The influence of high-heeled shoes on strain and tension force of the anterior talofibular ligament and plantar fascia during balanced standing and walking

During balanced standing, the tension force on the ATL increased from 14.8 N to 97.0 N, with a six-fold increase in strain from 0 in. to 3 in. (0-7.62 cm). The tension force and the average strain on the plantar fascia decreased from 151.0 N (strain: 0.74%) to 59.6 N (strain: 0.28%) when the heel height increased from 0 in. to 2 in. (0-5.08 cm). When heel height reached 3 in. (7.62 cm), the force and average strain increased to 278.3 N (strain: 1.33%). The walking simulation showed that the fascia stretched out while the ATL loading decreased during push off. The simulation outcome demonstrated the influence of heel height on ATL alteration and plantar fascia strain, which implies risks for ankle injury and suggests guidance for the treatment of plantar fasciitis.