Heel lifts are one way to try to take tension off an Achilles injury. There is concern of long term use of heel lifts because this generally leads to a shorter heel chord. Although studies on the benefits of lifts were of questionable methodology, a study by Wuff et al demonstrated decreased tension in the actual Achilles tendon with lift by measuring the velocity in the Achilles with ultrasound.The heel lift or drop in a shoe is also a factor. It has been generally recognized that lowering the heel height or drop in the shoe will put more load into n the achilles while adding can offload it.Deeper heel cup can potentially offer more control. Attention to make sure the heel cup height does not cause irritation to the tendon is essential. Although there are no conclusive studies that have linked orthotics with Achilles tendonitis , most clinicians will use inversion as needed for the appropriate foot pathology.
Most sports involve a forward angle of 20-30 degrees of flexion forward. (Richard Blake, DPM personal communication). Because of this it is essential to isolate the soleus which becomes active when the knee is flexed. To do this you can bend the knee at 90 degrees and plantarflex the foot with equipment that is readily available at most gyms.
A break in your shoe facilitates toe off. If there is no break it increases the workload of the Achilles . ( Steve Pribut , DPM personal communication)
Wulf M, Wearing SC, Hooper SL, Bartold S, Reed L, Brauner T. The Effect of an In-shoe Orthotic Heel Lift on Loading of the Achilles Tendon During Shod Walking. J Orthop Sports Phys Ther. 2016 Feb;46(2):79-86. doi: 10.2519/jospt.2016.6030. Epub 2016 Jan 11. PMID: 26755409.
