Heel Lifts and Shoe Lifts - Information and Opinions
A large percentage of people require a heel lift or shoe insert at some time in their lives, for reasons ranging from runners gait correction, golf swing correction, or Achilles' tendon problems, to orthopedic conditions such as lower back pain and scoliosis, or physical therapy and rehabilitation needs. Some of these needs are temporary, while others are more lasting.
A heel lift, also called a shoe lift, is a firm heel insert used in the one of both shoes for conditions where elevation of the heels is required for treatment of various biomechanical problems. A heel lift is not the same thing as a heel cushion, nor is it used for the same purposes - see A Guide to Selecting Heel Lifts.
The simple wedge-shaped shoe insert has somehow become an object on which medical belief systems have become focused. The most controversy focuses on the use of lifts to correct for leg length discrepancy - some professionals consider a heel lift to be the least-intrusive therapy indicated to balance the position of the pelvis and lower back, in order to reduce potential degenerative changes. Others point to statistics that leg length discrepancy is not statistically linked to lower back pain. Still other statistics indicate that leg length differences are strongly linked to lower back and leg problems caused by unbalanced mechanical stress.
Some professions, such as physical therapy and chiropractic, take a pragmatic view of the use of heel lifts, and have confirmed experimentally that heel lifts have a place in the treatment of leg length differential causing lower back pain and musculo-skeletal balance problems for many patients.
Other professionals take a dim view of the use of heel lifts as compensation for leg-length difference, and cite medical studies in which it is demonstrated beyond doubt that there is no statistically significant correlation between leg length differences of up to 2cm with lower back pain. The theory seems to be that most people with a leg length difference can easily compensate for the difference without problems.
Still other studies by reputable health-care professionals, show just the opposite - that leg length difference of as little as 6mm can easily cause lower body stress symptoms due to the constant compensation required when standing, culminating in lower back pain.
It is also clear that the use of heel lifts can cause side-effects, particularly when excessively high lifts are placed in shoes in an effort to enhance height. See Why Not Use Heel Lifts? for a discussion of common secondary issues with feet and tendons that can be caused by using heel lifts.
What to believe? Take your choice from the selected representative opinions below.
My personal view is that of a person who has had a 3/8" difference in leg lengths for many years. I am an active person - a long-distance cyclist and avid walker, who has had two back surgeries and a very sensitive back for more than 40 years. If I do not use enough compensation for my short leg, my gait becomes unbalanced, my back and leg muscles, cartilage, and fascia become asymmetrically stressed over time, and my back hurts a lot, all of which takes months of physical therapy to undo.
My personal experience with back problems is enough evidence for me to believe that heel lifts work very well for some people, and was enough motivation for me to invent the Clearly Adjustable heel lift (sorry for the commercial). I presently use my own heellift in every pair of shoes.
This document is intended as a guide to different Viewpoints and various Sources regarding the relationship between back pain and leg length discrepancy, and the therapeutic use of heel lifts. I've categorized the Viewpoints section articles as: Positive, Pragmatic, and Skeptical.
Disclosure: Richard W. Zehr, the author, is the manufacturer of the Clearly Adjustable Heel Lift, and a person who has required compensation for a moderate leg length discrepancy for several decades, thus having had considerable experience with in-shoe heal lifts. ©2002