By Christopher R.D. Menke, DPM, FACFAS | Double Board-Certified, Foot Surgery & Rearfoot/Ankle Reconstruction | American Board of Foot & Ankle Surgery
I hand out felt heel pads to patients more often than almost anything else in the office, and I tell nearly all of them the same thing: start with one, see how it feels, add a second only if you need it. It is a simple, low-cost tool, and most of the time one pad is more than enough.
Why Heel Elevation Helps an Injured Achilles Tendon
Any method of raising the back of the foot, whether through a wedge shoe, an orthotic, or a standalone heel lift, works the same way. It reduces tension on the Achilles tendon at rest. When the tendon is under maximum tension, it experiences maximum discomfort, which is also why aggressive stretching tends to make an injured Achilles tendon worse rather than better. Heel elevation reduces pressure at both the insertion point at the back of the heel and within the mid-substance watershed area of the tendon.
Orthotic or Isolated Heel Lift? How to Choose
An orthotic serves multiple purposes at once. It stabilizes the foot, provides real arch support, and delivers a mild degree of heel elevation, all in a single device. For most patients, this combination is the more effective starting point, not just because of the lift, but because of everything else it does structurally for the foot.
An isolated heel lift becomes useful specifically in situations where a full orthotic doesn't fit, such as dress shoes or more casual, flatter footwear. The tradeoff is comfort. A standalone heel lift is typically flatter and does not contour to the heel the way an orthotic does, which some patients find less comfortable over time.
Fine-Tuning the Amount of Lift
For patients using an orthotic who need a bit more elevation, felt heel pads placed underneath the orthotic are an effective and low-cost way to add lift gradually. The right approach is trial and error: start with one pad, assess how it feels, and add a second only if needed. Most patients find that one to two felt pads is enough, and in my own experience, even a single pad is often more than sufficient.
It is possible to overdo this. Too much material in the shoe, whether from an orthotic, a heel lift, felt pads, or some combination, can raise the foot too high and create new problems: abnormal rubbing at the back of the heel, discomfort from the foot sitting in a position it isn't meant to be in, or a sensation of the heel sliding out of the shoe. Felt pads also compress and flatten with wear over time and may eventually need to be replaced or supplemented.
Product Note
The All Purpose Orthotics from 26 Apothecary provide structural support, arch stabilization, and mild heel elevation in one product, and are the reasonable first option for most patients in athletic shoes or boots. For dress shoes, casual footwear, or situations where a full orthotic doesn't fit, the Isolated Heel Lift Pads offer standalone elevation instead. [FTC Disclosure: I am the founder and owner of 26 Apothecary. When I reference products available on this site, I have a financial interest in those recommendations.]
When Heel Elevation Alone Isn't Enough
The orthotic and felt pad combination is worth trying first, since it addresses support, stability, and elevation together. If that combination doesn't produce a meaningful improvement, an isolated heel lift alone is unlikely to move the needle either. At that point, it is reasonable to move on to other conservative measures, including kinesiology taping, physical therapy, or a walking boot, rather than continuing to add more elevation. For patients experiencing significant Achilles discomfort in dress shoes or casual footwear specifically, switching to a more supportive athletic shoe, when that is an option, is often a better path than trying to solve the problem with lift alone.
When to See a Foot and Ankle Specialist
Kinesiology tape, orthotics, a gel compression sleeve, heel lifts, and a compression ankle sleeve are reasonable starting points for individuals managing Achilles tendon pain conservatively at home. Evaluation by a foot and ankle specialist is recommended when pain persists, fails to improve, or worsens despite consistent use of these conservative measures.
What to Do Next
Starting with a supportive orthotic, and adding one felt heel pad if additional elevation is needed, is a reasonable first step for most patients. If this combination doesn't help meaningfully, escalating to taping, physical therapy, or a walking boot is a more productive next step than continuing to add lift.
Related Reading
- Achilles Tendinopathy: What a Foot Surgeon Recommends Before Anything Else
- The Footwear Mistake That Keeps Achilles Tendinopathy From Healing
- Eccentric Exercises vs. Night Splints for Achilles Tendinopathy: A Surgeon's Take
Frequently Asked Questions
Should I use an orthotic or a standalone heel lift for Achilles tendinopathy?
An orthotic is generally the better starting point since it provides support, stability, and mild elevation together. A standalone heel lift is more useful for dress shoes or casual footwear where a full orthotic doesn't fit.
How many felt heel pads should I use under my orthotic?
Most patients find that one to two felt pads is enough. It's reasonable to start with one, assess how it feels, and only add a second if more elevation is genuinely needed.
Can too much heel elevation cause problems?
Yes. Excess elevation from stacking an orthotic, heel lift, or felt pads can raise the foot too high in the shoe, leading to abnormal rubbing, discomfort, or a feeling of the heel sliding out of the shoe.
What if a heel lift or orthotic doesn't help my Achilles pain?
If an orthotic and felt pad combination doesn't produce meaningful improvement, an isolated heel lift alone is unlikely to help either. At that point, taping, physical therapy, or a walking boot are more productive next steps.
Do felt heel pads wear out over time?
Yes. Felt pads compress and flatten with regular use and may need to be replaced or supplemented with an additional pad over time.
About the Author
Christopher R.D. Menke, DPM, FACFAS is a double board-certified foot and ankle surgeon and the founder of 26 Apothecary, a physician-curated line of conservative care products for foot and ankle conditions. He practices at 26 Foot and Ankle in Georgia.
