Heel Lift Use for Prosthetic and Rehabilitation Needs September 24, 2018

Heel lifts or shoe lifts are useful for a number of orthopedic and physical therapy needs, both prosthetic and rehabilitative. These include:

  • Lower-limb amputations after a prosthetic is fitted,
  • A short leg resulting from healed fractures or a surgically-induced short leg resulting from knee or hip replacement, 
  • Post-stroke, post-surgical, or other rehabilitation, when ambulation is affected,
  • Shoe fit adjustment for various reasons which can be addressed by tighter heel pocket fit,
  • Equinas or tight-tendon conditions which require heel elevation.

A heel lift product used to meet any of these needs should have certain characteristics:

  • The heel lift should be firm and not compressible, as any added softness under the heel will be destabilizing at the ankle, knee, and hip levels, and can affect balance as well.
    Just as walking on carpet compared to a hard floor is less stable, any sponginess added to the shoe by an orthopedic insert should be avoided.
  • Fine adjustment of heel lift height is very desirable when adjusting for swing-through when lower-limb prosthetics, paralysis, or other dysfunction is involved, as well as when adjusting heel-cup fit.

Issues which are long-term, such as short leg compensation, will also put a premium on foot comfort. With modern shoe construction, where a removable insole is used, best comfort will be achieved by placing a firm lift under the footbed or insole, allowing both shoes to feel alike. 

Suggestions for Heel Lift Use with Prosthetics and in Rehabilitation

  • Adjusting shoe fit with a heel lift is a simple matter of adding a thin incompressible lift under the heel area. From one to four mm will raise the foot enough to tighten heel pocket fit substantially, and this will also move the foot slightly forward in the shoe.
  • With lower-limb prostheses, heel lifts may be used to adjust shoe fit on the prosthesis for best support and control, or on the opposite foot for height adjustment, as a means of improving the ability to swing-through with the prosthesis. During post-stroke rehab or post-injury rehabilitation, considerations are similar. 
  • For either use, a firm heel lift, not a cushion, will retain best control. As little as 1-2mm of lift height can make a significant difference in swingthrough or shoe fit, and the best height can differ from one pair of shoes to another. 
  • Once they are stable and familiar with the prosthetic, an adjustable heel lift can allow an amputatee to change the swing through and fit as needed with different shoes, without adjustments to the prosthesis.
  • For short leg compensation, a single lift under the shorter leg is used. For long-term comfort and least disturbance of gait and foot, a long firm lift should be used under the insole for less than 10-12mm of compensation, or a full-foot lift should be considered for shoes that can be modified, when greater height is required. (About shoe lifts for leg length discrepancy.)
  • Relieving stress on tight tendons can be accomplished with a heel lift in both shoes, very similar to the recommendations for heel lifts used to treat Achilles’ tendonitis.
  • When used during rehab for motion or control impairments, a firm adjustable lift is desirable: firm for best control, and adjustable as the users needs change over time. The article “Compelled weightbearing in persons with hemiparesis following stroke: The effect of a lift insert and goal-directed balance exercise” describes the use of a 10mm lift to retrain the affected leg.