Zen and the Art of Chiropractic Adjustment and Healing

Science, Art, and Philosophy of Chiropractic

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Heel Lifts and Inserts


Many people heard of heel lifts or inserts and some people were prescribed them by medical doctors. There are many experiences regarding heel lifts or inserts to help balance the leg length differences. Most often times they are used inappropriately. Some people have a functionally short leg which does not require heel lifts or inserts. Only to those who have an anatomically short leg with specific conditions may be helpful. Not all the time can the heel lifts can be helpful. How do we know when you have a functionally short leg or an anatomically short leg?

True Short Legdalton01__1_1_5760

To determine an anatomically short leg, the easiest way to find out is to get a ruler to put on the top of the knees parallel to the floor and then on the front of the knee while you are sitting. If the knees are even on the top but one leg is short on the front of the knees, it is a good possibility that there pelvic misalignment that can be corrected by a Chiropractor. If both top and front of the knee indicate a short leg on one side, then there is a pelvic misalignment or an anatomical short leg. If the ruler shows that it is only a slight difference, then most likely it will be a pelvic misalignment.
When it is a pelvic misalignment, it is considered a functionally short and chiropractic adjustments will help to regain balance. When it is a true anatomically short leg, there are conditions for giving heel lifts.

Dr. Gonstead’s Conditions for Heel Lifts:
  1. There must be a leg length deficiency of 6 mm on the radiological film.
  2. Rotary scoliosis must be toward the side of the leg in question.
  3. There must not be any hip joint degeneration to a marked degree nor a knee problem on that side.
  4. The client should not be older than 35 years of age. Never give heel lifts until growth has ceased, which would never be before 18 years of age.

After the first radiological x-ray film, chiropractic adjustments to correct the spine and using heel lifts, retake the radiological x-ray film after 30-60 days to make sure that the condition is not getting worse. The most area you will see changes in the most is the upper neck and the junction between the middle to low back will change for better or worse.

When the client gets a burning sensation in back after wearing the heel lift, don’t worry because it is a compensation and eventually the body will get used to the heel lift. Heel lift should not be given if there is pain involved, only after the pain is gone. The heel lift is for stabilization of the spine and hips and the heel lift itself does not correct anything.

The leg measurement from the crest of the ilium to the malleolus is worthless, but it is commonly used medically to determine if a built-up shoe is indicated.wpid-photo-12-jan-2014-0134

Potential Long-Term Side Effects of Using Heel Lifts:

If a lift raises only the heel, then there can be “bridging” between the heel and the ball of the foot. This lack of mid-foot support can cause arch problems, particularly if a soft lift is constantly pushing the foot upward against the tongue of the shoe. This can be avoided by using a lift which is long enough to support the mid-foot almost all the way forward to the metatarsal area, and which does not compress when walking. A well-designed heel lift should effectively tilt the footbed or insole forward as if it were part of the last of the shoe, rather than leaving the mid-foot unsupported. In heel lifts, longer is better.high-heel

The addition of a lift in the heel of a shoe causes the foot to be resting on a slope downward toward the toes. This can cause fore-and-aft slippage in the shoe when walking and can result in calluses under the metatarsal or ball of the foot or the large toe. This effect is very dependent on the person’s gait and stride and is seldom serious unless the calluses become corns, but they can be annoying. Such calluses can be avoided or reduced by the use of cushioned or silk socks, to reduce skin friction while walking.

Achilles tendon issues since a heel lift raises the foot within the shoe, it can cause inflammation of the tendon due to the pressure and rubbing of the narrower top part of the heel cup or heel counter pressing against the tendon, and it can cause shortening of the tendon and hamstrings due to the reduced angle at the ankle from the steeper slope on which the footrests. Tendons which are not stretched regularly tend to shorten. The reduction in tension on the Achilles’ caused by the use of a heel lift can be beneficial if the therapeutic goal is to allow for tendon healing. Achilles’ tendon shortening can be counteracted by regular stretching exercises which stretch the calf and bend the foot and ankle gently upward under light tension.

All molded foam in-shoe lifts are soft enough to create appreciable vertical motion in the shoe when walking or running, and the increased rubbing of the heel can cause calluses and blisters, inflammation of the Achilles tendon, and excessive wear on socks and shoes. Also, the constant pressure of a soft shoe lift pressing upward against the foot has the potential to cause or aggravate mid-foot and arch problems. Unless you are trying to cushion or reduce the impact on inflamed pressure points such as plantar warts or heel spurs, the use of compressible gel or foam heel lifts should be avoided.

A Short-Term Issue

In the short term, the acutest problem likely to come from using shoe lifts is associated with “height-enhancing” heel lifts, which are placed more than 1/2″ inside common types of shoes. If the height inserted is more than 1/2″, the heel will not be firmly held in place by the shoe and the wearer will tend to walk out of the shoe and be prone to sprain or break an ankle after losing control when the ankle rolls to the side with the foot tucked under. Shoe inserts which add more than 1/2″ of height should be avoided, due to this risk.

Only you can determine whether possible issues resulting from the use of therapeutic or height-enhancing shoes or lifts are acceptable for you and your body, but the use of in-shoe heel inserts is probably best prescribed and monitored by a Chiropractor.