Strutting in Style, Suffering in Silence: A Biomechanical Study of Hallux Valgus Deformity with High Heeled Shoes

Category: Midfoot/Forefoot; Other Introduction/Purpose: High heeled shoes (HH) have historically been thought to worsen existing hallux valgus (HV). However, no studies have shown if HH contribute to the pathophysiology of HV development. Weightbearing computed tomography (WBCT), distance mapping (DM), and coverage mapping (CM) allows for three- dimensional analysis of the forefoot and has been previously able to detect subtle differences in joint mechanics. However, no study has used WBCT to study 1st metatarsophalangeal (MTP) joint mechanics in HH. The aim of this study was to describe and compare DM and CM of the 1st MTP at varying HH heights. Methods: 10 non-frequent HH wearing volunteers with no underlying foot/ankle pathology received bilateral WBCT scans at four different HH heights: 0 cm, 3 cm, 6 cm, 9cm. A semi-automatic software was used to segment the 1st MTP. Manual selection of the 1st metatarsal head and proximal phalangeal surface was performed. DM and CM differences were statistically evaluated using One-Way ANOVA test and Wilcoxon rank sum test. P values < 0.05 were considered statistically significant. Results: For both DM and CM, there was a statistically significant difference when comparing all HH height parameters to one another (p < 0.0001). When comparing each HH height individually to the 0 cm condition, all heights demonstrated a statistically significiant difference (p < 0.0001). More specifically, the plantar lateral aspect of the 1st MTP joint space demonstrated the greatest change in both DM and CM compared to the control at all HH heights. Conclusion: This study demonstrates for the first time that HH may contribute to the development of HV in previously healthy feet. Interestingly, the plantar lateral aspect of the 1st MTP was the most affected with increasing HH heights. Further research is needed to elucidate the long term effects of HH shoes on forefoot deformity development.