Looks like Newbies are heel strikers

“Nearly all novice runners utilize a rearfoot strike when taking up running in a conventional running shoe. Hereby, the footstrike patterns among novice runners deviate from footstrike patterns among elite and sub-elite runners.”

please take some time to explore the links we put in, as they are germane to the post

The question begs, “Why?”

• do they believe running is merely an extension of walking, and just “speed up” the process?
• are they afraid of going too fast and are using the heel strike to “brake”?
• do they learn to strike differently with more experience? at least one paper eludes to “yes”
• is it “more comfortable” as this paper says it may be?
• If there is a rear foot strike, the foot is poised to be able to pronate to a greater degree. This theoretically means it (ie, the foot) can absorb more shock through this mechanism, although this seemingly contradicts the Lieberman study

This paper certainly had a nice cohort size (> 900 runners) so we can state, at least for this group, that this is not by chance.  When there is a fore foot strike, the foot is more supinated and makes a seemingly “rigid lever”, does this mean there is less shock (perceived or actual) with this foot posture?

Lots of questions. This is only 1 part of the puzzle.

The Gait Guys. Sifting through the literature and giving you the beef

Gait Posture. 2012 Dec 29. pii: S0966-6362(12)00448-1. doi: 10.1016/j.gaitpost.2012.11.022. [Epub ahead of print]

Footstrike patterns among novice runners wearing a conventional, neutral running shoe.

Bertelsen ML, Jensen JF, Nielsen MH, Nielsen RO, Rasmussen S.

Aarhus University Hospital, Aalborg Hospital, Orthopaedic Surgery Research Unit, Science and Innovation Center, Aalborg DK-9000, Denmark. Electronic address: miclejber@gmail.com.

Abstract

INTRODUCTION:

It has been suggested that striking on the midfoot or forefoot, rather than the rearfoot, may lessen injury risk in the feet and lower limb. In previous studies, a disparity in distribution in footstrike patterns was found among elite-, sub-elite, and recreational runners.

PURPOSE:

The purpose of this study was to investigate the footstrike patterns among novice runners.

METHODS:

All runners were equipped with the same conventional running shoe. Participants were video filmed at 300 frames per second and the footstrike patterns were evaluated by two observers. The footstrike was classified as rearfoot, midfoot, forefoot, or asymmetrical.

RESULTS:

A total of 903 persons were evaluated. The percentages of rearfoot-, midfoot-, forefoot-, and asymmetrical footstrike among men were 96.9%, 0.4%, 0.9%, and 1.8%, respectively. Among women the percentages were 99.3%, 0%, 0%, and 0.7%, respectively.

CONCLUSION:

Nearly all novice runners utilize a rearfoot strike when taking up running in a conventional running shoe. Hereby, the footstrike patterns among novice runners deviate from footstrike patterns among elite and sub-elite runners.

Copyright © 2012 Elsevier B.V. All rights reserved.

PMID: 23280125 [PubMed - as supplied by publisher]

all material copyright 2013 The Gait Guys/The Homunculus group. Please don’t lift our stuff without asking and giving credit.

A return to "the solitary externally rotated foot"

Dear Gait Guys:

I compete at a high level in a variety of sports, but over the past five years I have developed tremendous discomfort and occasional pain.  I have talked to orthopedic surgeons and physical therapists with no results.  I had MRIs done on my hip, shoulder and knee (my problem areas) but they came back clean.  Finally I saw your article on the “solitary externally rotated foot”.  My symptoms of the outward turned foot, weak glutes, uncomfortable patellar tracking and limited hip rotation.  Also, my shoulder seems to be externally rotated as well which causes pain and inhibits my pec major from firing.  You guys are the only ones who have come close to figuring out my problems and are the only refuge from my frustration.  How can I fix this?  Are their some good exersizes and why have no physical therapists heard of the “kickstand effect”?  

Thank you so much,

(name withheld, NW)

_____

Dear NW

We loosely used the name “kickstand Effect” to describe in part what the foot is acting as. By turning out the foot into the frontal plane you are engaging more of the frontal plane for stability, stability which you likely do not have in the frontal plane by the primary pattern stabilizer(s) and or synergists.

Without more clinical hands on exam we are at a loss to help you, remember a clean objective examination followed by a solid screen of movement patterns is always paramount, something we just cannot obtain over the internet.  We would love to give theories and exercises, but then we would just be shooting from the hip and and in a case like this more compensations (if we give the wrong recommendations) is not what you need at your level and level of frustration.  But, we wanted to share this kind readers case and attach the original article they were referring to. After all, it has been more than a year since we wrote it.

Here is the link:  “THE SOLITARY EXTERNALLY ROTATED FOOT”

http://thegaitguys.tumblr.com/post/14262793786/gait-problem-the-solitary-externally-rotated

SHAWN AND IVO

the gait guys

Functional Ankle Instability and the Peroneals 

Lots of links available here with today’s blog post. please make sure to take your time and check out each one (underlined below) 

As you remember, the peroneii (3 heads) are on the outside of the lower leg (in a nice, easy to remember order of longus, brevis and tertius, from top to bottom) and help to stabilize the lateral ankle. The peroneus brevis and tertius dorsiflex and evert the foot while the peroneus longus plantarflexes and everts the foot. We discuss the peroneii more in depth here in this post. It then is probably no surprise to you that people with ankle issues, probably have some degree of peroneal dysfunction. Over the years the literature has supported notable peroneal dysfunction following even a single inversion sprain event. 

Functional ankle instability (FAI) is defined as “ the subjective feeling of ankle instability or recurrent, symptomatic ankle sprains (or both) due to proprioceptive and neuromuscular deficits." 

Arthrogenic muscle inhibition (AMI) is a neurological phenomenon where the muscles crossing a joint become "inhibited”, sometimes due to effusion (swelling) of the joint (as seen here) and that may or may not be the case with the ankle (see here), or it could be due to nociceptive input altering spindle output or possibly higher centers causing the decreased muscle activity. 

This paper (see abstract below) merely exemplifies both the peroneals and FAI as well as AMI.

Take home message?

Keep the peroneals strong with lots of balance work!

The Gait Guys: bringing you the meat, without the filler!                                                                         

Am J Sports Med. 2009 May;37(5):982-8. doi: 10.1177/0363546508330147. Epub 2009 Mar 6.

Peroneal activation deficits in persons with functional ankle instability.

Palmieri-Smith RM, Hopkins JT, Brown TN.

Source

School of Kinesiology, University of Michigan, 401 Washtenaw Avenue, Ann Arbor, MI 48109, USA. riannp@umich.edu

Abstract

BACKGROUND:

Functional ankle instability (FAI) may be prevalent in as many as 40% of patients after acute lateral ankle sprain. Altered afference resulting from damaged mechanoreceptors after an ankle sprain may lead to reflex inhibition of surrounding joint musculature. This activation deficit, referred to as arthrogenic muscle inhibition (AMI), may be the underlying cause of FAI. Incomplete activation could prevent adequate control of the ankle joint, leading to repeated episodes of instability.

HYPOTHESIS:

Arthrogenic muscle inhibition is present in the peroneal musculature of functionally unstable ankles and is related to dynamic peroneal muscle activity.

STUDY DESIGN:

Cross-sectional study; Level of evidence, 3.

METHODS:

Twenty-one (18 female, 3 male) patients with unilateral FAI and 21 (18 female, 3 male) uninjured, matched controls participated in this study. Peroneal maximum H-reflexes and M-waves were recorded bilaterally to establish the presence or absence of AMI, while electromyography (EMG) recorded as patients underwent a sudden ankle inversion perturbation during walking was used to quantify dynamic activation. The H:M ratio and average EMG amplitudes were calculated and used in data analyses. Two-way analyses of variance were used to compare limbs and groups. A regression analysis was conducted to examine the association between the H:M ratio and the EMG amplitudes.

RESULTS:

The FAI patients had larger peroneal H:M ratios in their nonpathological ankle (0.399 +/- 0.185) than in their pathological ankle (0.323 +/- 0.161) (P = .036), while no differences were noted between the ankles of the controls (0.442 +/- 0.176 and 0.425 +/- 0.180). The FAI patients also exhibited lower EMG after inversion perturbation in their pathological ankle (1.7 +/- 1.3) than in their uninjured ankle (EMG, 3.3 +/- 3.1) (P < .001), while no differences between legs were noted for controls (P > .05). No significant relationship was found between the peroneal H:M ratio and peroneal EMG (P > .05).

CONCLUSION:

Arthrogenic muscle inhibition is present in the peroneal musculature of persons with FAI but is not related to dynamic muscle activation as measured by peroneal EMG amplitude. Reversing AMI may not assist in protecting the ankle from further episodes of instability; however dynamic muscle activation (as measured by peroneal EMG amplitude) should be restored to maximize ankle stabilization. Dynamic peroneal activity is impaired in functionally unstable ankles, which may contribute to recurrent joint instability and may leave the ankle vulnerable to injurious loads.

all material (except for the study); copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved. Please ask before you lift our stuff. If you are nice and give us credit, we will probably let you use it!

New Study Finds Group of Heel Striking Barefoot Kenyan Runners.

Not all that is barefoot is necessarily forefoot…

You may have seen our tweet yesterday and have read this article. Or maybe, because you are a foot geek, you have seen it already.

Here’s the summary: “Jan. 9, 2013 — A recently published paper by two George Washington University researchers shows that the running foot strike patterns vary among habitually barefoot people in Kenya due to speed and other factors such as running habits and the hardness of the ground. These results are counter to the belief that barefoot people prefer one specific style of running.”

The study reported a 72 percent rearfoot landing when running barefoot at endurance pace speeds supporting the notion that speed affects landing choice (faster speeds transitioned  the runners into more midfoot / forefoot landing).  Lieberman’s Harvard study which brought much of the forefoot strike principle to the western world was often based off of sub 5 mile paced runs.

It raises the question “ If barefoot IS better, and forefoot impact IS BETTER, then, what gives?”

We think the better response is:

• there are many variables (genetics, surface, speed, etc) that can influence foot strike patterns and this paper exemplifies that.
• Fore foot striking in runners does lessen impact forces.
• Forefoot striking does appear to accentuate any forefoot abnormality (ie: varus/valgus) that may be present (something we will continue to say until someone proves it otherwise).
• forefoot striking loads the posterior compartment of the lower leg (tricep surae (gastroc soleus complex)) to a greater degree

We like a mid foot strike, not because it is the middle road, but because it supports the notion in distance running that the entire foot tripod (which is more stable) engages the ground reducing solitary forefoot and rearfoot loading issues which each have their risks and challenges and allows for a more stable contact point for the body to negotiate over.  We have pounded sand on forefoot types, and the inherent risks of forefoot strike running with each of them, from our inception.  But, when it comes to midfoot strike there doesn’t appear to be much, if any literature out there to support our opinion.  Maybe now that the forefoot and rearfoot studies are out there maybe someone will find a tribe of midfoot strikers to support our rants.

We think the key is not necessarily strike position, but rather where the foot is hitting the ground relative to the body AND MORE IMPORTANTLY, having a competent foot and lower kinetic chain and core, along with the body’s ABILITY to absorb or attenuate those forces, no matter where the foot is striking the ground.

This is no doubt the 1st in a series of papers looking at this. It will be interesting to see where it goes from here.

Ivo and Shawn…  The Gait Guys

here is the link: http://www.sciencedaily.com/releases/2013/01/130109185856.htm

all material copyright 2013 The Homunculus Group/ The Gait Guys. Please ask to use our stuff and reference it appropriately. We know a guy named BamBam who helps people play nice.

Gait Guys, What is the truth when it comes time to buying/rotating new shoes ?

A few moons ago an awesome Facebook reader asked us about changing shoes and the validity of the “press test”.  Here was Eve’s link to the press test and here is what it said:

 Do the Press Test

“To determine if the midsoles of your shoes are compressed and are no longer providing cushioning, do the press test. Using your thumb, push on the outsole upward into the midsole. With new shoes, it should be easy to see the midsole compress into lines or wrinkles. As the shoe wears down, the midsole compresses less with the same amount of pressure. When the midsole shows heavy compression lines and the press test reveals a minimal amount of compression, there is little or no cushioning left.”

There is a valid point to this test, but it might be considered too rudimentary by many purists.  But most purists rarely can offer us a better solution.  Here is the issue, EVA foam has a lifespan in terms of maintaining its initial shock absorption. EVA foam cells compress and deform over time, most foam in this world does whether it is your Tempurpedic mattress, the foam base for your rugs or your car seat. And with areas of greater wear and compression the foam accelerates its deformation. This is why certain areas of your car seats, your rugs and your bed get softer.  The same thing goes with your shoes. But they really do not get softer, the areas get compressed and the foam changes its density and its integrity. It no longer performs.  Resistance, compressibility and resilience changes.  This is the problem with shoe foam as well, no matter what foam a company is using.  However, the bigger problem if you really think about it is that the foot type you have and the biomechanics (good or bad) that you drive your foam into will be the direction future foot loadings deviate into.  Can this be good ? Rarely. Can this be bad ? Usually.  EVA simply has a given number of cycles, and that number is variable with many factors in place such as weight, running form, foot strike, foot type, weathering of the foam, wet foam, dry foam, outer sole glue, foot bed components and attachment, number of miles.  So, degrading shoe foam is a fact of life for a walker or runner. 

The “press test” gives the user some idea of how much the foam is compressed and how much resilience it has left. But it is a test limited very much by the subjective assessment.  We wouldn’t hold a torch to the test and make it a solitary assessment factor, in fact we rarely do it ourselves. But every little test and assessment has some perks and information that can be gleaned from it.

For the record, we like to play it cautious because injuries cost money and time to a runner. So we error on the side of caution always and go for lower numbers for the life span of shoes.  Each shoe is different and we will  not leave you with actual numbers here because the algorithm gets a bit large and convoluted but the bottom line is that cheaper shoes usually use cheaper materials and more expensive shoes usually use better materials (yes, this does not always line up as truth, we know this).  But shoes like Newtons and Altras from our experience seem to survive the trials of running a bit better (at least in our athletes) and so we allow more miles in them.  But for those looking for some harder numbers here are our loose rules:

400-500 miles per pair of shoes.  At 200 miles begin a second pair of shoes and start alternating the shoes every run (old shoe one day, next day use the new shoe).  This will reduce the successive days in a shoe in which the foam is driving deeper and deeper into deformity and thus you are only a day away from a reprieve from the deforming shoe. This will reduce injury risk.  This will also give you a dry shoe on a run the day after a shoe got soaked or caked with mud.  Water and mud add shoe weight and change biomechanics. Once the older shoe his the end lifespan mark you have the second shoe at 200-250 and you are ready for a new shoe. So you are never in a shoe until its death, when it is completely deformed and driving pathomechanics and possible injury only to the very next day step into a new shoe with entirely different (albeit neutral and unbiased) mechanics in the foam.  Injuries occur much of the time with change. Be smarter with your shoe rotation and reduce change.

VITAL NOTE:

Running and walking use different biomechanics and loading styles. Walking has heel strike as a norm, running for the most part shouldn’t include heavy or any heel strike depending on the athlete and who’s “pulpit of running form” that athlete chooses to pray at the foot of. Like religion, there is no one right way …  we each need to find what is best for us. And thus, since running and walking biomechanics are so different you should keep your running shoes for running and have another pair for walking and your other workouts.  Remember though, running shoes are build mostly for sagittal (forward) movement and not for lateral sports. This is why you should never, never ever, use your running shoes for tennis, racquet ball, basketball or many forms of cross fit.  Get a court shoe that is build for lateral movement. Not only will the shoe last longer but it is built on a platform that is more suited for such activity.

Shawn and Ivo

The Gait Guys…….

A little neuro, anyone?

Welcome to Monday, and yes, it is a NEURO day. In fact, if you got up this morning, you too are having a NEURO day. Dr Allen thinks it’s all about the ORTHOPEDICS, but without NEURO, there would not be any orthopedics : )

A dialogue from one of our avid readers, Dr. Ryan.

Dr. Ryan: Hey Ivo,

I just read this article on Mercola’s site which is an interview with Dr. Craig Buhler who does muscle activation techniques.  Can you check this for accuracy?  This must be a mistake b/c I always thought spindle activation will facilitate the muscle to contract.  Also, I always wondered why the O/I attachment points are tender in muscles that are inhibited.  Does his description sound right to you.  If not, do you have a better explanation?

“Your muscle system and nervous system relate to each other from within tiny muscle fibers called spindle cells, which monitor stretch. If your muscle is overloaded too rapidly, the spindle cells will temporarily inhibit the muscle. The next time you contract the muscle, it will fire again. Similarly, cells within your tendons called Golgi tendon organs also measure and monitor stretch. If your tendon is stretched too rapidly or exceeds its integrity, the Golgi tendon organs will temporarily inhibit the muscle. But the next time the muscle fires, it will again fire appropriately.

"But there’s a fail-safe system," Dr. Buhler explains. "It’s where the tendon attaches into the periosteum of the bone and the little fibers there are called Sharpey’s fibers. Those fibers are loaded with little receptors that monitor tension. And if the integrity of those fibers are exceeded, they inhibit the muscle, just like a circuit breaker would inhibit an electrical circuit.

Once that happens, the muscle will still fire under passive range of motion. But if you load the muscle, it gives way. If you continue to load the muscle, your body creates pain at the attachment points to protect you. What the central nervous system does at that point is compute an adaptive strategy by throwing stress into the muscle next to it. Other tissues begin to take on more of the load for the muscle that’s been injured.”

Here is a link to the entire article if you want to check it out:

http://fitness.mercola.com/sites/fitness/archive/2013/01/04/advanced-muscle-integration-technique.aspx?e_cid=20130104_DNL_art_1"

Dr Ivo: Thanks Dr. Ryan.

Spindles monitor length and GTO’s monitor tension. My understanding is spindles, when activated, stimulate the alpha motor neuron(at the cord) and cause contraction of that muscle or motor unit. GTO’s, when activated, cause inhibition of the muscle they are associated with. I am not aware of them being inhibitory, only GTO’s. They are believed to be GABAnergic synapses. The impulse (at least in cats) can be smaller or inhibited if the muscle is held in contraction for an extended period of time (see attached)

Perhaps he is talking about spindle dysfunction, where the intrafusal portion of the spindle (which is innervated by a gamma motor neuron) is either excited or inhibited. The gamma’s are more of a slave to the interneuronal pool (in the cord), which would be the sum total of all excitatory and inhibitory input to that area (ie the central integrated state). This not only reflects local receptor input but also cortical information descending (from areas 4s and 6 in the precentral gyrus) AND descending information from the caudal reticular formation.

Based on what you sent, I do not agree with the 1st 2 sentences. I was not aware about increased receptor density of Sharpeys fibers. I did a quick search and found this: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2100202/  , which eludes to it and here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098959/. I will have to dive in more when I have time.

Not sure why O/I attachments are tender in inhibited muscles. I find them tender in most folks. Maybe because inhibited muscles ave altered receptor function and that preloads the nociceptive afferent pathway or at least that neuronal pool? Are they closer to threshold for some reason? Not sure. LMK what you find.

Thanks for getting me jazzed about sharpeys fibers!

for those of you who need to know YES, there will be a forthcoming Sharpeys fibers article

Dr. Ryan: That’s what I thought.  Thanks for looking into it and I will check out those links.  You have jazzed me plenty of times over the years.  Glad I could jazz you up for a change.  Have a great weekend.

Yes, Dr Ivo is definitely an uber neuro geek, especially when he spends time on the weekend talking about spindles!

all material copyright 2013 The Homunculus Group/ The Gait Guys. All rights reserved. Please as before you lift our stuff.

Previously unreleased Video Available for download

“Performance Theories: Dialogues on Training Concepts”

How about some one on one with Shawn and Ivo? Hear our thoughts on:

• What is the definition of the core and what does it entail ?

• Physiologic overflow of muscles with respect to joint motion

• Isotonic Exercise concepts

• Physiologic characteristics of muscle types

• Strength Training: Neural Adaptation

• Motor Pattern Muscle Compensation Concepts

• Exercise Prescription Concepts

• Hip Extension Motor Pattern: A discussion on compensations

• Neurologic Reciprocal Inhibition: Principles of joint movement and stability

• The Concept of Tight and Short Muscles: They are different

• Stretching: Good or Bad?

We tackle the tough questions and provide real world answers.  An hour packed with hours worth of information! Download your copy here from Payloadz.

all material copyright 2009 The Homunculus Group/ The Gait Guys. All rights reserved.

acupuncture and muscle strength

“The present study shows that a single acupuncture treatment was efficacious for improving isometric quadriceps strength in recreational athletes. These results might have implications not only for athletic performance enhancement, but also for rehabilitation programs aimed at restoring neuromuscular function."  

Wow. What a statement! If you read the abstract, you will also read this ”The difference in the mean change in MIVF from baseline between acupuncture (46.6 N) and sham laser acupuncture (19.6 N) was statistically significant (p < 0.05), but no significant difference was found between acupuncture (46.6 N) and sham acupuncture (28.8 N)“  

So what was "sham acupuncture”? Simply put, acupuncture to non acupuncture meridian points. In other words, they put needles in muscles, just not on established meridians. Hmmm…Sounds alot like a form of dry needling. When you place a needle in a muscle, there is a good chance you will stimulate (or change function) of a muscle spindle or golgi tendon organ (length and tension receptors we have talked about before. see here, here, here, here, and here. guess we wrote about them a bit, eh?). Sham acupuncture still showed a positive result.                                                                  

                                                                                                                             

The bottom line? Needling the muscle changes how it contracts. It can be a useful tool for improving performance and rehabilitation.                                                                                                                                                                    

The Gait Guys. Geeks to the core. Bringing you the information to help you make better decisions with every post.  

European Journal of Applied Physiology

September 2010, Volume 110, Issue 2, pp 353-358

Immediate effects of acupuncture on strength performance: a randomized, controlled crossover trial

• Markus Hübscher,
• Lutz Vogt,
• Thomas Ziebart,
• Winfried Banzer

Download PDF (205 KB) View Article

Abstract

The present study investigated the immediate efficacy of acupuncture compared to sham acupuncture and placebo laser acupuncture on strength performance. A total of 33 recreational athletes (25.2 ± 2.8 years; 13 women) were randomized to receive acupuncture, sham acupuncture (needling at non-acupuncture points) and placebo laser acupuncture (deactivated laser device) in a double-blind crossover fashion with 1 week between trials. Assessment included bipedal drop jumps for maximum rebound height and quadriceps maximum isometric voluntary force (MIVF). Furthermore, surface electromyography (EMG) was used to measure the EMG activity of the rectus femoris muscle during a 30-s sustained MIVF of the knee extensors. Mean power frequency (MPF) analysis was applied to characterize muscular endurance. Measurements were performed at baseline and immediately after treatment by a blinded investigator. Repeated measures ANOVA and post hoc paired-sample t test with Bonferroni–Holm correction were used for statistical analysis. The difference in the mean change in MIVF from baseline between acupuncture (46.6 N) and sham laser acupuncture (19.6 N) was statistically significant (p < 0.05), but no significant difference was found between acupuncture (46.6 N) and sham acupuncture (28.8 N). ANOVA did not show statistically significant treatment effects for drop jump height or MPF. The present study shows that a single acupuncture treatment was efficacious for improving isometric quadriceps strength in recreational athletes. These results might have implications not only for athletic performance enhancement, but also for rehabilitation programs aimed at restoring neuromuscular function.

http://link.springer.com/article/10.1007%2Fs00421-010-1510-y

all material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved.

Back and Better than ever….

More on the Core. Excerpted from some previously unreleased material which will be available for download soon…

High Heels and …..Orthotics?

What better way to end the year than to talk about something that some of you have worn last evening. Not only clean underwear, but also high heels!

You have heard all about high heels here on the blog (if not, click here). Now here is some info that may be surprising! This study found that increased heel height caused increased plantar pressures (no surprises) BUT the use of an orthotic or arch pad, attenuated impact forces. IOHO not a reason to wear heels (though we DO like the way they look : )) but if you need to wear them (really? you need to wear them?), then maybe consider an insert to make it more bearable.

Ivo and Shawn                                              

Appl Ergon. 2005 May;36(3):355-62.

Effects of shoe inserts and heel height on foot pressure, impact force, and perceived comfort during walking.

Yung-Hui L, Wei-Hsien H.

Source

Department of Industrial Management, National Taiwan University of Science and Technology, No. 43, Kee-Lung Road, Sec IV, Taipei, Taiwan, 106 ROC. yhlee@im.ntust.edu.tw

Abstract

Studying the impact of high-heeled shoes on kinetic changes and perceived discomfort provides a basis to advance the design and minimize the adverse effects on the human musculoskeletal system. Previous studies demonstrated the effects of inserts on kinetics and perceived comfort in flat or running shoes. No study attempted to investigate the effectiveness of inserts in high heel shoes. The purpose of this study was to determine whether increasing heel height and the use of shoe inserts change foot pressure distribution, impact force, and perceived comfort during walking. Ten healthy females volunteered for the study. The heel heights were 1.0cm (flat), 5.1cm (low), and 7.6cm (high). The heel height effects were examined across five shoe-insert conditions of shoe only; heel cup, arch support, metatarsal pad, and total contact insert (TCI). The results indicated that increasing heel height increases impact force (p<0.01), medial forefoot pressure (p<0.01), and perceived discomfort (p<0.01) during walking. A heel cup insert for high-heeled shoes effectively reduced the heel pressure and impact force (p<0.01), an arch support insert reduced the medial forefoot pressure, and both improved footwear comfort (p<0.01). In particular, a TCI reduced heel pressure by 25% and medial forefoot pressure by 24%, attenuate the impact force by 33.2%, and offered higher perceived comfort when compared to the non-insert condition.