Can high heels help relieve hip pain in OA?

People with hip osteoarthritis who wear shoes with heel heights ≥2.5cm appear to have fewer pain exacerbations than those who wear flatter shoes, Australian research shows.

The surprising findings come from a nSydney University study of 252 people, mostly women, with hip OA and who self-report hip pain on most days of the week. The mean age of the participants was 63 years and mean BMI was 29.

The Internet-based, case-crossover study over 90 days required participants to complete an online questionnaire when they experienced a pain exacerbation. An exacerbation was defined as an increase of ≥2 points on the numeric rating scale for pain compared to the participants’ mildest hip pain score at baseline.

Participants were asked to self-report on the type of shoes they wore, shoe heel height, and duration of wear. Few people wore heels >5cm so the study’s comparison was ultimately between those with heel heights <2.5cm or ≥2.5cm.

The study found people wearing shoes with heel heights ≥2.5cm during the past 24 hours had a significantly decreased odds of hip pain compared to those wearing flatter shoes (OR 0.54, 95% CI: 0.30 to 0.99).

There was no substantial difference after adjusting for physical activity level in the past seven days (OR: 0.59; 95% CI: 0.32 to 1.08).

And there was evidence of an independent dose response relationship with longer duration of time wearing shoes with heel height ≥ 2.5 cm during the past 24 hour associated with a lower risk of hip pain exacerbations.

The study, from Professor David Hunter’s team at the Kolling Institute of Medical Research in the Institute of Bone and Joint Research, suggested gait adaptations in people with hip OA might explain why wearing shoes with a higher heel could be associated with a lower risk of hip pain exacerbation.

“People with hip OA show gait adaptations that may be strategies to avoid pain and decrease hip joint loads, and/or result from a limitation in passive motion, particularly hip flexion contracture,” the authors wrote in the Journal of Clinical Medicine.

“Possible ways to compensate for inadequate hip extension are to increase lumbar lordosis and tilt the pelvis anteriorly, strategies which can occur via wearing higher heels,” they noted.

“Thus, wearing shoes with higher heels (up to a point) might indirectly help to compensate for inadequate hip extension, decreasing pain and leading to fewer pain exacerbations.”

However the findings come with warning that more research was required before adopting high heels as a treatment strategy for OA.

“Although we found these results in our study, we are not able to recommend people with hip OA to wear high heels up to 5 cm for longer periods, as this might lead to more severe constant pain and other issues related to foot, knee, low back and neck.”

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