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.
|