The Use of Heel Lifts to Treat Foot Pain

Foot pain is a pervasive issue affecting millions worldwide, often stemming from biomechanical imbalances, overuse, or structural abnormalities. Among the various conservative treatments available, heel lifts—simple inserts placed inside shoes to elevate the heel—have gained popularity as a non-invasive intervention. These devices, typically made from materials like foam, gel, or cork, work by altering the foot's position and redistributing pressure across the lower extremities. While heel lifts are not a cure-all, they offer targeted relief for conditions such as plantar fasciitis, Achilles tendinitis, and leg length discrepancies.

Heel lifts function primarily by modifying the biomechanics of the foot and lower leg. By elevating the heel, they reduce the angle of dorsiflexion at the ankle, which in turn decreases tension on key structures like the Achilles tendon and plantar fascia. This elevation shifts the body's weight forward slightly, redistributing pressure away from the heel and toward the midfoot or forefoot. For instance, in cases of Achilles tendinitis, where inflammation occurs due to repetitive strain on the tendon connecting the calf muscles to the heel bone, a heel lift shortens the tendon's effective length during movement, allowing it to heal while minimizing pain during daily activities. Similarly, for plantar fasciitis—an inflammation of the thick band of tissue running along the bottom of the foot—the lift reduces the load on the plantar fascia by limiting its stretch during gait, thereby alleviating the stabbing heel pain often experienced first thing in the morning. In leg length discrepancies, where one leg is structurally shorter than the other, heel lifts compensate by leveling the pelvis, which helps correct uneven gait patterns and prevents compensatory stress on the hips, knees, and lower back. This mechanism not only addresses immediate discomfort but also promotes long-term musculoskeletal alignment, making heel lifts a versatile option for biomechanical correction.

The efficacy of heel lifts extends to several common foot pain conditions. Plantar fasciitis, affecting up to 10% of the population at some point, responds well to heel lifts as they provide cushioning and arch support, easing tension and facilitating recovery. Patients often report reduced pain during standing or walking, with the lift acting as a supportive wedge to maintain proper foot alignment. Achilles tendinitis, common among athletes and those with sudden increases in activity, benefits from the reduced strain on the tendon; studies indicate that heel lifts can lead to better pain outcomes compared to sham interventions in midportion Achilles tendinopathy. For heel spurs—bony growths on the heel bone often associated with plantar fasciitis—heellifts offer relief by minimizing impact and inflammation in the affected area. Additionally, in cases of leg length inequality greater than 5-10 mm, structural discrepancies can be managed with lifts in the shorter leg's shoe, preventing secondary issues like stress fractures or joint degeneration. Beyond these, heel lifts aid in general foot pain by providing extra cushioning to the heels and arches, improving overall comfort during prolonged activity. A recent systematic review supports their use for lower limb musculoskeletal conditions, noting improvements in symptom severity and gait after short-term application.

The benefits of heel lifts are multifaceted, making them an appealing choice for many sufferers. Primarily, they provide rapid pain relief without the need for surgery or medication, allowing individuals to maintain mobility and continue daily routines. For example, adjustable heel lifts enable customization to specific needs, such as varying heights from 4mm to 15mm, ensuring a gradual adaptation that enhances comfort. They also improve posture and balance by correcting pelvic tilt and spinal alignment, which can alleviate associated pains in the back and hips. In rehabilitation settings, heel lifts serve as a rehabilitative aid post-injury, absorbing shock and preventing further damage while the foot heals. Moreover, their affordability and ease of integration into existing footwear make them accessible; unlike custom orthotics, basic heel lifts can be purchased over-the-counter and adjusted as needed. Evidence from clinical observations suggests that when combined with exercises like calf stretches, they can accelerate recovery in conditions like tendonitis, with patients experiencing reduced stiffness and improved function within weeks. Overall, these advantages position heel lifts as a practical, low-risk entry point into foot pain management.

However, heel lifts are not without drawbacks, and their misuse can exacerbate problems. One significant risk is the alteration of natural gait patterns; by creating a downward slope toward the toes, lifts can cause forefoot slippage, increasing pressure under the metatarsal heads and potentially leading to new pains in the ball of the foot. Studies have confirmed that even in asymptomatic individuals, heel inserts can shift biomechanics, raising forefoot plantar pressure and risking conditions like metatarsalgia. Prolonged use without proper fitting may wreak havoc on the hips and spine, as the body compensates for the artificial elevation, potentially causing musculoskeletal dysfunction over time. For instance, if the lift is too high or used unilaterally without a true leg length discrepancy, it can induce pelvic obliquity or poor posture, leading to degenerative joint issues or stress fractures. Additionally, heel lifts often provide only temporary relief, masking symptoms rather than addressing underlying causes such as muscle imbalances or improper footwear. In some cases, they may even delay necessary interventions like physical therapy. A systematic review on heel elevation highlights potential harms, including altered tendon loading that could be detrimental in certain scenarios, such as plantar fasciopathy. Therefore, while effective short-term, heel lifts require careful monitoring to prevent these adverse effects.

To maximize benefits and minimize risks, best practices emphasize professional oversight and personalized application. Consulting a podiatrist or orthopedic specialist is essential for accurate diagnosis and fitting; they can recommend the appropriate height, material, and duration of use based on individual needs. Start with lower lifts and gradually increase to allow adaptation, and pair them with complementary therapies like stretching, strengthening exercises, or weight management to address root causes. Regular follow-ups ensure the lifts do not cause new imbalances, and using them in both shoes for bilateral conditions prevents asymmetry. For those with leg length issues, combining lifts with full orthotics may offer superior support.

Alternatives to heel lifts include custom orthotics, which provide comprehensive foot correction; physical therapy focusing on strengthening and flexibility; anti-inflammatory medications for acute pain; or supportive footwear with built-in cushioning. In severe cases, procedures like extracorporeal shockwave therapy or surgery may be warranted, but these are typically reserved for when conservative measures fail.

Heel lifts represent a valuable, accessible option for treating foot pain by alleviating tension, correcting imbalances, and enhancing mobility. Their benefits in managing conditions like plantar fasciitis and Achilles tendinitis are well-supported, offering quick relief with minimal invasiveness. However, potential risks such as gait alterations and increased forefoot pressure underscore the importance of professional guidance and viewing them as part of a broader strategy rather than a standalone solution. When used appropriately, heel lifts can significantly improve quality of life for those plagued by foot pain, bridging the gap between symptom relief and long-term healing.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.