Heel cups and heel lifts

What are heel cups and heel lifts, and how do they work?

A heel cup is a rubber, thermoplastic or firm-foam device that sits under your heel inside a shoe¹. A heel lift raises the heel. It's designed to reduce the pull of the soft tissues that attach to your heel bone, and it can add some cushioning². Lifts are also used to make up for a leg length difference³.

Both go at the base of the heel inside your shoe, and differently shaped ones do much the same job². They're types of foot orthoses (shoe inserts). A podiatrist or physiotherapist can help you choose between a heel cup, a heel lift and a full-length insole.

What are they used for, and how well do they work?

They're mainly used for pain under the heel (plantar heel pain) and for leg length differences. The benefit is modest, and it's weak for both.

How well heel cups work on their own for heel pain isn't clear yet⁴. Foot orthoses in general weren't better than sham inserts or other simple treatments for adults⁵. Even so, simple advice plus a heel cup is a reasonable place to start, because adding exercise or an injection didn't give clearly better results after 12 weeks⁶.

In adults with a leg length difference and a painful condition, shoe lifts may ease pain and improve function, but the quality of the evidence is low³. For Achilles tendon pain, heel lifts may ease pain a little more than calf exercises, though the difference may be too small to notice⁷. In children with heel pain (calcaneal apophysitis), the options made no difference by 6 and 12 months, and children's results don't necessarily apply to adults⁸.

Expect a small benefit that may be mainly short-term. In adults with plantar fasciitis, orthoses improved function at 3 months compared with sham inserts, but not at 12 months⁹.

Are heel cups and heel lifts right for me?

A heel lift may suit you if a clinician has confirmed a true leg length difference³. Don't use one for a suspected difference that hasn't been confirmed, because a lift you don't need can cause pain¹⁰.

For heel pain, clinicians are advised to be cautious about giving inserts to everyone, and to take your preferences and whether you'll keep wearing them into account⁵. If you have reduced feeling in your feet, talk to a podiatrist before you start¹¹. In young children, corrective footwear doesn't help developmental flat feet¹².

What happens when I start using them?

Heel pain is mostly diagnosed from an examination of your foot¹³. If a leg length difference is suspected, it's measured and confirmed first¹⁴. No proven guideline sets the best material or height for a lift, so a podiatrist or physiotherapist will set it for you⁷.

You'll then wear the device in a cushioned, stable shoe, such as a trainer or walking shoe, and avoid flat or slip-on shoes².

What are the risks and side effects?

Problems are usually minor. You may notice aching in your feet, legs, thighs or lower back when you first wear them, which should settle quickly if you build up gradually¹¹. Heel cups may make your feet sweat more, so wash your feet and change socks more often¹. Take the device off and ask a podiatrist to review it if you notice blistering, bruising or marked skin.

A lift you don't need has been linked with hip and groin pain¹⁰, and new pain in the back, hips, knees or feet, and blisters, can occur with lifts⁷. If new pain appears in your hip, groin, knee or back after starting a lift, stop using it and ask a podiatrist to review it.

If you have neuropathy (loss of feeling in your feet), start with only 15 minutes of use and check your feet after every wear. Stop straight away and contact a podiatrist if you see damage, redness, blistering or bruising¹¹. How often side effects happen isn't clear yet.

How do they compare with other options?

Heel cups may help more than stretching in the short term for adults with plantar heel pain⁵, but contoured full-length insoles relieved symptoms better than heel cups¹⁵. Combining night splints or rocker shoes with insoles worked better than any one alone¹⁵. Ready-made and custom-made orthoses seemed to work similarly⁹. Orthoses also take less effort to stick with than stretching⁵.

Corticosteroid injections can help in the short term but may have negative long-term effects, so discuss them with your doctor⁵. If a heel cup isn't helping, ask about a full-length insole.