The Influence of Heel Height on Strain Variation of Plantar Fascia During High Heel Shoes Walking-Combined Musculoskeletal Modeling and Finite Element Analysis

The therapeutic benefit of high heel shoes (HHS) for plantar fasciitis treatment is controversial. It has been suggested that plantar fascia strain can be decreased by heel elevation of shoes which helps in body weight redistribution throughout the length of the foot. Yet it is a fact that the repetitive tension caused by HHS wearing resulting in plantar fasciitis is a high-risk disease in HHS individuals who suffer heel and plantar pain. To explore the biomechanical function on plantar fascia under HHS conditions, in this study, musculoskeletal modeling (MsM) and finite element method (FEM) were used to investigate the effect of heel height on strain distribution of plantar fascia. Three-dimensional (3D) and one-dimensional (1D) finite element models of plantar fascia were generated to analyze the computed strain variation in 3-, 5-, and 7-cm heel heights. For validation, the computed foot contact pressure was compared with experimental measurement, and the strain value on 1D fascia was compared with previous studies. Results showed that the peak strain of plantar fascia was progressively increased on both 3D and 1D plantar fascia as heel elevated from 3 to 7 cm, and the maximum strain of plantar fascia occurs near the heel pain site at second peak stance. The 3D fascia model predicted a higher strain magnitude than that of 1D and provided a more reliable strain distribution on the plantar fascia. It is concluded that HHS with narrow heel support could pose a high risk on plantar fasciitis development, rather than reducing symptoms. Therefore, the heel elevation as a treatment recommendation for plantar fasciitis is questionable. Further studies of different heel support structures of shoes to quantify the effectiveness of heel elevation on the load-bearing mechanism of plantar fascia are recommended.