Orthotic heel lifts or shoe lifts are needed by many people at some point in their lives. They help with issues like correcting a runner's gait or improving a golf swing. They can also assist with Achilles tendonitis, lower back pain, and other conditions. These lifts are useful for physical therapy and rehabilitation after a stroke or surgery.

This article aims to provide an overview of the types of in-shoe orthotic heel inserts. It will discuss their strengths and weaknesses. The goal is to help you choose the right heel lift products. These products can help with leg length discrepancy, short leg syndrome, Achilles tendonitis, sports, or prosthetic and rehab needs.


Background

In recent times past, most shoes were made by glueing, sewing, and nailing pieces of leather and rubber, and any changes to customise a shoe were generally performed by a shoemaker.

Shoe technology has improved. Now, it is common to make a complex synthetic sole and the upper part of the shoe in one process. As a consequence, it has become much more difficult to modify shoes externally without impairing their appearance.

Moulded-sole shoes often have a removable insole or footbed. This makes it easier for the wearer to change the fit or feel of the shoe. They can use over-the-counter or custom-made orthotic inserts. Our understanding of body mechanics has improved a lot in recent years. As a result, the changes suggested by medical professionals are now much more advanced.

New technology is needed to keep up with changes in manufacturing and medicine. Heel inserts have changed to meet these needs.

There are two types of heel inserts. They help with many medical issues. These include leg length differences, lower back pain, Achilles tendon problems, heel spurs, arthritis, and gait correction. Some of these conditions need different types of inserts. These inserts help reduce pain or inflammation in many joints, muscles, and connective tissue.

Heel lifts and heel cushions are not the same thing.

Firm heel lifts or shoe lifts are used as therapy or support for various reasons:

  • Leg Length Discrepancy
  • Postural imbalance
  • Lower back pain or spinal scoliosis
  • Achilles tendon condition
  • Rehabilitation needs
  • Prosthetic adjustment
  • Sports uses such as gait or golf swing correction or compensation for tilted running surfaces


Soft heel pads or heel cushions are used for other conditions, such as:

Impact-generated conditions. Walking or running can cause pain in the joints and muscles of the lower body and back. This is especially true if there is already inflammation.

Pressure-related problems, such as Plantar warts or heel spurs, where pressure on a small area of the heel is painful.

This document does not cover soft heel cushions or heel pads. It is meant to help you choose heel lifts. Heel lifts are firm inserts used when one or both heels need to be raised for different biomechanical reasons.


Heel Lift Selection Issues

It is likely that you may want several different types of heel lifts for different shoes. No single heel lift is perfect for every need. However, heel lifts work best when used in all your shoes. This way, you get support from the lift as much as possible.

Consider whether your need for heel elevation is temporary or long-term. Temporary use may require varying elevation over time. Long-term use puts a premium on foot comfort and minimal disturbance of shoe fit. Sports uses of heel lifts will almost always require firm support to retain control and prevent injuries.

The amount of elevation you need can affect your choice of a heel lift or external shoe heel or sole additions. It is widely agreed that adding more than 12mm (1/2") of heel height in a shoe is unwise. Many people also find this amount uncomfortable.

The most comfortable height in a shoe depends on the person and the shoe's style and size. Smaller feet usually need less height. Lace-up shoes can offer more height than slip-ons or loafers. The highest heel you can comfortably wear in a shoe depends on how tight the fit is. It also depends on how much the heel of the shoe already raises your foot. Laced shoes with four or five eyelets can assist in accommodating a heel lift.

The type of shoes in which you use heel lifts may determine the type of lift you can use with them. Closed-heel shoes are usually the easiest to adjust with a heel lift. Sandals or flip-flops may need a clear heel lift for a better look. A shoe-repair shop can also help by adding a wedge to the sole.

You should raise the shoe by more than 12mm. This should be done partly with external changes. Add elevation under the whole foot, not just the heel. This helps with stability and keeps lower-body balance steady.

Cosmetic heel lifts that claim to add more than 1/2" of height are not useful. Your heel will slip out of the shoe when you walk. If you want to buy shoes to look taller, choose ones made for that purpose. They will be more comfortable and less likely to harm your feet and legs.

Using heel lifts to gain height in sports can be very risky. They can lead to falls and sprained ankles because they reduce stability. Heel lifts may also cause problems with the Achilles' tendon.


Design Considerations for Shoe Lifts

There are several things to look for when choosing heel lifts:

Good heel lifts should be long enough to reach under the arch, towards the ball of the foot. This helps prevent "bridging" between the heel and the ball. 

If the lift is too short along the length of the foot, you can cause foot problems, and will be able to feel the heel lift underfoot. A "slope" that is too steep also causes the foot to slip forward in the shoe when walking, and does not support the foot well. The longer the heel lift, the better.

A well-designed in-shoe lift should have a long constant slope from the back all the way to the front edge. A heel lift should not be tapered only at the front and level at the back. 

If the taper changes, you will feel a "hump" in the lift. This can be uncomfortable and may harm your foot. The hump will also tend to push the lift forward in the shoe when walking, and this makes it difficult to fix such a lift in place.

An ideal in-shoe heel lift should add height but not softness. This helps prevent vertical heel movement and rubbing inside the shoe. Up-and-down rubbing of this type can cause Achilles tendon irritation, as well as calluses and blisters.

Firm shoe lifts are necessary for active sports. They help prevent loss of control while moving in the shoe. This can reduce the risk of injuries, especially ankle sprains.

It may be necessary for a lift to perform multiple functions, e.g. varus/valgus wedging at the same time as it provides elevation for leg length discrepancy or Achilles tendon problems. An ideal heel lift should be adjustable. It should fix all issues without needing multiple products in your shoes.

In-shoe lifts must remain in place under the heel. It is very annoying to feel a heel lift crawling forward underfoot. If you want to use shoe lifts made of soft material, consider having a shoe-repair shop put them in.

You should determine the exact heel lift height that makes you most comfortable by experimenting with different heights. It may be that the difference between 8mm and 9mm is just the difference that will make you best balanced and most comfortable. You can adjust a lift by placing pieces of cardboard under it. This will help you find what works best for you. Alternatively, you can use an adjustable heel lift to find the right height. You might notice a tradeoff between how shoes fit and their height. Try different heights until you find the best one. Use that height whenever you can.

If some of your shoes are too tight with the heel lift, try using 1mm less. This may make the shoes more comfortable and wearable without causing harm. You may wish to take a shoe lift with you when shopping for shoes, to check for fit with the lift in place.

To be consistent, measure the heel lift height where the calcaneal bone sits. Do not measure at the back of the lift. This effective height can be measured at the point where the curve at the back of the lift joins the straight sides.


Heel Lift Materials

Keeping that in mind, let us look at the different types and materials of shoe lifts that raise heels.

Cork Heel Lifts

Cork is an attractive material for certain types of in-shoe lifts, as it is inexpensive and lightweight, and does not crush much. Cork lifts come in many sizes and heights. They usually have a leather or vinyl cover. This cover protects the cork from wear and helps it last longer.

Cork lifts are a particularly good alternative for ladies' dress shoes, due to their lightweight.

Cork heel lifts can be placed above or under the insole or heel pad of the shoe. Putting a firm lift under the insole means your foot has the same cushioning as in the original shoe. The lift just adds height, not bounce. This is especially important for leg length compensation. When a lift is used in just one shoe, it helps. A firm lift under the insole makes both shoes feel the same.

Cork shoe lifts are a great option if you do not want to remove the insole of your shoe. They can be placed directly under the insole. The slight softness of cork feels more comfortable underfoot than harder materials.

Cork lifts come in different widths and heights. They can fit almost any shoe because the material can be easily cut with a knife. Cork adheres well with contact adhesives or double-faced tape to fix the lift permanently in place.

The primary shortcoming of cork heel lifts is that while they are economical, they are not particularly durable.

Solid Plastic Heel Lifts

Cast or moulded plastic shoe lifts are often used to help with leg-length differences. They last longer than cork or foam rubber. This makes them better for heavy use, like in men's work shoes. These lifts are available in a variety of sizes and heights, and in various firmnesses of plastic. The best firmness, or durometer, is between 50 and 60. Softer plastic can lead to losing height over time and cause heel rubbing in the shoe.

Solid plastic lifts are designed to be placed beneath the insole or heel pad of a shoe. The footbed is placed so the foot has the same cushioning as in the original shoe. The lift only adds height, not softness.

There are different qualities of solid plastic lifts. Better quality lifts are usually made by injection moulding, not casting. This method creates a more even thickness and better shape control. Cast or poured plastic lifts can vary in thickness.

Solid plastic lifts are typically available in several different widths and heights, (commonly 3mm, 5mm, 7mm, 9mm & 12mm). Special double-faced tape is used to fix these lifts in place, rather than glue.

If solid plastic lifts have a flaw, it is that they do not fit well in all shoes. This is due to the stiffness of the plastic. The shape of shoe insoles varies a lot. Some are curved, some are flat, some are narrow, and some are wide. A firm plastic lift is harder to adjust for different shoes than softer materials like cork.


Foam Rubber, EVA or Urethane Foam Heel Lifts

Foam rubber in-shoe lifts are easy to find in shoe-repair shops. They often come with a leather or fabric top. These lifts can go directly under the foot or under an insole. They usually add a maximum height of 9mm (3/8").

Foam rubber heel lifts are sometimes used for leg-length compensation, but spongy rubber material has certain problems:

  • Foam lifts will crush permanently with use. When the foam crushes, it loses its original height, so it is not well suited to long-term use.
  • Foam urethane or rubber materials let the heel move up and down in the shoe. This movement can be as much as half the thickness of the lift. 


Adjustable Heel Lifts

Adjustable heel lifts let you change the height by adding or removing layers of soft material.

Adjustable shoe lifts offer advantages both to medical professionals and to the user:

Adjustable lifts are very helpful when you are moving from no lift to a set height. You can change the lift's height slowly. This helps you get used to the change with less stress.

Adjustable heel lifts let you make small changes to find the most comfortable height. You can also change the elevation in small amounts to help fit into tight shoes.

Adjustable lifts are helpful for therapy professionals. They need fewer sizes to meet everyone's needs. This means lower inventory and stocking costs.

Adjustable heel lifts come in two types. One type has three layers of rubber or soft plastic foam. The other type is the Clearly Adjustable lift, made of many thin layers of vinyl.

Three-layer lifts are widely sold as "adjust-a-lift," "adjust-a-heel," or similar names. All are made of three layers of 3mm foam rubber, cork, or soft plastic. They have a leather or fabric cover on top. You can remove or replace the layers to choose a height in 3mm increments. These lifts are intended for use directly underfoot, rather than beneath the insole.

These three-layer lifts have a big problem. If one or two foam layers are taken out, the lift becomes flat on top. This is not the best shape, as it should have a smooth taper. The edge between the flat top and the tapered portion will be felt as a lump underfoot, and tends to make the lift crawl forward in the shoe.

If foam rubber lifts are used to raise the heel, a leather top surface is better than stretch fabric. Leather is stiff, which reduces the cushioning of the foam rubber below. This helps to lessen the extra vertical heel movement in the shoe.

Three-layer lifts are best when placed directly under the foot. This means they should go on top of the heel pad or insole. This also makes them applicable for sandals and shoes where the insole cannot easily be lifted.

The Clearly Adjustable heel lift is a new type of adjustable lift. It is meant to be used under the insole or footbed. This lift does not compress, so both shoes feel the same. It does not add extra cushioning or cause heel rubbing in the shoe. The fourteen 1mm layers of firm plastic let the lift shape itself to the shoe. This makes it more comfortable than solid plastic lifts.

The Clearly Adjustable heel lift has many layers. This allows you to easily change the lift height by 1mm for better foot comfort. The soft plastic material can be trimmed and customised with scissors.

Content from GW Heel Lifts (USA).