Heel Lift and Shoe Lift Use in Active Sports

It is often necessary that a heel lift be inserted in athletic footwear for therapeutic purposes, such as for athletes with different leg lengths, heel spurs, or Achilles' tendonitis. 

There are also valid uses for thin heel lifts when used to improve fit and reduce heel motion in athletic and running shoes and boots: ski boots, ice and roller skates, and many other types of specialized athletic footwear require that firm support be maintained without heel slippage. Chafing and blisters often result from excessive heel motion in boots and shoes as well.

If possible, one should use as little heel lift height as possible during active sports such as running, dancing, tennis, skiing, skating, and field sports, due to the potential loss of control at the foot and ankle level. If the heel is elevated too much in the shoe by heel inserts, rollover ankle injuries and falls can result. 

Thin heel lifts can be used as shims under the heel, placed beneath the footbed or insole to tighten heel pocket fit, reduce heel lifting, and increase control. Typically, 1mm to 3mm might be used for adjusting heel fit. Lifts extending forward of the heel under the arch will reduce bridging of the heel and ball of the foot for best comfort.  

Heel lifts used in active sports must not create additional foot motion within the athletic shoe or boot or compress under load, for good support and control, and for stable balance. For shoes and boots used during active sports, use firm shoe lifts, rather than soft pads.

If soft heel inserts were used during active sports, problems would include:

• Loss of control at the ankle and foot. If the foot is not firmly anchored in the shoe, exerting strong lateral pressure, such as when changing direction, can cause loss of control and rollover ankle sprains, or serious unexpected falls.
• Compressible material under the heel can destabilize balance and aggravate knee problems by causing lateral motion from the foot on up.
• Loss of control is worsened by the use of softer heel lift material. If the heel lift is composed of foam or sponge rubber, then compression of the foam will loosen the fit of the shoe temporarily, and greatly increase your chances of injury.
• Thicker shoe lifts increase the risk of injury, as the foot is raised within the shoe. This increases the likelihood of a "rollover" sprain or a fall, since the foot is higher above the sole and the ground, and because there will be less heel cup supporting the sides of your foot and ankle.
• Foamed plastic or foam rubber heel lifts and the heel motion they create can cause or worsen blisters and Achilles' tendon inflammation. The compression of foam rubber shoe lifts causes heel rubbing in the shoe at every step, and running or active movement will create even worse heel rubbing. The effects can range from painful blisters to disabling tendonitis.

For relief from heel spurs or pressure-point problems such as plantar warts, athletic shoes can be customized with heel pads using two strategies:

• Use a firm heel lift placed under the footbed or insole, and remove material to make a dent in it to relieve pressure on the affected area, or,
• If you must use soft heel pads for comfort, use the thinnest gel pad you can find, to minimize heel motion. If possible, use gel pads, rather than foam rubber. The gel pads do not compress, but merely redistribute pressure, so they minimize heel motion in the shoe.

 

One vendor of shoe lifts advertised for increasing apparent height offered this stunningly bad advice on their web site:

 

"We recommend these lifts for athletic activities because they are lighter, and offer a higher compression level than any of the XXXXXX models. Although this means the level of height increase is not as high, the comfort level of this softer foam is more appropriate for sports and athletic activities."

This is really ill-advised, and needs to be refuted:

• Trying to increase height, as for basketball, by using "height-enhancing" shoe lifts during active sports is counterproductive. It is almost impossible to jump while the ankle is already extended by a heel lift, and hazardous as well. Don't do it - it doesn't work.
• The risk of ankle and foot injury when using a "softer foam" shoe lift is much greater.
• Using a 2" shoe lift to increase your height, as recommended by the same site, creates a serious risk of injury.
• Using a soft 2" foam heel lift during "sports and athletic activities" will result in a great deal of discomfort, due to the blisters it will almost certainly create.

Another vendor, PostureFlex, asserts, without any evidence, that leg length compensation should always be placed under the right leg. This is simply false, and can be seriously damaging to anyone whose left leg is shorter.

By making the leg length difference even greater, using any sort of lift under the wrong leg will cause even greater unbalanced stresses on the back and legs, and can cause severe lower back pain and crippling shortening of the psoas muscles and iliotibial band. 

Even worse, vendors of these products are using completely invalid methods of diagnosing LLD, and are prescribing lifts without any professional qualifications whatsoever.

In summary: if your therapeutic professional recommends that you use heel lifts, always use firm heel lifts for active sports, and use the minimum height necessary.