| Research Objective: Patellofemoral Pain Syndrome(PFPS)is a common musculoskeletal disorder around the knee joint and is an important trigger for a variety of lower extremity injuries,the incidence of which is significantly higher in women than in men.When women wear high heels,the height of the heel affects the gait characteristics of the body.Currently,the gait biomechanics of female patients with PFPS under different heel heights is unclear.This study investigated the effect of heel height on biomechanical characteristics of gait in female patients with PFPS and provides reasonable advice on shoe fitting and rehabilitation for this population by comparing the gait characteristics of healthy people and female patients with PFPS with the increase in heel height during walking.Research methods: A total of 32 female subjects were screened for inclusion in the experimental study by G-Power software through minimum sample size calculation and were divided into a pilot group of PFPS patients(EG group,n=16)and a healthy control group(CG group,n=16).The EG and CG groups walked on a flat gait wearing flat heels,3cm,5cm and7 cm heels,respectively,and lower limb kinematic,kinetic and surface EMG indices were collected during the period.Two-factor repeated measures ANOVA(height*group)was used between groups to observe the main effects and interaction effects of the two groups,and if the interaction effects were significant,simple effects analysis was performed,and if the interaction effects were not significant,the effect of main effects on the results was analyzed,with P < 0.05 indicating that the differences were significant and P < 0.01 indicating that the differences were highly significant,using Graph Pad Prism9 was used to draw the relevant graphs.Research results:(1)Kinematic characteristic indexes:(1)Gait spatiotemporal parameters:the interaction effect of group*heel height factor on gait speed was significant(P=0.011).Simple effect analysis revealed that gait speed in the EG group decreased significantly with increasing heel height(P < 0.05),and there was a main effect of the group*heel height factor on gait speed at flat heel and 3 cm high heel(P < 0.05).(2)Joint mobility: the interaction effect of group*heel height on knee mobility was significant(P=0.005).Simple effect analysis revealed that knee joint mobility in the EG group decreased significantly(P < 0.05)from flat heels to 5cm heels and increased from 5cm heels to 7cm heels,while knee joint mobility in the CG group decreased significantly(P < 0.05)from flat heels to 7cm heels,and the trend of knee joint angle change in the two groups was significantly different at greater than 5cm,with the EG group increasing from 5cm heels to 7cm heels.high heels to 7cm high heels instead increased.(2)Surface EMG characteristic indicators:(1)In the mid-support period,the interaction effect of group*heel height on IEMG values of the medial femoral muscle,gastrocnemius,biceps femoris and rectus femoris was significant(P=0.047,P=0.02,P=0.024,P=0.041).medial femoral muscle in the EG group increased significantly(P<0.05)from flat heels to5 cm heels,and increased significantly(P <0.05)from 5cm heels to 7cm The medial femoral muscle in the EG group decreased significantly(P < 0.05)from flat heels to 3 cm high heels and increased significantly(P < 0.05)from 3 cm high heels to 7 cm high heels,while the medial femoral muscle in the CG group increased significantly(P < 0.05)from flat heels to 7cm high heels,and the trend of medial femoral muscle in the two groups appeared significantly different at 7 cm high heels.The biceps and rectus femoris in the EG group decreased significantly(P < 0.05)from flat heels to 5 cm heels and increased significantly(P< 0.05)from 5 cm to 7 cm heels,while the biceps and rectus femoris in the CG group decreased significantly(P < 0.05)from flat heels to 5 cm heels and increased significantly(P< 0.05)from 5 cm to 7 cm heels.The biceps femoris and rectus femoris in the CG group decreased significantly(P < 0.05)from flat heels to 7 cm heels.(2)In the late support period,the interaction effect of group*heel height on the medial and lateral femoral muscles was significant(P=0.012,P=0.014),and the effect of the remaining muscle groups was not significant(P >0.05).Simple effect analysis revealed that medial and lateral femoral muscles in the EG group significantly increased(P < 0.05)from flat to 5 cm heels and decreased(P <0.05)from 5 cm to 7 cm heels,while medial and lateral femoral muscles in the CG group significantly increased(P < 0.05)from flat to 7 cm heels.(3)Kinetic characteristics index:(1)Peak pressure(PP)results showed that the group*heel height had a significant PP interaction effect on the M04 zone(P=0.043).Simple effect analysis revealed that the EG group had a significant decrease(P < 0.05)in the M04 zone with increasing heel height from flat heels to 5cm heels and an increase(P < 0.05)from5cm to 7cm heels,while the CG group had a significant decrease(P < 0.05)in the PP in the M04 zone from flat heels to 7cm heels.(2)The results of the impulse(PTI)showed a significant interaction effect of group*heel height on PTI values in zone M05(P < 0.05).Simple effect analysis revealed that the EG group increased in the M05 zone from flat heels to5 cm heels and significantly decreased in the 5cm to 7cm heels(P < 0.05),while the CG group PTI did not show significant changes in the M05 zone(P > 0.05).Research Conclusion: With the increase of heel height,especially when the heel height is greater than or equal to 5 cm,female PFPS patients have abnormal gait in the middle and late stages of gait support,which is manifested in kinematics as lower gait speed than healthy people with the same heel height and increased joint mobility of patients;in kinetics as increased PTI value in the big toe area and decreased PP value in the lateral forefoot area;in neuromuscular lower limb In terms of control,they showed abnormal activation of the medial femoral and lateral femoral muscles,significant compensations in the rectus femoris and biceps femoris,increased fatigue in the gastrocnemius muscle,and reduced electromyographic activity in the muscles around the hip joint,which in turn triggered an imbalance in the function of the entire muscle group around the knee joint,which may be the power source of triggering PFPS,which in turn directly led to increased symptoms or pain in patients. |
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