A temporary heel lift of roughly 10–12 mm, worn in both shoes inside a supportive shoe, is the best-supported insert choice for early Achilles tendinitis relief.
A shoe insert won’t fix an irritated Achilles tendon on its own. What a well-chosen heel lift can do is take strain off the tendon while you build back strength. Get the insert wrong — too high, one shoe only, crammed into a floppy sneaker — and you can shift load onto your knees and hips instead. The order below starts with the cheapest, most evidence-supported move and only escalates to custom work when a clinician finds a reason.
Why A Heel Lift Comes First
A heel lift reduces how far your ankle bends upward with each step, and that reduced dorsiflexion is what lowers pull on the Achilles tendon. The American Academy of Orthopaedic Surgeons describes Achilles tendinitis as an overuse injury worsened by repetitive strain, and cushioning the heel is one of the standard self-care steps.
Older clinical literature describes a 12–15 mm range as temporary, not a universal prescription. Start at the low end of that window — a small raise around 10–12 mm — and go higher only if a clinician advises it. Excessive elevation can change your gait and load other joints.
Place matching lifts in both shoes, even when only one tendon hurts. A single lift creates a leg-length difference that throws off your stride and invites new problems upstream.
Matching The Insert To Your Type Of Pain
Where the pain sits changes what to try. Insertional tendinopathy, at the spot where the tendon meets the heel bone, may respond well to softer shoes, open-backed footwear, and a heel lift. Mid-portion tendinopathy — pain a couple of inches up the tendon — has no reliable evidence that routine orthoses improve pain or function, so a lift is a comfort measure there, not a treatment.
Pair either insert with the right shoe. Look for cushioning, a firm midsole, solid heel support, a proper fit, and some heel-to-toe drop. Skip flat, hard, flexible, or unsupportive shoes — an insert can’t rescue bad footwear. Remove the factory insole only if the replacement is designed for that and the shoe still fits well; the insert must not crowd your toes, push your heel out, or cause rubbing.
| Insert Option | When It Fits | Key Caveat |
|---|---|---|
| Heel lift (~10–12 mm) | First-line relief for either tendinopathy type | Wear in both shoes; don’t go high without advice |
| Cushioned heel cup | Extra comfort plus slight heel raise | Place at the base of the heel inside the shoe |
| Full-length over-the-counter orthotic | Flat feet, high arches, or marked pronation flagged by a clinician | Not routinely recommended for everyone |
| Custom orthotic | Persistent symptoms or unusual foot alignment | Reserve for after fitted OTC options fail |
| Any insert in a flat, unstable shoe | Never a substitute for supportive footwear | Fix the shoe first |
Choosing And Fitting Your Insert
Work through these steps in order, and stop escalating once symptoms ease with the simplest option.
- Identify the pain location so you know whether you’re dealing with insertional or mid-portion tendinopathy.
- Pick a stable, cushioned shoe before you pick an insert.
- Buy the smallest effective elevation — a small heel raise or roughly 10–12 mm lift.
- Fit matching lifts in both shoes at the base of the heel.
- Check that the insert fits without crowding toes or destabilizing your walk.
- Use the lift alongside activity modification and a progressive strengthening program.
- Reassess. Stop or swap the insert if you get pain, numbness, blisters, altered gait, or symptoms in your knees, hips, or back.
Heel lifts ease symptoms early, but they don’t fix the underlying tendon problem. Progressive loading is the rehab that actually changes the tissue, so treat the insert as a bridge, not a cure. Our breakdown of the best shoe inserts for achilles tendonitis walks through specific options if you want a starting point.
For the clinical picture, the AAOS guide to Achilles tendinitis covers causes, self-care, and when to see a doctor.
Mistakes And When To Get Help
Most insert mistakes come down to skipping a step or over-relying on the insert. Watch for these traps.
- A lift in only one shoe.
- A very high lift without professional advice.
- Wearing the insert in flat, poorly fitting shoes.
- Treating the orthotic as a cure instead of pairing it with rehab.
- Doing heel-drop exercises off a step when the condition is insertional.
- Continuing aggravating activity because the insert masks the pain.
Some situations call for urgent care. Sudden injury, a popping sensation, an inability to point your foot downward, or an inability to rise onto your toes can signal an Achilles rupture — get medical assessment right away. Severe pain, or pain that persists after a properly fitted insert, may need physical therapy or, in selected cases, immobilization. Skip over-the-counter guesswork if you have neuropathy, significant vascular disease, diabetes-related loss of sensation, major foot deformity, or unexplained swelling. A podiatrist or physical therapist can assess alignment and tailor an offloading plan.
Sources
- American Academy of Orthopaedic Surgeons. “Achilles Tendinitis.” Supports the description of Achilles tendinitis as an overuse injury and standard self-care steps.
- Journal of Orthopaedic & Sports Physical Therapy. “Clinical Practice Guidelines.” Source of the 12 mm heel lift and heel gradient offloading guidance.
- NCBI Bookshelf. “Achilles Tendon Injuries.” Background on tendinopathy presentation and rupture warning signs.