None listed
Conditions
Brief summary
Use of high-heeled footwear began more than 1000 years back, and resulted in the development of changes in gait, posture and the kinematics and kinetics of the spine, hip, knees, and ankle. High-heeled shoes force the ankle into plantar flexion which leads to changes in lumbar spine, pelvic tilt, and other joints. High-heeled shoes induced plantar flexion has also been found to alter the activity of pelvic floor muscles (PFM) through its effect on lordosis of the lumbar spine and pelvic inclination (tilt). Several studies have evaluated the influence of high-heeled shoes on lumbar lordosis however, results are controversial. Some studies found an increase lumbar lordosis angle and some found a decrease or no change with increased heel height. It is reported that there might be an epidemiological association between lumbopelvic posture and urinary incontinence in women. Assuming a hyper or hypolordotic posture is thought to distort the PFM activity; hyperlordosis resulted in lengthening and hypolordosis resulted in a shortening of the PFM. The proposed mechanism is, in hypo-lordosis the pelvis tilts posteriorly causing the sacrum to move in an anterior and inferior direction and pubis in a posterior and superior direction drawing closer the attachment of the key PFMs, resulting in shortening of the muscle; and in hyperlordosis the reverse of this is thought to occur causing a stretch of the muscle. The evidence for the effect of various ankle positions on PFM activity is limited. To our knowledge only three studies have evaluated the effect of various ankle positions on PFM activity with controversial results. We hypothesize that passive plantar flexion induced by high-heeled shoes might decrease the activity of PFM through its effect on lumbar spine and pelvis in women. If women habitually wear high-heeled shoes, this might have the potential to reduce the activity and length of the PFM and deconditioning which might contribute to stress urinary incontinence. Paucity of literature and contradicting results of available literature on the impact of various ankle positions on lumbar spine, pelvis and PFM activity has led the authors to conduct this study. This study will determine the effect of four ankle positions (two plantar flexion positions induced by 5.08 cm (2 inches) and 7.62 cm (3 inches) high-heeled shoes; a neutral and a dorsiflexion position) on bioelectric and contractile activity of PFM. The primary aim of this study is to assess the influence of high-heeled shoes induced plantar flexion on bioelectrical and contractile activity of PFM and compare it to ankle neutral and dorsiflexion positions. The secondary aim is to assess the effect the four ankle positions on lumbar lordosis and pelvic tilt.
Interventions
Non-pregnant women with stress urinary incontinence will attend a 3-hour testing session.
Resting and functional activity of pelvic floor muscles (PFM) using transperenial ultrasound (TPS), intra-vaginal pressure measurement using vaginal manometer and evaluation of lumbar lordosis and pelvic tilt using spinal mouse will be done in standing with ankle in four positions including: neutral ankle position (bare feet); 10-degree dorsiflexion with a wedge under toes; and two ankle plantar flexion po
Non-pregnant women with stress urinary incontinence will attend a 3-hour testing session. Resting and functional activity of pelvic floor muscles (PFM) using transperenial ultrasound (TPS), intra-vaginal pressure measurement using vaginal manometer and evaluation of lumbar lordosis and pelvic tilt using spinal mouse will be done in standing with ankle in four positions including: neutral ankle position (bare feet); 10-degree dorsiflexion with a wedge under toes; and two ankle plantar flexion positions. Initially assessments using vaginal manometry, TPS and spinal mouse will be done in ankle neutral position condition for approximately 10-20 minutes. Following this, assessments will be repeated with ankle in 10-degree dorsiflexion, assessment lasting for about 10-20 minutes. Women will then be made to stand or walk (at participant’s discretion) around with 5.08 cm (2 inches) high-heeled shoes for 30 minutes (for possible postural adjustments) before measurements are repeated. Participants will then be made to wear the 7.62 cm (3 inches) high-heeled shoes for 30 minutes during which time they decide to stand or walk around following which measurements will be repeated. Between the two plantar flexion positions a 10-minute rest period will be provided. In each ankle position women will undergo 3D- (for resting PFM activity) and 4D-TPS (for obtaining images at maximum PFM (2) contraction) using the GE Healthcare/Logiq TPS system with a 2-5.5 HMz probe. A five-minute rest period will be allowed between measurements in the consecutive ankle neutral and dorsiflexion conditions. All assessments will be done at the physiotherapy Department of Kwong Wah Hospital by a physiotherapist with specialist experience in Women's health and assisted by another physiotherapist with expertise in TPS.
Sponsors
Dr Priya Kannan
Study design
Allocation
Non-randomised trial
Primary purpose
Prevention
Eligibility
Sex/Gender
All
Age
18 Years to 49 Years
Healthy volunteers
No
Inclusion criteria
Non-pregnant women with stress urinary incontinence in the age group of 18-49 years will be included. Participants need not be habitual high-heeled shoes users to participate in the study.
Exclusion criteria
Women with previous pelvic surgeries, body mass index over 30 kg/m2, diabetes, smoking, chronic lung diseases, neurological problems, and urinary tract infection will be excluded from the study.
Outcome results
None listed