Correlation of Foot Wears with MSK Disorders in Ankle Joints Among Females

AIM: This paper is a report of study conducted to explain the factors that causes ankle sprain by wearing high heels among students of Sargodha medical college and university of Sargodha. BACKGROUND: High heeled shoes have been worn for several centuries and despite numerous cautions against their use, they remain extremely popular. Wearing high heeled shoes is thought to increase the individual’s likelihood of experiencing a lateral ankle sprain. The 19 th century saw the first warnings that wearing high heels footwear could lead to trips and falls. Previous investigations have shown that high heeled shoes align the foot in planter flexion, modifying the relative orientation of the skeletal structures of ankle, midtarsal, and metatarsophalangeal joints, and alter the insertion angles of the foot and gliding joint muscles, therefore increasing the risk factor for ankle sprain. METHODS: observational non-experimental study was conducted via a questionnaire which was distributed among 500 female students of SMC (Sargodha medical college) and university of Sargodha. These female students fall in age group between18-26. RESULT: The result of our study concluded that the types of heel and height of heel are the most significant factors that cause ankle sprain. The ankle sprain caused by wearing pencil heels and by use of <3 inch heels are greatest. results from present study suggest that high-heel-related injuries have nearly doubled during the 11 from to 2012. Injuries from high heels are differential with most injuries occurring as sprains and strains to the foot and ankle. The results of this study can be used in the development of a prospective cohort study to investigate the risk of injury from high-heeled shoes, accounting for the exposure time and studying differences in demographics such as race and age.[13]

 To find out which height of heel contributes more in causing ankle sprain due to use of high heels.

IV. METHODOLOGY Study design:
Cross sectional study. Study Setting: University of Sargodha and Sargodha medical college. Sample size: 500 female students. Inclusion criteria: Female students from age 18-26. Exclusion criteria: Female students with any congenital ankle problem and female students from any college other than University of Sargodha and Sargodha medical college. Method: Self-constructed Questionnaire V. STATISTICAL ANALYSIS Data was compiled via SPSS. We took sample set of 500 female students. According to SPSS analysis the dependent variable is type of heel and independent variable is age of student.
a. Age Factor: In our study, we collected data from 500 girls of different age groups and according to our data the most frequent age group that are using high heels are of age 22 years, this age group carries 27.2 percent of the total percent. Other age groups that are mostly using high heels are of age 21 years and 23 years of girls. Our descriptive statistics shows that the minimum age group in our study is of 18 years of girls and maximum age is 26years.The mean of age group is 21.95 it means that mostly this age group took part in our study.
b. Weight Factor Weights vary according to age and height. Weight was asked from our subjects. The highest frequency that we got according to our study is of weight 50 whose frequency was 61.That is of girls who weigh 50 kg they carry 12.2 percent of the total subjects. However the results indicate that minimal weight changes do not significally affect our results. c. Height Factor In our study we collected data of 500 people who have different ages and heights and according to our study, the girls of height 5.3 inches are most frequent and the frequency of this height group is 130 and it carries 26 percent of the total subjects. Other height groups which are frequent according to our study are 5.2 inches and 5.4 inches and their frequencies are 123 and 56 respectively. d. Duration of Using High Heels 500 girls of different age and height were asked about the regular duration of using high heels and according to our study, the girls using high heels for 4-6 hrs regularly are most frequent and they carries 50 percent of the total.
What is the duration of using high heels?  72 is the most significant factor that r contributing 0.79in hurting your ankle. The 2 nd significant factor is the height of heels that contributes about 0.691 in hurting the ankle.
According to our study, the most frequently used heels are pencil heels and the ankle sprain caused by wearing pencil heels are most frequent as compared to other heels. Pencil heels cause twisting of foot mostly hence the chances of ankle sprain by the use of pencil heel are greatest.  The result shows that 50.8 % were wearing <3 inch heel which mostly cause twisting of foot and ankle sprain. And according to our SPSS analysis height of heels is the significant factor that are causing the ankle sprain.  Table 13: Coefficients According to our study and SPSS analysis type of heels and height of heels are the most significant factors in causing the ankle sprain and in type of heels pencil heels are the most frequently used heels and pencil heels are the main cause of twisting of foot and ankle sprain and among height of heels <3 inch height are used by the girls of age 18-26 which are causing the ankle sprain.

VII. DISCUSSION
High heels have long been a symbol of a sophisticated woman. From Marilyn Monroe to Carrie Bradshaw, heels have been worn by fashion-minded women for quite some time now, and they've become synonymous with style and luxury. However, this particular accessory is not without its downfall, and looks like the popular saying was right: Beauty is pain. High heels can have a number of long-lasting negative health effects on the body, extending just beyond the foot.
Here we discuss some effects that are caused by use of high heels. High heels cause damage to toes and nails. According to Lyolamedicine high heels are the leading cause of ingrown toe nails. This occurs because the toes compress together, causing the big toe nails to grow into the skin. This can also lead to nail or fungal infections.
High heels can cause bi unions. Because use of high heels can tip your body weight forward, forcing the toes towards the front of the shoe. This action pushes the big toes against the other toes, which can cause the bunion protrusion High heels can cause hip and knee pain. It is the most common problem that many girls experienced while using high heels. Walking in high heels increases the amount of weight put on the knee joints, as women tend to bend their knees more while walking in high heels shoes. This can strain knee joints as well as the hip, and exert extra pressure on these joints and due to its excessive use it can trigger fractures and compresses the nerves.
Regular use of high heels increases the risk of osteoarithritis, which is the inflammatory joint condition in women of old age bt the prolonged use of high heels can increase the risk of osteoarithritis. According to the study of Orthopedic journal women wearing heels higher than 3.5 inches can increase the lifetime risk of osteoarithritis.
The most common complaint from girls wearing high heels are about muscle pain and spasm. Long-term wear of high heels can shorten the muscles in calves and in back, which can cause muscle pain and spasms, according to the American Osteopathic Association. Many women also experience and complain of painful leg cramps after wearing the high heels shoes.
It is a common experience that there is usually a less support and comfort in high heels. The high heels exert a constant pressure on the balls of your feet which causes weight distribution to be less even and lower back pain often results. Nerves can also become stressed in the lower back because of the odd posture while wearing high heels. Resting the body weight on balls of feet cause worsening pain after some time. Walking around on the balls of feet all day tend can create yellowed areas on bottom of feet that remains sore after high heels are removed.
High heels effects the natural curve of spine. The lower back becomes even more arched than usual when you wear high heels. The higher the height of heels are, the more the lower back has to arch to keep the positioned upright. This extreme curve is a contributor to back pain in both the lower and the upper region.
We conducted a study about high heels that regular use of high heels cause ankle sprain. We collected data from 500 girls of different age and according to our study and statistical analysis, height of heels and type of heels is the most significant factors that are causing ankle sprain. Type of heels is the main factor which is causing the ankle sprain. As we know that heel height greater than 1.5 inches can cause changes in the body so the girls using high heels regularly, more often suffer from ankle sprain than other girls. As height of heels can change the mechanics of the body while walking, it can exert greater pressure on ankle and other joints as well. So while using high heels during ambulation due to greater forces and stresses exert on the foot the high heels causes twisting of your foot which can cause ankle sprain. Age also plays an important factor in twisting of foot because with age the body is unable to maintain balance and while using high heels balance of person lost and person may fall and results in twisting of foot and ankle sprain while walking with high heels.
High heels hurt the ankle mostly and according to our study the most significant factor of causing ankle sprain and hurting your ankles are type of heels and height of heels. Type of heels also plays the significant role in hurting the feet. There are different types of heels in the market and different girls prefer different heels according to their choices. According to our data analysis, pencil heels are the most frequently used heels by girls and while using pencil heels the balance of girls is lost and ankle is hurt mostly which in turn leads to spraining of ankle.
High heels, whether stilettos, wedges, or pumps, have been fashionable for decades. Many women don't feel dressed for work if they aren't wearing high heels with their business suits. And dressing up for a special event almost always involves stepping out in heels. While high heels add inches to height and make legs look longer and sleeker the eventual result of wearing these shoes much of the time may not be a pretty picture. In fact, high heels can put your health in danger. Sprains and strains to the foot and ankle were the most common complaints, and most patients were in their 20s and 30s, the study found. "Although high-heeled shoes might be stylish, from a health standpoint, it would be worthwhile for those interested in wearing high-heeled shoes to understand the risks and the potential harm that precarious activities in high-heeled shoes can cause," said the study's lead investigator, Gerald McGwin, an epidemiology professor in the UAB School of Public Health, in a university news release. Not surprisingly, young women in their 20s were most likely to get these injuries, which were usually sprains and strains to the foot or ankle. What is surprising is that half of these injuries happened at home, not at work or out on the town. In the study, which is published in the Journal of Foot and Ankle Injuries, researchers recommend you think about the risks to your safety before you strap on those six-inch stilettos.
The study conducted in SMC has some limitations. The foremost is that in this study data was collected and analyzed only from the girls of Sargodha Medical College and University of Sargodha. Our study was confined to specific age group i.e. 18-26.Furthermore, it does not address the effects of high heels on other parts of body such as knee, hip and spine etc. Our survey was evaluated through self-made questionnaire not by clinical analysis.

VIII. CONCLUSION
According to our study and statistical analysis the types of heel and height of heels are the most significant factors that are causing the ankle sprain while using the high heels:- 54% female experience ankle sprain mostly  13% experience ankle sprain rarely.  33% not often experience ankle sprain. According to our study and ankle sprain caused by wearing heels of  <2 inch is 32.6%  <3 inch is 50.8%  4-5 inch is 16.6% According to our study the ankle sprain caused by wearing  Pencil heel is 62.2%  wedge heel is 16%  Sole heel is 1.6%  Block heel is 20.2%

IX. RECOMMENDATION:
 Study should be analyzed through clinical analysis in future.  Seminars can be conducted to spread the awareness among females.  Study should also be conducted on females above 30 years of age in future.  Research should also include the aspect of brand and quality of shoes.  Longitudinal study should be conducted to evaluate the long term effects of wearing high heels.