臺灣博碩士論文加值系統

在現代社會，許多女性基於專業考量或社會環境的需求穿著高跟鞋。高跟鞋增加平衡的困難度與跌倒的風險，導致傷害如骨折或踝關節扭傷的發生，而跨越障礙物增加這些困難度與風險。瞭解穿著高跟鞋步行與跨越障礙物時關節力學與平衡控制有助於高跟鞋的人因工程設計或選擇，以預防肌肉骨骼相關的疾病。本研究徵召習慣性穿著高跟鞋的女性，藉由動作分析系統探討步行與跨越障礙物時，鞋跟底面積與高度對下肢生物力學與平衡控制的影響。穿著高跟鞋步行時，女性採取較保守的平衡控制策略。鞋跟減少底面積是導致步行速度變慢、額狀面質量中心-壓力中心傾斜角度變小，以及影響總支撐力矩及關節貢獻度最主要的因素。額狀面質量中心-壓力中心傾斜角度減少主要來自於雙腳站立期質量中心-壓力中心傾斜角度變化率的控制。於矢狀面，膝關節伸直力矩增加代償減少的踝關節蹠屈力矩以維持不變的總支撐力矩；於額狀面，單腳站立後期時，關節外展力矩與踝關節旋前力矩增加以因應鞋跟底面積減少造成的不穩定。當穿著不同高度鞋子跨越障礙物時，相較於赤腳受試者前腳透過踝關節蹠屈以維持不變的腳尖與障礙物間距。面對不同鞋高，跨越瞬間前腳腳尖與障礙物間距雖可被精準控制，但因鞋跟尖端位置不易精確偵測，鞋跟與障礙物間距因而減少。與赤腳相比，鞋跟與障礙物增加導致鞋跟與障礙物間距減少可能增加跨越障礙物時絆倒的風險。穿著高跟鞋跨越障礙物，女性亦採取較保守的平衡控制策略，減少額狀面質量中心-壓力中心傾斜角度。站立腳離地時，矢狀面質量中心-壓力中心傾斜角度變化率減少以維持雙腳站立與單腳站立轉換時的穩定，也有助於之後後腳跨越的穩定性。跨越障礙物時，總支撐力矩之關節間分配協調策略與步行時相似。

In modern society, many women wear high-heeled shoes in both professional and social settings High-heeled shoes increase the difficulty of maintaining balance and thus the risk of falling, leading to injuries such as fracture and ankle sprain. This is further increased with the present of obstacles. Knowledge of the joint mechanics and whole body balance control during level walking and obstacle-crossing with high-heeled shoes may offer better insights into the ergonomic design or choice of high-heeled shoes to prevent relevant musculoskeletal problems. In the present study, female habitual wearers of high-heeled shoes were recruited to investigate the influence of the base and height of the shoe heels on the biomechanics of level walking and obstacle-crossing using motion analysis techniques. For level walking, females appeared to adopt a conservative strategy for balance control during narrow-heeled gait. The reduced base of the heels was found to be the primary factor for the reduced normalized walking speed, and the reduced frontal COM-COP inclination angles (IA) throughout the gait cycle, as well as the affected total support moments (Ms) and individual joint contributions for body balance control. Reduced frontal IA was achieved mainly through the control of the rate of change of IA (RCIA) during double-limb support (DLS). They maintain an unaltered sagittal Ms through increasing the knee extensor moment to compensate for the diminished ankle plantarflexor moments. In the frontal plane, they had to sustain an increased demand for balance control during late single-limb support (SLS) by increasing knee abductor and ankle pronator moments as a result of the reduced base of the shoe heels.

When crossing an obstacle of a given height with the leading limb, young females in high-heels were found to maintain the same leading toe-clearance as in the barefoot condition irrespective of the heel-height, primarily through the increase of the plantarflexion of the leading swing ankle. While the swing toe clearance was accurately controlled in response to different heel heights, the shoe-heel clearance was not, leading to reduced shoe-heel clearance, presumably related to the difficulty in the precise sensing of the position of the shoe-heel tip. The reduced shoe-heel clearance with increasing heel-height or obstacle height may increase the risk of tripping over the obstacle when compared to barefoot condition. Females also showed more stable body control with reduced frontal IA in high-heels during obstacle-crossing compared with barefoot condition. Shoes with high heels reduced sagittal RCIA at toe-off to ensure a stable transition from DLS to the following SLS and provide sufficient stability for the following trailing leg crossing. The inter-joint sharing of total support moment of the lower extremities during obstacle was similar with those during level walking.

口試委員會審定書 i
Acknowledgements ii
中文摘要 iii
Abstract v
Table of Contents vii
List of Tables xi
List of Figures xiii
Chapter 1 Introduction 1
1.1. Background 1
1.2. Biomechanical Analysis of Locomotion 2
1.2.1. Inverse Dynamics 2
1.2.2. Gait Analysis 3
1.2.3. Obstacle-Crossing Analysis 5
1.2.4. Total Support Moment 9
1.2.5. Dynamic Stability 12
1.3. Effects of Base and Height of Shoe Heels on Gait Performance 13
1.3.1. Temporospatial Parameters 13
1.3.2. Joint Kinematics 14
1.3.3. Joint Kinetics 15
1.3.4. Balance Control 16
1.3.5. Limitations of Previous Studies 17
1.4. Strategies of Obstacle-Crossing 19
1.4.1. Effects of Obstacle Height on the End-Point Variables 20
1.4.2. Effects of Obstacle Height on the Joint Kinematics 21
1.4.3. Effects of Obstacle Height on the Joint Kinetics 22
1.4.4. Effects of Obstacle Height on the Balance Control 23
1.4.5. Limitations of Previous Studies 25
1.5. Aims of This Dissertation 25
Chapter 2 Materials and Methods 28
2.1. Subjects 28
2.2. Shoes 29
2.3. Instruments 31
2.4. Experimental Protocol 33
2.5. Biomechanical Analysis Models 36
2.5.1. Coordinate Systems 36
2.5.2. Anthropometric Parameters 42
2.5.3. Inverse Dynamics Analysis 43
2.5.4. Body COM Model 50
2.6. Data Analysis 51
2.6.1. Definition of the Gait Cycles 51
2.6.2. Definition of the Crossing Cycles 52
2.6.3. Temporal-Spatial Variables of Level Walking 53
2.6.4. End-Point Variables and Crossing Speed 53
2.6.5. Joint Kinematics 57
2.6.6. Joint Kinetics 57
2.6.7. Total Support Moment and Individual Joint Contributions 58
2.6.8. COM and COP Varialbes 61
2.7. Statistical Analysis 67
2.7.1. Level Walking 67
2.7.2. Obstacle-Crossing 67
Chapter 3 Joint Kinematics and Inter-joint Sharing of Total Support Moments in the Lower Extremities During High-Heeled Gait 68
3.1. Subjects 69
3.2. Data Analysis 69
3.3. Results 70
3.4. Discussion 81
3.5. Conclusions 88
Chapter 4 Control of the Motion of the Body’s Center of Mass in Relation to the Center of Pressure During High-Heeled Gait 89
4.1. Subjects 90
4.2. Data Analysis 90
4.3. Results 90
4.4. Discussion 99
4.5. Conclusions 105
Chapter 5 End-Point and Joint Kinematics of the Locomotor System During High-Heeled Obstacle-Crossing 106
5.1. Subjects 107
5.2. Data Analysis 107
5.3. Results 107
5.4. Discussion 120
5.5. Conclusions 124
Chapter 6 Inter-joint Sharing of Total Support Moments in the Lower Extremities During High-Heeled Obstacle-Crossing 125
6.1. Subjects 126
6.2. Data Analysis 126
6.3. Results 126
6.4. Discussion 135
6.5. Conclusions 139
Chapter 7 Control of the Motion of the Body’s Center of Mass in Relation to the Center of Pressure During High-Heeled Obstacle-Crossing 141
7.1. Subjects 142
7.2. Data Analysis 142
7.3. Results 142
7.4. Discussion 148
7.5. Conclusions 151
Chapter 8 Conclusions and Suggestions 152
8.1. Conclusions 153
8.1.1. Effects of Base and Height of Shoe Heels on the Kinematics and Total Support Moments During High-Heeled Gait 153
8.1.2. Effects of Base and Height of Shoe Heels on the Control of the Motion of the Body’s Center of Mass in Relation to the Center of Pressure During High-Heeled Gait 153
8.1.3. Effects of Base and Height of Shoe Heels on the End-Point Variables and Joint Kinematics During High-Heeled Obstacle-Crossing 154
8.1.4. Effects of Base and Height of Shoe Heels on the Kinetics and Total Support Moments During High-Heeled Obstacle-Crossing 155
8.1.5. Effects of Base and Height of Shoe Heels on the Control of the Motion of the Body’s Center of Mass in Relation to the Center of Pressure During High-Heeled Obstacle-Crossing 155
8.2. Suggestions for Further Studies 156
8.2.1. Effects of Long-Term Wearing of High-Heeled Shoes 156
8.2.2. Risk Factors in the Elderly 156
8.2.3. Compromise Between Mechanical energy Expenditure and Foot Clearance 158
References 160
Appendix A Publications 173

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