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題名：女性高跟鞋及鞋墊的生物力學與傳力機制分析
作者：洪維憲
作者(外文)：Wei-Hsien Hong
校院名稱：國立臺灣科技大學
系所名稱：工業管理系
指導教授：李永輝
學位類別：博士
出版日期：2004
主題關鍵詞：高跟鞋；鞋墊；生物力學；傳力機制；步態；high-heeled shoes；insert；biomechanical；force transmission；gait
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高跟的設計在女鞋中仍佔優勢，主要是它能讓女性體態曲線更加優美，然而長期下來卻在步態穩定上及對下肢的肌肉骨骼系統造極大的傷害，即便如此，在社交和流行的引領下，高跟鞋的巿場需求歷久不衰。過去相關鞋類的研究中主要著重在生物力學的效應，同樣地舒適性是穿著者是很重要的因素，有些研究將足底壓力增加和足部不適作連結，因此，瞭解高跟鞋鞋足介面間的舒適性與生物力學變數間的關係是需要被探究的。而過去研究也顯示鞋墊的使用能增進舒適，且能有效地降低壓力及控制足部穩定，但這些研究都是應用在平底和慢跑鞋上，到目前為止沒有相關研究探討鞋墊應用在高跟鞋的效應分析。此外，作用在腳底的作用力及壓力上傳到身體，為了穩定及好的肢體運作，需要作些姿勢調整來代償這些變化，包括肌肉負荷和關節活動變化，特別是在踝關節。因此，本研究也嚐試去試驗在跟高和鞋墊的影響下肌肉負荷和足部穩定的情形；同時，對於有、無穿著高跟鞋經驗者間在步態表現上的差異也是本研究感興趣的課題。
因此，本研究的目的:
1. 探討在高跟鞋步態上，舒適度和生物力學變項間的關係。
2. 測定各種型式鞋墊的生物力學效應。
3. 從後足運動、地板作用力與肌肉負荷測試鞋墊修飾後在傳力上的效益。
4. 以穿著經驗為考量探討高跟鞋步態的穩定。
結果顯示從生物力學及舒適性量測在跟高影響和鞋墊效應上已有初步的瞭解，前足內側的峰壓、衝擊力及最大垂直作用力三者對舒適評分有強的相關性，研究建議女性穿不超過5.1公分(2吋)的高跟鞋，此高度衝擊力和平底鞋差異不大，且前足內側壓的壓力也不致過大，但在3吋鞋高時則明顯會比穿平底鞋增加52%前足內側壓力及30%的衝擊力。
研究發現在各種型式的鞋墊間，有後跟杯(heel-cup)和足弓支撐(arch-support)機制的鞋墊能有效地降底前足內側壓力或衝擊力，特別是，全觸式鞋墊(total contact insert, TCI)能有效地降低24%的前足內側壓力及33.2%的衝擊力，並提供較好的舒適性。
此外，在傳力機制上，穿著高跟鞋在步態著地時也增加後足內翻的角度、以及在脛前肌、內側腓腸肌及骶棘肌的活動，這是導致足部不穩定及肌肉負荷增加的原因。全觸式鞋墊的使用將有效地支撐足部穩定(矯正1.5度的內翻角度)，並且降低在腓腸肌(18.4%)及骶棘肌(18.6%)的負荷。
而隨著跟高的增加，有經驗的穿著者有較低的Q/H 比率的值及著地期時四頭肌持續活動，顯示四頭肌較弱及不穩定的收縮；而對無經驗的穿著者則有較強的骶棘肌活動，顯示其下背肌肉負荷增加。
鞋墊的介入雖然在骨骼的排列上只是小角度改變，然而對生物力學及傳力機制上有很大的效應，本研究所採用的高跟鞋鞋墊的取模-製作技術，將有助於鞋墊製造者及臨床輔具師對穿著高跟鞋的女性提供合宜的鞋墊，達到舒適改善的目的。
The high-heeled design remains one of the dominant features of women’s footwear. Societal and fashion customs encourage the continuous use despite concerns regarding their detrimental effects on gait and lower extremity function. Accordingly, comfort is an important factor for wearing high-heeled shoes. Previous research into footwear focused on the biomechanical effectsand linked increased plantar pressure to foot discomfort. To determine the relationship between perceived comfort and relevant biomechanical measures at the foot-shoe interface must be explored. Shoe inserts have been used to promote comfort, effectively reduce pressure and control foot stability in previous studies. These inserts were often applied in flat and running shoes. No studies, insofar as we have examined, attempted to identify insert effectiveness in high heels. In addition, the foot contacts the ground and transmits the force and pressure from ground up to the body. For stable and well functioning body, some postural adaptations should occur to compensate for these alterations, including muscular loads and joint motion, particularly at the ankle joint. Therefore, we also attempted to identify muscle loading and foot stability under different heel height and insert during walking. In addition, we were also interested in comparing differences in foot stability and muscle loading between experienced and inexperienced wearers.
The objectives of this study were:
1. To determine the relationship between comfort perception and biomechanical variables during high-heeled walking.
2. To identify the biomechanical effect of various types of shoe inserts.
3. To identify the force transmission benefit of shoe-insert’s modification from rearfoot motion, GRF, and EMG of selected leg muscles.
4. To determine gait stability from rearfoot motion and muscle loading with consideration for experience of wearers.
The results represented an initial step toward a better understanding of the effects both heel heights and shoe inserts on biomechanics and comfort measure. Peak medial forefoot pressure, impact force, and first peak vertical GRF provided a strong explanation for 75.6% of the comfort rating. Women are advised to wear heel height limit at 5.1 cm (2 inches) that would has lower medial forefoot pressure and impact force. When shoes beyond this height would increase 52% the peak pressure in the medial forefoot and 30% the impact force than flat shoes.
Among various types of shoe inserts, the results of this study found that a custom-made insert with heel-cup or an arch-support mechanism would be effective for reduction on medial forefoot pressure or impact force, In particular, utilization of the total contact insert (TCI) effectively reduced medial forefoot pressure by 24%, impact force by 33.2%, and offered a better comfort.
In addition, in force transmission mechanism, high-heeled walking also increased inversion angle and muscle activity tibialis anterior (TA), Medial gastrocnemius (MG), and erector spinae (ES) at heel strike, which would lead to foot instability and muscle loading increase. Utilization of TCI was also effective in supporting foot stability and reducing MG (by 18.4%) and ES (by 18.6%) muscle loadings.
By increasing heel height, experienced wearers have lower Q/H ratio and prolonged quadriceps activity during stance phase, which showed weak and instability in quadriceps contraction. Inexperienced wearers have larger ES activity than experienced wearers, which would increase low back muscle loading.
The results of this study found that the effects of insert intervention produced only small effects on the alignment of the skeleton but large effects on biomechanics and force transmission mechanism for women wearing high-heeled shoes. The insert casting –fabrication technique for high-heeled shoes in this study would be helpful to provide insert manufacturer and clinical orthotist to serve women wearing high-heeled shoes for comfort improvement.
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