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

Meizi Wang,Gusztáv Fekete,Ee-Chon Teo,Shudong Li,Yaodong Gu

doi:10.3389/fbioe.2021.791238

Abstract

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.

Highlights

The plantar fascia is a rather complex and important structure, which has different biomechanical functions in gait, such as supporting transverse and longitudinal arch, facilitating force transmission between foot and ground, balancing weight-bearing distribution on foot, cushioning ground reaction force, and preventing the foot from injury (D’Ambrogi et al, 2003; Wearing et al, 2007; MahowaldPlantar Fascia Influence by Shoes et al, 2011; Stecco et al, 2013; Chen et al, 2015)
In the United States, approximately two million people experience symptoms of heel and plantar pain due to plantar fascia injury yearly (Chen et al, 2015). It is caused by excessive repetitive loading of the plantar fascia leading to microtears and inflammation of the calcaneal adhesions (Luffy et al, 2018; Trojian and Tucker, 2019), and it is a common complaint among women, especially those wearing high heel shoes (HHS) regularly (López-López et al, 2018)
Khodair and Younes investigated the relationship between the plantar fascial pathology and HHS wearing in 40 female patients with resulting heel pain; they reported that 30 patients had fascial edema at calcaneal insertion and the plantar fascia thickened; the signal intensity in plantar fascia increased in 21 patients, which are characteristic signals of plantar fasciitis (Khodair and Younes, 2019)

Summary

Introduction

The plantar fascia is a rather complex and important structure, which has different biomechanical functions in gait, such as supporting transverse and longitudinal arch, facilitating force transmission between foot and ground, balancing weight-bearing distribution on foot, cushioning ground reaction force, and preventing the foot from injury (D’Ambrogi et al, 2003; Wearing et al, 2007; MahowaldPlantar Fascia Influence by Shoes et al, 2011; Stecco et al, 2013; Chen et al, 2015). The plantar fascia is a rather complex and important structure, which has different biomechanical functions in gait, such as supporting transverse and longitudinal arch, facilitating force transmission between foot and ground, balancing weight-bearing distribution on foot, cushioning ground reaction force, and preventing the foot from injury Any injury of plantar fascia inevitably affects the biomechanical function of the foot. It is evidence that wearing HHS adversely affects the musculoskeletal system, altering ankle–foot complex function, changing the force transmission pattern of muscle tendon, and interfering in load distribution of the foot (Di Sipio et al, 2018; Wiedemeijer and Otten, 2018; Wan et al, 2019). Khodair and Younes investigated the relationship between the plantar fascial pathology and HHS wearing in 40 female patients with resulting heel pain; they reported that 30 patients had fascial edema at calcaneal insertion and the plantar fascia thickened; the signal intensity in plantar fascia increased in 21 patients, which are characteristic signals of plantar fasciitis (Khodair and Younes, 2019)

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