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.

Viewpoints

Positive

The effect of leg length discrepancy on spinal motion during gait, Kakushima, Miyamoto, Shimizu. This 2004 study by orthopedic surgeons concludes that "Patients who have leg length discrepancy due to disorders in the lower extremities are at greater risk of developing disabling spinal disorders due to exaggerated degenerative change. Therefore, treatment for leg length discrepancy may be helpful in preventing degenerative spinal changes."

Conservative correction of leg-length discrepancies of 10mm or less for the relief of chronic low back pain, Defrin, Ben, Aldubi, Pick. Can a shoe insert reduce lower back pain? This 2005 study says it can, and recommends that even one-quarter inch to one-third inch leg-length difference should be treated with a shoe insert for back pain relief.

The Short Leg Syndrome: An Overlooked Source of Low Back Pain, Ronald J. Grisanti D.C. As little as 5mm of leg length difference can cause back pain and other problems.

Are You Lopsided? by Dr Rick Allen. Leg length discrepancy from an athletic point of view in Instep dance magazine. Also  see Treating The Lopsided Dancer, from the same source.

Compelled weightbearing in persons with hemiparesis following stroke: The effect of a lift insert and goal-directed balance exercise - Heel lifts can improve ambulation in post-stroke patients.

Pragmatic

Discussion Paper: Leg Length Inequality. A technical article from the Canadian Veterans Administration on evaluating and treating Leg Length Imbalance. Their conclusion is that LLI can cause osteoarthritis of the knee, hip, or back, and can cause or aggravate degenerative disc disease.

Limb length Discrepancy An overview of causes and treatment from the American Academy of Orthopaedic Surgeons.

Heel Lifts and Orthotics: Usage and Indications, Keith Gurnick, D.P.M. A podiatrist discusses the use and fitting of heel lifts for various conditions.

Dr. Pribut on Achilles Tendon Injuries and the use of heel lifts to treat them.

Skeptical

Heel Lift Influence on Achilles Tendon Loading, Drs. Dixon and Kerwin, University of Exeter.

Limb Length Inequalities / Growth Deformities Wheeless' Textbook of Orthopaedics, a standard reference, suggests that leg length discrepancies of less than 1/2" require no treatment at all. I'd suggest that this is a surgeon's point of view - when all you have is a hammer, every problem looks like a nail.

Other Sources

A Guide to Selecting Heel Lifts - by Yours Truly. A reasonably objective view of the various types of in-shoe lifts available, and their strengths and weaknesses. Comments on the design aspects of a good shoe lift - what to look for, and how to find what you need.

Dr. Arthur Gross, D.C. is a recognized authority on the measurement and treatment of leg length differences. Several of Dr. Gross' articles about the measurement of leg length discrepancy and chiropractic uses of heel lifts may be found at G&W Heel Lift.