Heel lifts for Achilles Tendonitis – evidence based or fad?
If you have been dealing with Achilles pain and haven’t tried heel lifts for Achilles Tendonitis, our immediate advice would be to trial heel lifts.
Why would I suggest this?
They are cheap, there aren’t any harmful side-effects and evidence suggests they may work. Does anyone really need any further convincing? In our opinion, this is similar to trying taping for Achilles Tendinopathy – a no-brainer!
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With that being said, lets elaborate on the possible benefits of heel lifts for Achilles Tendinopathy. Keep in mind, there are relatively few randomised studies exploring heel lifts for Achilles Tendinopathy so we will have to use a little creative license.
Before we dive into the detail, if you want further information on Achilles Tendinopathy please visit our Achilles Tendinopathy ultimate guide, and also our Tendon Page for an overview on tendinopathies. We also have an article giving you advice on the things you should avoid doing if your Achilles Tendon exercises simply aren’t working.
If you would like to skip ahead, here is some of what is covered:
- Proposed benefits of heel lifts
- Rationale behind heel lifts for Achilles Tendonitis
- Do heel lifts help with Achilles Tendonitis?
- Can heel lifts help insertional Achilles Tendonitis?
- What are the best heel lifts for Achilles Tendonitis?
- How long should you trial heel lifts?
- Would we recommend using heel lifts for Achilles Tendonitis?
What are the proposed benefits of heel lifts for Achilles Tendonitis?
Achilles Tendonitis (now called Tendinopathy) is usually a result of loading the tendon excessively. As a result, the tendon fibres become twisted instead of running parallel, often resulting in a visible lump.
Because the fibres are no longer parallel, the tendon is unable to handle the usual load you may place on the tendon. This load is placed on the tendon through walking, running or life in general.
The aim of early rehabilitation is to decrease the amount of load on the affected Achilles tendon. If we can reduce the load going through the tendon, it helps to lessen the pain response from an aggravated tendon.
Heel lifts help to keep the hind foot elevated which shortens the tendon and muscle. This is thought to decrease the load on the tendon as it doesn’t stretch as much as you walk or run. This is a similar concept to immobilising the tendon for a short time.
What is the rationale behind using heel lifts for Achilles Tendonitis?
As above, the aim of inserting heel lifts is to reduce the amount of load on the Achilles tendon. The idea being if the foot can’t bend as much with walking, there may be less stress on the Achilles tendon.
To illustrate this, imagine if you were walking with high heels. (or a built up back heel for men reading this) There wouldn’t be as much bend in the ankle, as the toes are already pointed. This reasoning could be applied in principle to the smaller alternative which is the heel lift.
There have been studies that would suggest there is a change in load through the Achilles Tendon with the use of heel lifts. One study used ultrasound to show that there is a decrease in tensile load (pulling force) of the Achilles Tendon when the subjects were wearing heel lifts.
Other studies have shown that there is definitely a difference in the load going through the Achilles Tendon during walking and running. Unfortunately, it was hard to show exactly what that difference was.
So we know there is a change in load through the Achilles Tendon with heel lifts. But maybe the more important question to ask is:
Do heel lifts help for Achilles Tendonitis?
In short, yet however there is more work to be done. Looking at the research, it does appear that heel lifts for Achilles Tendinopathy can have beneficial effects on Achilles pain.
One clinical trial by Rabusin compared two groups of people. One group were given heel lifts, and another group was given eccentric exercises.
This study was interesting as currently eccentric exercises are one of the gold standard ways of treating Achilles Tendonitis and we know these work.
The results showed that there was improvement in both groups. There was slightly more pronounced effects in the group that was given heel lifts!
The limitation of this study was there was still low numbers of participants (50 in each group). So it is hard to make any sweeping statements.
So yes, heel lifts can result in change for Achilles Tendinopathy, but unfortunately this isn’t a guarantee. Achilles Tendinopathy is a complex process which is different for every patient. For this reason, sometimes heel lifts will not have any affect.
Heel lifts can work for mid-portion of insertional tendinopathy. (Watch out for other causes of heel pain as well)
Can heel lifts help insertional Achilles Tendonitis?
Most research on heel lifts has been on Mid-portion Achilles Tendinopathy. So there isn’t a body of evidence to give advice, however there is clinical expertise.
Most clinicians would still recommend the use of heel lifts for insertional tendonitis as an alternative treatment.
The reasons for this is similar to mid-portion Achilles Tendinoapthy. They are cheap, and there are no side-effects.
So if you have insertional Achilles Tendonitis – heel lifts are still ok to trial for 6-12 weeks.
What are the best heel lifts for Achilles Tendonitis?
Not all heel lifts are the same. There are certain heel lifts that are best for Achilles Tendonitis. Some heel lifts won’t be thick enough, and may be to soft which means you lose the height as your heel sinks into it.
Most studies recommend heel lifts that are at least 1.2cm thick (just under half an inch). If they are too thin, then the tendon will not be shortened enough for any effect to be felt.
Gel heel lifts can seem really good as they would appear to cushion the heel more. We would recommend gel heel lifts as long as they provide enough firmness to keep the heel elevated.
We can recommend the below heel lifts available at amazon. They have the required height needed to make an impact for Achilles Tendinopathy.
We would suggest a firm heel lift that is still comfortable. Something like this heel wedge is great as it sticks into the shoe that is comfortable for you to wear. We would recommend using both pads to create at least 1cm height.
Can heel lifts work in open shoes?
If you are suffering with Achilles Tendinopathy, it is advised that you check out our article on the best shoes for Achilles Tendonitis. Heel lifts could in theory work for open shoes, but this is not ideal.
If you need a reduction in heel pain with running then closed in shoes are definitely better.
Your foot needs to be supported well, closed in shoes will do this the best. The only thing to avoid is direct pressure over the sore part of your Achilles Tendon. This may take some shopping to find a comfortable shoe.
How long should you trial heel lifts for Achilles Tendonitis?
Most studies looking at heel lifts for Achilles Tendonitis usually give around a 6-12 week trial. This is a good amount of time to see any effects on your tendon pain.
Some people may experience increased pain with the use of heel lifts.
If you have increased pain with the use of the heel lift, then don’t wait 6-12 weeks before removing it. Heel lifts should not increase the pain in your Achilles Tendon.
Would we recommend using heel lifts for Achilles Tendonitis?
We stand by our introductory paragraph and say yes it is recommended as it is cheap with no side-effects. You have nothing to lose by giving a heel lift a go. And if there is a chance it will improve your symptoms, why wouldn’t you try it?
The evidence is strong enough to recommend a trial, however there is much more that needs to be done in that space.
Keep in mind, heel lifts alone may be good, but they wont trump a combination of exercise and load management.
If you need further help after this article, click below to find out more information on our Achilles Tendinopathy online course.
We will be covering every detail of rehabilitation in detail with video tutorials and dietary input.
Other Articles of Interest
Dilger CP, Chimenti RL. Nonsurgical Treatment Options for Insertional Achilles Tendinopathy. Foot and Ankle Clinics. 2019 Sep;24(3):505-513. DOI: 10.1016/j.fcl.2019.04.004.
Mathias Wulf, Scott C. Wearing, Sue L. Hooper, Simon Bartold, Lloyd Reed, and Torsten Brauner (2016) The Effect of an In-shoe Orthotic Heel Lift on Loading of the Achilles Tendon During Shod Walking. Journal of Orthopaedic & Sports Physical Therapy 46:2, 79-86
Rabusin, C. et al. (2018) Efficacy of heel lifts in the treatment of mid-portion Achilles tendinopathy: A randomised trial. Journal of Science and Medicine in Sport, Volume 21, S10
Rabusin, C.L., Menz, H.B., McClelland, J.A. et al. Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (the HEALTHY trial): study protocol for a randomised trial. J Foot Ankle Res12, 20 (2019) doi:10.1186/s13047-019-0325-2
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