Orthopaedic Heel Lifts Bad Idea for Runners

An elite distance runner, Shalane Flanagan, ditched her orthopaedic heel lifts to run pain free.

Back in January 2015, Shalane Flanagan was in the midst of preparing for the Boston Marathon when her training was interrupted due to a heel injury. Flanagan discussed her injury in the April 2015 issue of Runner’s World Magazine and reported that her physical therapists recommended heel lifts to alleviate heel pain.

Orthopaedic Heel Lifts Bad For Runners
Months before the Boston Marathon, Flanagan wore heel lifts to eradicate heel pain during running, however the heel lifts established more pain in her glutes and back which interrupted her training.

Orthopaedic Heel Lifts Bad Idea for Runners

As expected, the heel lifts consequentially altered her gait to the point where Flanagan experienced additional pain in her glutes and back. But, the Boston Marathon was fast approaching and Flanagan could not afford the setback of adjusting to a new gait with the risk of more injury. So Flanagan ditched her heel lifts and was fine after that, running a 2:25 in Boston.

The Purpose of Heel Lifts and Why They Don’t Work

Heel pain arises in running if a heel strike landing is used, or if the Achilles tendon is exposed to high peak forces. Heel lifts are used to raise the heel in attempt to mute peak force exerted on the Achilles tendon and to reduce heel pressure. Heel lifts are commonly prescribed to heel strike runners as heel strike running increases pressure on the heel at touchdown. However, Dixon and Kerwin concluded that there is no scientific evidence to support the efficacy of heel lifts in heel strike runners.

If anything, heel lifts are the equivalent to a cushioned heeled running shoe in that both permit greater ankle dorsiflexion at touchdown resulting in heel strike. Based on this, even though Shalane Flanagan typically exhibits an inconsistent foot strike pattern during running — alternating between midfoot and heel strike —the heel lifts most likely caused her heel strike to be more aversive.

Another study by Dixon and Kerwin dealt head-on with the issue of the efficacy of heel lifts and found that peak force and loading on the Achilles tendon was not significantly reduced with increased heel lift. Based on their inconsistent data, the researchers concluded that it cannot be assumed that all heel strike runners have reduced Achilles tendon force and loading following heel lift intervention. In other words, heel lifts do not protect against the high peak loading rate generated at heel strike.

Awareness on the role of heel lifts in facilitating heel strike, probably spurred Flanagan to ditch the heel lifts so that her gait could be soothed out without raising her heel relative to her forefoot. This would also minimize the probability of heel strike at touchdown thereby reducing the high accelerations associated with injury.

Scientists do not completely understand why heel elevation drives many runners to heel strike, but scientists do know that heel elevation of any kind leads to problematic patterns in running gait such as heel strike which is signature for pain. There are no mechanical advantages to heel lifts and strong evidence, including Flanagan’s experience, is mounting in favor of this.

New research however, indicates that zero-drop footwear is an ideal proving ground for reducing heel pain because the lack of under-heel cushioning improves messages travelling between the plantar surface and the brain. Heel striking while running in zero-drop shoes delivers more pulses to the heel thereby encouraging the runner to touchdown on the forefoot first to derail that event. To prevent chronic foot pain, many East African runners, who were formerly barefoot runners, tend to touchdown farther away from the heel and more towards the front of the foot.

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References:

Clement, D.B., Taunton, J.E., & Smart, G.W. (1984). Achilles tendinitis and peritendinitis:
Etiology and treatment. American Journal of Sports Medicine, 12, 179-184.

Dixon SJ and Kerin DG. Variations in achilles tendon loading with heel lift intervention in heel-toe runners. J Appl Biomech, 2002, 18, 321-331.

MacLellan, G.E. (1984). Skeletal strike transients, measurement, implications and modifi-
cation by footwear. In E.C. Frederick (Ed.), Sport shoes and playing surfaces (pp.76-86). Champaign, IL: Human Kinetics.


Bretta Riches

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!

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