Heel lifts, also known as heel wedges or heel raises, are simple yet effective orthotic devices that have become increasingly important in the treatment of various foot and lower limb conditions. These small inserts, typically made from materials such as foam, cork, silicone, or rigid plastics, are placed inside the shoe beneath the heel to elevate it relative to the forefoot. While they may seem like a minor intervention, heel lifts can provide significant therapeutic benefits for a range of biomechanical and pathological conditions affecting the feet, ankles, and lower extremities.

The primary function of heel lifts is to alter the biomechanics of the foot and leg by changing the angle of the ankle joint and redistributing weight-bearing forces. When the heel is elevated, the ankle is placed in a more plantarflexed position, which reduces tension on the Achilles tendon and calf muscles. This mechanical advantage makes heel lifts particularly valuable in treating conditions involving these structures. Additionally, by changing the angle at which the foot strikes the ground during walking, heel lifts can modify gait patterns and reduce stress on specific anatomical structures throughout the lower kinetic chain.

One of the most common applications of heel lifts is in the treatment of Achilles tendinopathy, a condition characterized by pain, swelling, and dysfunction of the Achilles tendon. This condition often results from overuse, improper training techniques, or biomechanical abnormalities. By elevating the heel, the lift reduces the stretch and tension placed on the Achilles tendon during daily activities and exercise. This reduction in mechanical stress allows the injured tissue to heal while still permitting the patient to remain relatively active. Many clinicians recommend heel lifts as part of a comprehensive treatment program that may also include physical therapy, stretching exercises, and activity modification.

Plantar fasciitis, another prevalent foot condition, can also benefit from the use of heel lifts. This painful inflammation of the plantar fascia, the thick band of tissue running along the bottom of the foot, causes characteristic heel pain that is often worst with the first steps in the morning. Heel lifts work by reducing the strain on the plantar fascia through multiple mechanisms. The elevation decreases the dorsiflexion angle at the ankle, which reduces tension on the fascia. Additionally, some heel lifts are designed with cushioning or cut-outs that reduce direct pressure on the painful heel area, providing symptomatic relief while healing occurs.

Leg length discrepancy represents another important indication for heel lift therapy. When one leg is shorter than the other, whether due to anatomical differences or functional biomechanical issues, the body compensates in ways that can lead to pain and dysfunction in the feet, knees, hips, and lower back. Even small differences in leg length can create significant problems over time. Heel lifts provide a straightforward solution by elevating the shorter leg to achieve better symmetry. This correction can dramatically improve gait patterns, reduce compensatory movements, and alleviate pain throughout the musculoskeletal system. The amount of lift required depends on the degree of discrepancy, and practitioners often start with partial correction before progressing to full correction to allow the body time to adapt.

Patients recovering from ankle injuries or surgeries may also benefit from temporary use of heel lifts. Following an ankle sprain, Achilles tendon repair, or other lower leg procedures, maintaining the ankle in slight plantarflexion can reduce stress on healing tissues. Heel lifts provide this positioning advantage while allowing patients to bear weight and walk, facilitating earlier mobilization and potentially faster recovery. As healing progresses, the height of the lift can be gradually reduced, allowing the tissues to adapt to increasing loads in a controlled manner.

Certain chronic conditions, such as posterior tibial tendon dysfunction and various forms of arthritis affecting the ankle or subtalar joints, may also warrant the use of heel lifts. In these cases, the lifts help reduce painful joint motion and redistribute forces to less symptomatic areas of the foot. For patients with limited ankle dorsiflexion due to arthritis or previous injury, heel lifts can compensate for this restriction and improve overall gait mechanics.

The selection and implementation of heel lifts require careful consideration of several factors. The height of the lift must be appropriate for the specific condition and patient. Common heights range from a few millimeters to twenty millimeters or more for significant leg length discrepancies. The material is also important, as firmer materials provide better structural correction but less cushioning, while softer materials offer comfort but may compress over time. Some patients benefit from bilateral heel lifts even when treating a unilateral problem, as this maintains better overall symmetry and balance.

Proper patient education is essential for successful heel lift therapy. Patients should understand that there may be an adaptation period during which they might experience temporary discomfort in different areas as their body adjusts to the altered biomechanics. They should also be advised to ensure their footwear has adequate depth to accommodate the lift without causing excessive pressure on the top of the foot. In some cases, patients may need to size up their shoes or choose styles with removable insoles to create sufficient space.

While heel lifts are generally safe and well-tolerated, they are not without potential drawbacks. Improper use or excessive lift height can create new problems, including knee or hip pain, altered gait patterns, or increased pressure on other areas of the foot. Therefore, heel lifts should ideally be prescribed and monitored by qualified healthcare professionals such as podiatrists, physical therapists, or orthopedic specialists who can assess their effectiveness and make appropriate adjustments.

Heel lifts represent a valuable tool in the conservative management of numerous foot and lower limb conditions. Their ability to modify biomechanics, reduce tissue stress, and correct anatomical discrepancies makes them an important component of comprehensive podiatric care. When properly selected, fitted, and monitored, heel lifts can provide significant symptomatic relief and functional improvement, often allowing patients to avoid more invasive interventions while maintaining their desired activity levels.