Quick answer
Footwear and heel lifts can modify Achilles load or compression and may help selected patients, especially during an irritable phase. They are adjuncts rather than substitutes for progressive rehabilitation.
Article
Footwear pressure
Insertional symptoms can be aggravated by a rigid heel counter or direct pressure over a prominent posterior heel. Footwear modification may therefore provide practical symptom relief.
Temporary heel lifts
A heel lift reduces ankle dorsiflexion and can reduce strain or insertional compression during walking. It may be useful temporarily while rehabilitation progresses, with later reassessment rather than automatic permanent use.
Biomechanics and orthoses
A biomechanical assessment may identify factors relevant to an individual patient, and orthoses can be considered when there is a clear clinical rationale. There is no need to assume that every Achilles problem is caused by pronation or that every patient needs orthoses.
Key points
- Use adjuncts for a defined purpose.
- Insertional shoe pressure is often overlooked.
- Avoid simplistic claims that one foot posture “causes” Achilles tendinopathy.
Frequently Asked Questions
Should I wear flat shoes?
Not necessarily. Some patients find a modest heel-to-toe drop more comfortable during an irritable phase.
Do I need orthotics?
Only if assessment identifies a reason they may help; they are not mandatory for Achilles tendinopathy.