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Sunday, November 14, 2010

Top 100 Biomechanical Guidelines #20: Full Length Lifts are more stable and mechanically reliable than Heel Lifts

Heel lifts for the treatment of short leg syndrome are simple, but many times ineffective. They are less problematic for shoe fit than full length lifts, but have a major trade-off in function. They produce 3 major disadvantages over full length lifts. These are:
  1. They maintain their correction only 50% of each step (when the heel is on the ground)
  2. They produce possible heel and ankle (and lower extremity) instability by lifting the heel further out of the shoe
  3. They allow the patient to easily compensate (and negate the effectiveness) for the heel lift by bending the knee on that side
Full length lifts are normally thinned or cut at the toes so that the toes do not get jammed. Full length lifts carry the lift effect desired all the way through each step (into the propulsive phase). Full length lifts can be cut (as demonstrated in the above video) so as to not block forward motion.

Cutting at the ball of the foot to allow more bend

When using heel lifts, make sure the effectiveness of the lift is monitored. Is it helping? Also, make sure you are evaluated for stability. Are you more or less stable with the lifts? This evaluation should be in all shoes that you wear the lift.

I will end with a story of a runner with a short right leg and achilles tendinitis on the short side. The podiatrist he saw correctly identified the short leg and gave him a heel lift, a stretching program, and an anti-inflammatory routine. The runner felt slightly better, but would continue to irritate the achilles with running. When he came to me for a 2nd opinion I felt the program was perfect except for the heel lift. You see this runner ran the hills of Mt Tamalpais near San Francisco routinely and ran alot on the balls of his feet. In this instance, the heel lift was very ineffective since his heels rarely touched the ground, and I switched it to a full length lift which corrected him with every step. Soon afterwards his achilles pain went away and he has remained a happy camper.

The 2 links below are for spenco and korex. I normally buy 1/8 inch and then gradually add layers.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.