Influence of high-heeled shoes on pelvic floor muscles

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Objective and participants: To investigate if high-heeled shoes induced plantar flexion might have an impact on pelvic floor muscle activity in continent women. Written informed consent will be obtained from all interested women. Women who provide written consent will be made to complete a sociodemographic questionnaire with the following details: age; marital status; number of successful and unsuccessful pregnancies; occupation; smoking history; history of previous pelvic surgeries; history of neurological and respiratory conditions; urinary tract infection; and foot wear; details of high-heeled shoes- heel height, number of years worn, number of hours worn each day, and number of days worn each week; Women will undergo a 3-hour testing session. Prior to testing, they will receive information on the equipment (transabdominal ultrasound (TAS) and spinal mouse) to be used. Following this women will be briefed on preparation for ultrasound; they will be requested to void 1-hour prior to testing and then drink 500 ml of water and not urinate until after the end of the test. During assessment with TAS two tasks will be performed: a PFM contraction and a Valsalva maneuver; these two tasks will be done thrice and the mean will be calculated for analysis. TAS and evaluation of lumbar lordosis and pelvic tilt will be done in standing with ankles in four positions. Initial assessment using TAS and spinal mouse will be done with ankles in neutral position. Following this, assessment will be repeated with ankles in 20-degrees dorsiflexion (by placing wedges under the toes). A five-minute rest period will be allowed between measurements in the consecutive ankle neutral and dorsiflexion conditions. 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 (standing or walking 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 4D-TAS (for obtaining images at maximum PFM contraction [Valsalva]) with a 2-5.5 HMz probe. All study procedures will be carried out at the outpatient physiotherapy centre in Kwong Wah hospital. Assessments with TAS will be conducted by a physiotherapist with expertise in TAS and assisted by the principal investigator who has specialist experience in women's health. Measurement with spinal mouse will be done by the principal investigator. The TAS machine from Kwong Wah hospital and spinal mouse from HK PolyU will be used in this study.

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