Heel lifts for achilles tendon problems are for many one of the first cool, cheap things they try. And rightly so.
Here in this sheet we will go over how heel lifts function, what the literature says about them, which is best to use and how to incorporate these into a complete rehab program.
How heel lifts for achilles tendon problems work
The Achilles tendon links your calf muscles with your heel bone, this makes it one of the strongest tendons in your body. During activities such as walking, stair climbing and running the tendon is subjected to enormous forces.
Whenever this tendon is loaded excessively or becomes inflamed, the consequence is known collectively as Achilles tendinopathy which encompasses inflammation, or breakdown and degeneration of the tendon tissue.
Heel lifts are just and insert put into your shoe to lift up your heel slightly, that is to reduce a little bit of that mechanical load. on the tendon when walking.
Achilles tendon complaints are mainly two presentations.
Mid-portion tendinopathy affects the tendon midway between the heel bone and its attachment to the heel. Insertional tendinopathy is where the problem is at the point of attachment to the bone.
The same two conditions cause pain, stiffness, and in some cases visible thickening of the tendon.
In particular, insertional problems may be made worse by direct pressure from shoe collars.
People generally think about heel lifts after they find that lower-heel shoes or walking barefoot produces a considerable increased in their discomfort.
Reduces the amount of load on the tendons. By raising the heel there is a decreased length that the calf muscles have to stretch during every cycle, thereby decreasing the tensile load on the achilles tendon.
Essentially, raising up the heel causes the entire calf-tendon unit to assume a slightly slackened out position, meaning the muscle-tendon has a lesser amount of work against its maximum potential pull.
This isn’t a fix – it’s a load-management program.
Subluxation it offers- it opens a window for where the tendon can re-adapt to activity without constant re-irritation.
Do heel lifts for achilles tendon problems help?
The down-to-earth answer is they will work – but quite often they are not enough on their own.
There is some clinical evidence that heel lifts are effective at providing significant short term symptom relief and would seem to be most useful during the first few weeks of managing tendinopathy.
They aren’t a structural fix, nor do they provoke tendon remodelling as working specifically exercise do.
However as an option to alleviate daily pain, and enable the person to remain active during rehabilitation, it has gained a firm footing within conservative therapies.
Significant trials for heel lifts in Achilles tendinopathy
Several trials have compared heel lifts with eccentric exercise programs, placebo devices, and anti-inflammatory protocols.
The most often quoted paper, which was published in the British Journal of Sports Medicine, suggested that 12 weeks of eccentric exercise provided better long term results than heel lifts.
Indeed, in the early period within that same study, downhill heel lifts seemed to accelerate initial pain reduction.
Other reviews have also pointed out that if you do both heel lifts and exercise the results are superior to either treatment alone. That’s good to bear in mind when beginning treatment.
Advantages, disadvantages and circumstances where they may be not helpful
Main advantage is decrease in pain on weight bearing activities i.e. walking, standing, walking, light exercises.
For many people this also means they are able to get back into their normal footwear more comfortably.
The limitations are real, though:
Heel lifts don’t specifically target the tendon weakness nor do they correct the mechanics that caused the overload initially.
In the case of insertional Achilles problems there is some evidence to support the use of very high lifts as these may actually cause the tendon to be crushed onto the heel bone therefore aggravating symptoms not alleviating them.
For anyone with a very severe tear of the tendons heel lifts are certainly not sensible to attempt without healing guidance.
Choosing the kind and height of heel lift
One size does not fit all
As this ranges from a basic foam wedge to a custom orthotic, the variations in material, strength and height can be clinically significant in providing the optimum effect for a specific individual.
This decision is more significant than most give it credit for.
Type of heel lifts and material
In-shoe orthotic heel lifts are the most widely used- they are placed underneath the heel into an already existing shoe, no alteration being made to the shoe it would normally be used with.
Gel lifts are soft and provide shock absorption and lift which is why a lot of people that have to stay on their feet for a long time choose them.
Holding EVA foam blocks under the heels resulted in more variation in height and less compression over time, allowing them to maintain effectiveness for longer.
Variable layered lifts. With variable layered lifts the height can be less abruptly as advantage for early rehabilitation where the amount of lift is gradually reduced as the tendon becomes stronger.
Custom orthotic by a podiatrist can treat other biomechanical problems but is more expensive.
How high should I make the heel lift?
Most clinicians…recommend to start with a lift of about 12–15mm.
Higher than that could transfer too much load to the forefoot and produce another problem (knee pain or changed gait pattern, for example).
The increased roller height may have a negative effect on the strength of the calf muscle in the long-term by premature weakening.
It may be best to use the lowest height that relieves symptoms and then taper this over a several-month period as strength and tolerance return.
How to make the most of heel lifts safely and effectively
It seems pretty simple to get your heel lifts going, but there are some practical precautions that make all the difference between actually helping or just creating something new and unpleasant.
How to fit heel LIFTS into every day SHOES
Somthing u need to watch out for is putting a lift in one SHOES when pain is unilateral.
A leg length discrepancy will result from this, which may put strain on the hips and lower back.
Typically, it’s best to put lifts in both shoes—this is true even when only one tendon is painful.
The lift should be sitting flat against the bottom of the heel and should not be curling up around the edges. If the fit is uncomfortable it will be less effective and can be blister causing.
Shoes with a removable insole take the difficulty out of it as the insole can be taken out to give some space.
Track your pain, comfort and when to change or stop.
Over the initial two to four weeks, keep track of how much pain or comfort you are experiencing.
A bit of initial adjustment discomfort is to be expected, however, persistent evolving pain after using the lifts is a subtext alert for re-evaluation.
In the event that symptoms have not at all resolved within six weeks, with consistent use of braces in combination with appropriate training, a physio or sports medic should be sought.
Heel lifts should be used adjunctively with other pain management strategies (rather than in isolation). Treatments such as:
Exercise Therapy.
Exercises that utilize loading, stretching eccentric and heavy slow resistance calf exercises appear to be the most evidence based treatments for Achilles tendinopathy and they work in conjunction with heel lifts.
The injures increases damage, which causes pain. The pain is then reduced by the lifts to enable exercise to commence. And the exercise induces true tendon adaptation.
Aggressive static stretching of the calf may have negative effects in certain situations, particularly in cases of insertional problems, as the increased compressive load on the bone attachment may aggravate the injury.
Medication, supportive devices and when to seek professional help
Brief topical anti-inflammatory gels may offer short-term symptomatic relief in conjunction with heel lifts, without the associated systemic risks.
For stiffening in the morning, some practitioners have reported using night splints. However there are contradictory reports of the effectiveness.
Consult a doctor if there is an onset of severe pain of sudden onset or swelling or inability to weight bear as this could be a tearing or rupture of the tendon that needs to be managed differently.
Heel lifts for achilles tendon problems provide effective short-term relief when used correctly as part of a comprehensive treatment approach that includes proper exercise therapy and professional guidance.