Heel lifts and Achilles tendinopathy

Where do heel lifts fit in Achilles tendinopathy management?

Clinical commentary by Nick Haley, Formthotics Medical Director


The humble Formthotics Heel Raiser. There would not be a day that goes by in my clinical practice that I don’t use one. I find it one of the most effective ways to reduce pain levels in patients with Achilles issues. Be it from in the insertional irritation from the back of shoe and just needing to shift the point of impact or the grumpy mid-portion tendinopathy. Alongside appropriate progressive loading, they are one of the mainstays of my clinical practice.

When it comes to Achilles Tendinopathy, heel lifts should not be used in isolation but in conjunction with progressive loading and exercise modification.   

Although Bourke et al (2025) found a statistically significant reduction in pain levels between a heel lift and sham groups in the treatment of midportion Achillies tendinopathy, it was perceived as below the trials predicted threshold for clinical importance. Heel lifts however may provide additional pain relief for some patients, but the average benefit over a sham intervention was modest. The influence of treatment expectancy and the uncertainty around the effect size should be considered when interpreting the findings 

Current evidence provides limited support for the idea that heel lifts meaningfully alter Achilles tendon loading or function. However, they may help reduce pain in some individuals, potentially improving activity tolerance and allowing patients to remain active while progressing through rehabilitation, with progressive tendon-loading exercise remaining a cornerstone of Achilles tendinopathy management.  

When using Heel Raisers for the management of Achilles Tendinopthy it is suggested that:  

• Place heel raisers under the shoe liner or Formthotics to improve comfort and reduce the risk of them slipping forward. 

• Choose adhesive or non-adhesive options depending on the patient’s needs. 

• If needed, trim the width of the heel raiser to fit the geometry of the footwear and improve comfort. 

• Fit heel raisers bilaterally to avoid contributing to leg-length asymmetry. 

Caution is advised however as it is not a cure all and, in a small number of patients, it may have a detrimental effect on symptoms.   

In clinical practice, consider: 

• Introducing heel raisers progressively.  

• Checking footwear fit, comfort and heel retention. 

• Monitoring for new or worsening foot, ankle, knee or Achilles symptoms. 

• Adjusting the heel raiser height or duration of use when appropriate. 

• Reassessing whether continued use provides sufficient benefit to justify its inclusion in the management plan 

For selected patients, a heel raiser may be considered as an adjunct where its use appears to improve comfort or help manage symptoms during daily activities or exercise. These potential benefits should be evaluated in the individual rather than assumed from the diagnosis alone. 

Clinical decision-making should consider: 

• Symptom response during and after activity. 

• Comfort in the patient's usual footwear. 

• Tolerance of walking, running and other relevant activities. 

• Functional goals and rehabilitation progress. 

• Patient preference and treatment acceptability. 

• Any new symptoms associated with heel lift use. 

The aim is not to correct an assumed biomechanical fault, but to determine whether the intervention provides a meaningful, observable benefit in symptom reduction for that patient. Once the symptoms settle the Heel Raiser can be removed from their shoes.  

Overall, Formthotics heel raisers are a relatively low-cost intervention that alongside other modalities can improve patient outcomes and above all increase their comfort levels. Heel raisers are relatively simple to implement, but they should not displace treatments with an established role in rehabilitation, particularly progressive tendon-loading exercise and patient education. 

Reference 

Bourke J, Munteanu SE, Garofolini A, Malliaras P. Efficacy of heel lifts for managing midportion Achilles tendinopathy (the LIFT trial): a participant- and outcome assessor–blinded randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy. 2025;55(9):611–620. 

https://doi.org/10.2519/jospt.2025.13422