Heel lifts and padding are commonly utilized in orthotic prescriptions for various purposes, and are applied symmetrical except when dealing with a short leg.
Heel lifts and various pads are common orthotic modifications (or free standing) to treat pain. Anything under the heel can either shift the weight to the heel or off the heel and more forward. Anything under the heel can cushion the soft tissue. However, since many of the problems we treat present unilateral, the heel padding/lift must be symmetrical unless part of the treatment for a short leg.
The most important message here concerns our understanding that putting anything under the heel of the patient affects the entire lower leg mechanics, symmetrical or not. Additional lifts and pads raise the heel, both taking stress off of the achilles, but allowing it the possibility of over-tightening. Therefore, your mantra here should be "Raise the Heel, Stretch the Achilles". Raising the heels also flexes the knees, and causes more lordosis in the lower back. As you increase knee flexion, you potentially make the knee more unstable, and more prone to certain pain syndromes. This was one of the big points made by the "Barefoot Theory" proponents, that had some truth, raising the heel in the shoe did seem to increase some knee injuries. Increasing lordosis helps many with certain back types with back problems, and is terrible for other patients with back problems. I always ask my back patients (you may just be treating them for plantar fasciitis) if they feel better in heels or flats. The answer is about 50-50.
So, when adding anything to an orthotic device at the heel area, it first should be symmetrical right to left, even in unilateral issues. If it is not symmetrical, make sure you are not making the longer leg longer. And, in your followup visits, ask the patient about their symptoms since getting their orthotic devices, or just heel lifts and pads, both any new symptoms and their old symptoms. And yes, I can not wait for AI to come to my rescue.
Read more about heel lifts here >
Read more about heel pads here >
