid
NO DIFFICULT 3 1.9 2.0 100.0
Total 153 99.4 100.0

Missing System 1 .6
Total 154 100.0
34
Discomfort: Wearing heels and going down the stairs?

Percent
UNABLE TO DO 7 4.5 4.5 4.5

Valid
NO DIFFICULT 5 3.2 3.2 100.0
Total 154 100.0 100.0
35
Discomfort: Wearing heels for 15+ minutes?

Percent
UNABLE TO DO 4 2.6 2.6 2.6

Valid
NO DIFFICULT 3 1.9 1.9 100.0
Total 154 100.0 100.0
36
Discomfort: Daily life activities with heels on? (Going to work/college, Driving, etc.)

Percent
UNABLE TO DO 5 3.2 3.2 3.2

Total 154 100.0 100.0
37
Discomfort: Recreational activities with heels on? (Going out with friends, etc.)

Percent
UNABLE TO DO 6 3.9 3.9 3.9
Total 154 100.0 100.0
38
The following questions (19 to 24) pertain to the pain felt during or after usage of heels:
19. General pain level with footwear on? (Overall/Average pain level)

Percent
UNABLE TO DO 1 .6 .6 .6

Total 154 100.0 100.0
39
Pain: Sleeping after removing footwear?

Percent
UNBEAREABLE 2 1.3 1.3 1.3
SEVERE PAIN 15 9.7 9.7 11.0
MODERATE PAIN 75 48.7 48.7 59.7

Valid
MILD PAIN 48 31.2 31.2 90.9
NO PAIN 14 9.1 9.1 100.0
Total 154 100.0 100.0
40
Pain during normal activity with footwear on?

Percent
UNBEAREABLE 3 1.9 1.9 1.9
SEVERE PAIN 28 18.2 18.2 20.1
Valid MODERATE PAIN 103 66.9 66.9 87.0
MILD PAIN 20 13.0 13.0 100.0
Total 154 100.0 100.0
41
Pain at rest while wearing footwear?

Percent
UNBEAREABLE 1 .6 .6 .6
SEVERE PAIN 11 7.1 7.1 7.8
MODERATE PAIN 52 33.8 33.8 41.6

Valid
MILD PAIN 73 47.4 47.4 89.0
NO PAIN 17 11.0 11.0 100.0

Total 154 100.0 100.0
42
Pain first thing in the morning without footwear?

Percent
SEVERE PAIN 10 6.5 6.5 6.5
MODERATE PAIN 31 20.1 20.1 26.6
Valid MILD PAIN 45 29.2 29.2 55.8
NO PAIN 68 44.2 44.2 100.0
Total 154 100.0 100.0
43
After removing heels at the end of your day?

Percent
UNBEAREABLE 38 24.7 24.7 24.7
SEVERE PAIN 45 29.2 29.2 53.9
Valid MODERATE PAIN 60 39.0 39.0 92.9
MILD PAIN 11 7.1 7.1 100.0
Total 154 100.0 100.0
44
DISCUSSIONS
The purpose of this study is to find out the disorders and problems caused in the foot vis-à-vis
the regular usage of high heels in college going population, through the non-experimental,
observational method. In this study, I discovered there is high prevalence of foot pain and
other related foot disorders in college going population regularly wearing high heels.
Multiple studies have observed that the disorders affect the whole body, not just the foot and
ankle complex. Even though it is socially promoted and a fashion staple, the negative side
effects of these kinds of footwear are many, which are exacerbated on regular usage.
The hindrance I faced during this study is finding participants who wear high heels regularly,
for example, to college, work, going out with friends, etc. and their willingness to participate
in the study, finding a large number of women wearing heels on such a regular basis was
tough.
NCI defined disorder as a disturbance of normal functioning of the mind or body. Disorders
maybe caused due to genetic factors or disease or trauma. A foot disorder is any disturbance
from normal functioning of the foot. It mainly starts with foot pain.
Meir Nyska et al. concluded that the regular usage of high heels put increased pressure on the
forefoot and toes and can cause or aggravate hallux valgus and other foot disorders.
Amir Ahmady et al. concluded there is increased presence of strain and total tensional force
in plantar fascia, and Yolanda et al. (2020) observed middle aged women having higher
prevalence of foot pain due to daily high heel usage
45
CONCLUSION
The study has concluded to show result that there is great prevalence of foot pain and other
such foot disorders in college going female population aged 18 to 30 years who regularly
wear high heels.
46
LIMITATIONS AND RECOMMENDATIONS
LIMITATIONS
 Smaller sample size

 No control groups were performed in this study
 Lack of willing participants
 Lack of people wearing high heels regularly
RECOMMENDATIONS
 The same case study can be done in vast geographical area

 The same case study can be performed across various age groups
 The same case study can have added variables
 The same case study can be used to discover or formulate any
intervention methods for related disorders
47
REFERENCES
1) Puszczałowska-Lizis E, Dąbrowiecki D, Jandziś S, Żak M. Foot Deformities in

Women Are Associated with Wearing High-Heeled Shoes. Med Sci Monit. 2019 Oct
16;25:7746-7754. doi: 10.12659/MSM.917983. PMID: 31701921; PMCID:
PMC6816328.
2) Menz HB, Morris ME. Footwear characteristics and foot problems in older people.
Gerontology. 2005 Sep-Oct;51(5):346-51. doi: 10.1159/000086373. PMID:
16110238.
3) Dawson J, Thorogood M, Marks SA, Juszczak E, Dodd C, Lavis G, Fitzpatrick R.
The prevalence of foot problems in older women: a cause for concern. J Public Health
Med. 2002 Jun;24(2):77-84. doi: 10.1093/pubmed/24.2.77. PMID: 12141589.
4) Cong Y, Cheung JT, Leung AK, Zhang M. Effect of heel height on in-shoe localized
triaxial stresses. J Biomech. 2011 Aug 11;44(12):2267-72. doi:
10.1016/j.jbiomech.2011.05.036. Epub 2011 Jun 25. PMID: 21705002.
5) Csapo R, Maganaris CN, Seynnes OR, Narici MV. On muscle, tendon and high heels.
J Exp Biol. 2010 Aug 1;213(Pt 15):2582-8. doi: 10.1242/jeb.044271. PMID:
20639419.
6) Cronin NJ. The effects of high heeled shoes on female gait: a review. J Electromyogr
Kinesiol. 2014 Apr;24(2):258-63. doi: 10.1016/j.jelekin.2014.01.004. Epub 2014 Jan
24. PMID: 24508305.
7) Alsancak S, Güner S, Güven E, Özgün AK. Effects of heel height with backpack
loading in young people. J Sports Med Phys Fitness. 2020 Mar;60(3):388-394. doi:
10.23736/S0022-4707.19.10222-8. Epub 2019 Dec 5. PMID: 31818056.
8) Fu F, Zhang Y, Shu Y, Ruan G, Sun J, Baker JS, Gu Y. Lower limb mechanics during
moderate high-heel jogging and running in different experienced wearers. Hum Mov
Sci. 2016 Aug;48:15-27. doi: 10.1016/j.humov.2016.04.002. Epub 2016 Apr 18.
PMID: 27101561.
9) Farinelli V, Hosseinzadeh L, Palmisano C, Frigo C. An easily applicable method to
analyse the ankle-foot power absorption and production during walking. Gait Posture.
2019 Jun;71:56-61. doi: 10.1016/j.gaitpost.2019.04.010. Epub 2019 Apr 11. PMID:
31005856.
10) Blanchette MG, Brault JR, Powers CM. The influence of heel height on utilized
coefficient of friction during walking. Gait Posture. 2011 May;34(1):107-10. doi:
10.1016/j.gaitpost.2011.03.023. Epub 2011 May 4. PMID: 21536444.
11) Cha YJ. Analysis of Differences in the Degree of Biomechanical Adaptation
according to Habituation to Different Heel Heights. ScientificWorldJournal. 2020 Jun
1;2020:1854313. doi: 10.1155/2020/1854313. PMID: 32565748; PMCID:
PMC7285271.
12) Farrag A, Elsayed W. Habitual Use of High-Heeled Shoes Affects Isokinetic Soleus
Strength More Than Gastrocnemius in Healthy Young Females. Foot Ankle Int. 2016
Sep;37(9):1008-16. doi: 10.1177/1071100716649172. Epub 2016 May 9. PMID:
27162223.
48
13) Cronin NJ, Barrett RS, Carty CP. Long-term use of high-heeled shoes alters the
neuromechanics of human walking. J Appl Physiol (1985). 2012 Mar;112(6):1054-8.
doi: 10.1152/japplphysiol.01402.2011. Epub 2012 Jan 12. PMID: 22241055.
14) Hansen AH, Childress DS. Effects of shoe heel height on biologic rollover
characteristics during walking. J Rehabil Res Dev. 2004 Jul;41(4):547-54. doi:
10.1682/jrrd.2003.06.0098. PMID: 15558383.
15) Snow, Rebecca E., and Keith R. Williams. "High heeled shoes: their effect on center
of mass position, posture, three-dimensional kinematics, rearfoot motion, and ground
reaction forces." Archives of physical medicine and rehabilitation 75.5 (1994): 568-
576.
16) Gollnick, Philip D., Charles M. Tipton, and Peter V. Karpovich. "Electrogoniometric
study of walking on high heels." Research Quarterly. American Association for
Health, Physical Education and Recreation 35.3 (1964): 370-378.
17) Lee, Chang-Min, Eun-Hee Jeong, and Andris Freivalds. "Biomechanical effects of
wearing high-heeled shoes." International journal of industrial ergonomics 28.6
(2001): 321-326.
18) Guéguen, Nicolas. "RETRACTED ARTICLE: High Heels Increase Women’s
Attractiveness." Archives of sexual behavior 44 (2015): 2227-2235.
19) Liau, Yee Yeng, et al. "The effect of wearing high-heels and carrying a backpack on
trunk biomechanics." International Journal of Industrial Ergonomics 86 (2021):
103229.
20) Bae, Young-Hyeon, et al. "Effect of revised high-heeled shoes on foot pressure and
static balance during standing." Journal of physical therapy science 27.4 (2015):
1129-1131.
21) Guo, Lan-Yuen, et al. "Effect on plantar pressure distribution with wearing different
base size of high-heel shoes during walking and slow running." Journal of Mechanics
in Medicine and Biology 12.01 (2012): 1250018.
22) Nyska, Meir, et al. "Plantar foot pressures during treadmill walking with high-heel
and low-heel shoes." Foot & ankle international 17.11 (1996): 662-666.
23) Ahmady, Amir, et al. "The effect of various heights of high-heeled shoes on foot arch
deformation: Finite element analysis." Journal of Foot and Ankle Research. Vol. 7.
No. 1. BioMed Central, 2014.
24) Adrian, Marlene J., and Peter V. Karpovich. "Foot instability during walking in shoes
with high heels." Research Quarterly. American Association for Health, Physical
Education and Recreation 37.2 (1966): 168-175.
25) Cong, Y., Yan Luximon, and Ming Zhang. "Effect of Shank Curve of high-heeled
shoe on the plantar pressure distribution." 7th Asian-Pacific Conference on Medical
and Biological Engineering: APCMBE 2008 22–25 April 2008 Beijing, China.
Springer Berlin Heidelberg, 2008.
26) Kumar, N. Venkatesh, et al. "High Heels Footwear Causes Heel Pain and Back Pain:
Myth or Reality?." International Journal of Scientific Study 2.8 (2014): 101-104.
27) https://www.hopkinsmedicine.org/health/conditions-and-diseases/foot-pain-and-
problems [1]
28) https://www.chicagolandfootandankle.com/blog/signs-youre-living-with-a-stress-
fracture-in-your-foot [2]
49
29) https://www.allcarefootdoc.com/blog/how-your-high-heels-are-wreaking-havoc-on-
your-feet [3]
30) Buldt, A.K., Menz, H.B. Incorrectly fitted footwear, foot pain and foot disorders: a
systematic search and narrative review of the literature. J Foot Ankle Res 11, 43
(2018) [4]
31) Thomas, M.J., Whittle, R., Menz, H.B. et al. Plantar heel pain in middle-aged and
older adults: population prevalence, associations with health status and lifestyle
factors, and frequency of healthcare use. BMC Musculoskelet Disord 20, 337 (2019)
[5]
32) Lewis DMG, Russell EM, Al-Shawaf L, Ta V, Senveli Z, Ickes W and Buss DM
(2017) Why Women Wear High Heels: Evolution, Lumbar Curvature, and
Attractiveness. Front. Psychol. 8:1875. [6]
33) https://www.livescience.com/10738-high-heels-reshape-leg-muscles-create-pain-
worn.html [7]
34) https://www.livescience.com/10738-high-heels-reshape-leg-muscles-create-pain-
worn.html [8]
35) Thomas, M.J., Whittle, R., Menz, H.B. et al. Plantar heel pain in middle-aged and
older adults: population prevalence, associations with health status and lifestyle
factors, and frequency of healthcare use. BMC Musculoskelet Disord 20, 337 (2019).
[9]
36) Hill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates of foot pain in a
population-based study: the North West Adelade health study. J Foot Ankle Res.
2008;1(1):2.
37) Dufour AB, Broe KE, Nguyen US, Gagnon DR, Hillstrom HJ, Walker AH, Kivell E,
Hannan MT. Foot pain: is current or past shoewear a factor? Arthritis Rheum.
2009;61:1352–8.
50
ANNEXURE – I
INFORMED CONSENT
 I, Mr./Mrs. _________________, freely and voluntarily agree to participate in the

study conducted on the “PREVALENCE OF FOOT DISORDERS IN COLLEGE
POPULATION REGULARLY WEARING HIGH HEELS” done by Ms.
RAMYA RAMAKRISHNAN, BPT 8TH SEMESTER, IV YEAR, SRM
COLLEGE OF PHYSIOTHERAPY, SRM INSTITUTE OF SCIENCE AND
TECHNOLOGY, KATTANKULATHUR, KANCHEEPURAM, 603203.
 I was explained in detail about the procedure of the study and understood the
requirements and benefits of the study.
 I surely and solely give consent to participate in this study.
DATE: SIGNATURE:
PLACE:
ANNEXURE – II
51
ASSESSMENT FORM
52
ANNEXURE – III
53
ANNEXURE – IV
54

Ramya Rough Draft 1

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ramya Rough Draft 1

Uploaded by

Copyright:

Available Formats

PREVALENCE OF FOOT DISORDERS IN COLLEGE

POPULATION REGULARLY WEARING HIGH

STUDENT: Ms. Ramya Ramakrishnan

GUIDE: Mr. N. Ashok, Senior Physiotherapist

In partial fulfillment of the

SRM COLLEGE OF PHYSIOTHERAPY

(Deemed to be University u/s of UGC Act, 1956)

Signature with date- ______________________________________

Signature with date- _______________________________________

In partial fulfilment of the

requirement for the fulfilment of

SRM COLLEGE OF PHYSIOTHERAPY

SRM INSTITUTE OF SCIENCE AND TECHNOLOGY

(Deemed to be University u/s of UGC Act, 1956)

completed her project on the topic “PREVALENCE OF FOOT

DISORDERS IN COLLEGE POPULATION REGULARLY WEARING

HIGH HEELS”. This project is submitted towards partial fulfillment of

Degree of Bachelor of Physiotherapy Examination, – 2023.

OFFICIAL SEAL WITH DATE DEAN

DECLARATION BY THE STUDENT

SIGNATURE OF THE STUDENT

CERTIFICATE BY THE GUIDE

I submit my Heartful thanks to Prof. T.S. VEERAGOUDHAMAN, M.P.T.,

I would like to thank Mr. T.N. SURESH, M.P.T., VICE-PRINCIPAL, for

I am highly indebted to my guide, Mr. N. ASHOK, SENIOR

I thank my Coordinator Mr. AYYAPAN, ASSISTANT PROFESSOR

My entire effort stand credited at this moment only because of my family

I DEDICATE THIS PROJECT TO MY PARENTS

S.NO CONTENTS PAGE NO.

8. LIMITATIONS AND RECOMMENDATIONS 32

Occurrence was slightly higher in females, comparable across age-groups, and

NEED OF THE STUDY

Csapo et al. (2010) observed shortened gastrocnemius Lf and increased AT stiffness in

• College going students

• Not willing to participate in study

• The participants will be selected based on inclusion and exclusion criteria.

N Minimum Maximum Mean Std. Deviation

Age 154 18 30 23.44 2.921

N Minimum Maximum Mean Std. Deviation

Discomfort: Wearing heels

MINIMUM MAXIMUM MEAN STD.

AGE 18 30 23.44 2.921

Frequency Percent Valid Percent Cumulative

18 3 1.9 1.9 1.9

19 7 4.5 4.5 6.5

20 11 7.1 7.1 13.6

21 23 14.9 14.9 28.6

22 24 15.6 15.6 44.2

23 17 11.0 11.0 55.2

26 10 6.5 6.5 83.8

27 6 3.9 3.9 87.7

28 8 5.2 5.2 92.9

29 5 3.2 3.2 96.1

30 6 3.9 3.9 100.0

Total 154 100.0 100.0

How often do you wear heels?

Frequency Percent Valid Percent Cumulative

ONCE 9 5.8 5.8 5.8

2-3 TIMES 39 25.3 25.3 31.2

Valid 3-4 TIMES 65 42.2 42.2 73.4

EVERYDAY 41 26.6 26.6 100.0

Total 154 100.0 100.0

Following questions (4 to 19) pertain to discomfort during or after usage of