Heel Lift Use

Arthur B. Gross, DC

What are Heel Lifts?
A Heel Lift is a mechanical device, which lengthens the anatomical short leg by a prescribed amount. Heel lifts are commonly available in thicknesses of 3mm, 5mm, 7mm, 9mm, and 12mm. Lifts are made from cork, plastic, or dense foam rubber.

Why do we use them?

To hold the foot in plantar flexion during the recovery and rehabilitation phase of Achilles tendonitis, Achilles rupture, or Achilles repair.
To reduce the shortening effect of hip or knee prosthesis.
To reduce an inferiority which has initiated a scoliosis.
To support a rotatory scoliosis and prevent further degradation.
To help with gait training with stroke patients.
To stabilize the manipulative corrections of lumbar subluxations.
To improve spinal balance.
To reduce disc wedging.
To force spinal change.
Heel lifts are a mechanical device in which you can not only lengthen short legs, but also level wedged bodies of the 5th lumbar vertebra.
To be used as adjuncts in whatever mobilizing or manipulative technique is used.
To improve oxygen consumption when used with patients with leg deficiency.
To support the pelvis, and the lowest freely movable vertebra by a prescribed amount.
Bilateral lifts in the shoes of golfers have proven to be a help with their swing and resulted in longer yardage off the tee.

Before beginning to use heel lifts, an x-ray procedure should be performed which includes a weight bearing A-P pelvis and lumbar spine, a lateral lumbar and a sacral plane view. This will provide adequate information as to the cause of the primary inferiority and the amount of lift to be used. These x-ray procedures will reveal the causes of low back or pelvic instability, some of which are:

Anatomical short leg.
Anomalous sacrum, 5^th lumbar, which creates a non-level surface.
Pelvic misalignments.
Anomalies of the zygapophysial joints
Disc block subluxations and disc wedges.

The use of a heel lift should be given serious consideration as treatment. Used correctly it will be of great benefit correcting spinal curvature, and low back and pelvic instability. Used incorrectly its effects can be equally deteriorative. The primary consideration when correcting spinal curvature and lumbar instability is to properly identify the dominant inferiority. This inferiority when reduced will tend to reverse the spinal curvature and the vertebral rotations. The reduction of the inferiority will also give better balance to the lumbar spine. When lifts are used effectively, the end result is quicker restoration of normal contour, of muscular tone, and of more perfect organic and systemic function.
Excerpts of Research - Ora Friberg, M.D.
A simple and reliable low dose radiologic method developed by the author was used to measure leg length inequality of 798 patients with chronic and therapy resistant low back and/or unilateral hip symptoms and 359 symptom free subjects. Leg length inequality is so common that it is considered the normal variant. Leg length inequality of 5 mm or more was found in 75.4% of the symptomatic patients and 43.5% of the controls.

Leg Length Inequality	Low Back Pain Patients Group		Symptom-Free Control Group
mm	n	%	n	%
0-4	161	24.6	203	56.5
5-9	296	45.3	100	27.9
10-14	120	18.4	48	13.4
15 or more	76	11.7	8	2.2
Total	653	100.0	359	100.0

Correcting the leg deficiency with an adequate heel lift (shoe lift) on the short leg side, complete or nearly complete age related relief of symptoms was achieved in the majority of the cases that could be followed up for at least 6 months. Application of lift therapy when needed is recommended for clinical use as an inexpensive, safe, and non-invasive alternative to methods of treatment that have already proven unsatisfactory.

"Clinical symptoms and Biomechanics of Lumbar Spine and Hip joint in Leg Length Inequality." Ora Friberg, MD. Spine, Vol 8 Number 6 Pages 643-649