Running with Heel Lifts: Benefits, Risks, and When to Use Them

Can you run with heel lifts?

Yes, it is possible to run with heel lifts, but their use should be considered a targeted intervention, primarily for specific biomechanical issues or injuries, and ideally under the guidance of a healthcare professional.

Understanding Heel Lifts in Running

Heel lifts, also known as heel wedges or heel pads, are inserts placed inside a shoe beneath the heel to elevate it. They are typically made of materials like foam, silicone, or cork and vary in thickness. While often associated with casual footwear, their application in athletic activities like running warrants a deeper understanding of their purpose and impact.

• What are Heel Lifts? Heel lifts are orthotic devices designed to raise the heel relative to the forefoot within a shoe. Their primary function is to alter the angle of the ankle joint, thereby influencing the kinetic chain up the leg.
• Common Applications in Running: In the context of running, heel lifts are not a general performance enhancer but rather a therapeutic or compensatory tool. They are usually employed to address specific musculoskeletal issues, such as leg length discrepancies, certain types of Achilles tendinopathy, or to temporarily reduce strain on the calf muscles and plantar fascia.

Biomechanics of Heel Lifts and Running Gait

Introducing a heel lift fundamentally alters the biomechanics of the lower limb during running. Understanding these changes is crucial for assessing their suitability.

• Impact on Ankle Dorsiflexion: A heel lift reduces the amount of ankle dorsiflexion required during the gait cycle. This means the calf muscles (gastrocnemius and soleus) and Achilles tendon are under less stretch, as the heel is already elevated.
• Influence on Knee and Hip Mechanics: The altered ankle angle can cascade up the kinetic chain. A reduced need for ankle dorsiflexion might slightly change knee flexion and hip extension patterns, potentially influencing how impact forces are absorbed and distributed.
• Altered Foot Strike Pattern: While not a primary goal, a heel lift can subtly encourage a more rearfoot (heel) dominant strike or reduce the challenge of a midfoot/forefoot strike by lessening the demand on the calf complex.
• Changes in Ground Reaction Forces: By altering joint angles and muscle activation patterns, heel lifts can redistribute ground reaction forces, potentially reducing peak loads on certain structures (e.g., Achilles tendon) while possibly increasing them elsewhere.

Potential Benefits of Running with Heel Lifts

When used appropriately, heel lifts can offer several therapeutic benefits for runners.

• Addressing Leg Length Discrepancy (LLD): One of the most common and evidence-based uses of a heel lift is to compensate for a structural leg length discrepancy, which can help equalize limb lengths and reduce compensatory stresses on the spine, pelvis, and lower limbs during running.
• Managing Achilles Tendinopathy or Calf Tightness: By reducing the stretch on the Achilles tendon and calf muscles, heel lifts can provide temporary relief and facilitate healing for individuals suffering from Achilles tendinopathy or severe calf muscle tightness. This allows the inflamed or strained tissues to recover without excessive lengthening.
• Temporary Relief for Plantar Fasciitis: For some individuals with plantar fasciitis, a heel lift can indirectly reduce tension on the plantar fascia by decreasing the demand on the calf muscles, which are often tight and contribute to plantar fascia strain.
• Support for Certain Foot Deformities: In specific cases, such as pes cavus (high arch) where the foot may be more rigid and less shock-absorbent, a heel lift might help optimize foot mechanics and reduce localized pressure.

Potential Risks and Considerations

Despite their potential benefits, running with heel lifts carries inherent risks if used indiscriminately or without proper assessment.

• Altered Natural Gait Mechanics: The human body is designed for a specific range of motion. Artificially elevating the heel can disrupt the body's natural shock absorption and propulsion mechanisms, potentially leading to inefficient movement patterns.
• Increased Stress on Other Joints: While relieving stress on one area (e.g., Achilles), heel lifts can shift stress to other joints, such as the knees, hips, or lower back, by altering the alignment and force distribution up the kinetic chain.
• Reduced Proprioception and Stability: The elevation can slightly alter the foot's sensory feedback from the ground, potentially impacting proprioception (the body's awareness of its position in space) and overall stability, especially on uneven terrain.
• Dependency and Muscle Imbalances: Long-term, unsupervised use can lead to a dependency on the lift, potentially hindering the natural development or strengthening of the calf muscles and Achilles tendon. This could exacerbate existing muscle imbalances or create new ones.
• Improper Fit and Material: A poorly fitted or excessively thick heel lift can cause discomfort, blistering, or further destabilize the foot within the shoe, increasing the risk of injury.

Who Should Consider Heel Lifts for Running?

Heel lifts are not a "one-size-fits-all" solution for runners. Their use should be highly specific and evidence-based.

• Under Professional Guidance: The primary candidates for running with heel lifts are individuals who have been assessed by a qualified healthcare professional, such as a physical therapist, orthopedist, or sports podiatrist.
• Specific Clinical Conditions: Their use is most appropriate for documented conditions like:
  • Clinically significant leg length discrepancies.
  • Acute or chronic Achilles tendinopathy where offloading is necessary for healing.
  • Severe calf tightness or contracture that significantly limits ankle dorsiflexion and contributes to injury.
  • Certain foot or ankle deformities that benefit from altered mechanics.

Best Practices for Integrating Heel Lifts

If a healthcare professional recommends heel lifts for your running, adherence to best practices is essential for safe and effective integration.

• Professional Assessment is Crucial: Never self-diagnose or self-prescribe heel lifts for running. A thorough biomechanical assessment can identify the underlying issue and determine if a heel lift is the appropriate intervention, as well as the correct thickness.
• Gradual Introduction: If recommended, introduce heel lifts gradually. Start with shorter runs and incrementally increase distance and intensity as your body adapts.
• Monitor Your Body's Response: Pay close attention to how your body feels. Any new pain, discomfort, or altered sensation in your feet, ankles, knees, hips, or back should prompt a review with your healthcare professional.
• Combine with Rehabilitation and Strengthening: Heel lifts are often a temporary or adjunctive measure. They should ideally be part of a broader rehabilitation plan that includes strengthening exercises for weak muscles, stretching for tight muscles, and gait retraining to address the root cause of the issue.
• Regular Review: The need for heel lifts may change as your condition improves. Regular reassessment by your professional is vital to determine if the lift is still necessary or if its thickness needs adjustment.

Conclusion: A Measured Approach to Running with Heel Lifts

Running with heel lifts is not an inherent problem, but it is a nuanced strategy. For the majority of runners, maintaining natural foot and ankle mechanics is optimal for performance and injury prevention. However, for individuals with specific, clinically diagnosed biomechanical limitations or injuries, heel lifts can serve as a valuable tool to facilitate recovery, reduce pain, and allow for continued activity. Their application should always be a deliberate, professionally guided decision, integrated into a comprehensive approach to health and performance, rather than a casual modification to running shoes.