Heel Lifts for PTTD: A Practical Treatment Option

When it comes to treating posterior tibial tendon dysfunction, sometimes the simplest solutions are worth trying first. Heel lifts — those small inserts that go inside your shoes — are a straightforward, low-cost option that many people with PTTD find helpful.

What Are Heel Lifts?

Heel lifts are thin inserts (typically 1/4 to 1/2 inch thick) that you place inside your shoes, usually under the insole or directly on top of the shoe’s footbed. They’re designed to slightly elevate your heel, which changes the mechanics of your ankle and foot during walking and standing.

How They Help With PTTD

The main benefit of heel lifts for PTTD comes from reducing the strain on the posterior tibial tendon:

Decreases Achilles tendon tension. When your heel is elevated, your Achilles tendon doesn’t have to stretch as far during walking. This reduces the pulling force that the Achilles exerts on the back of your ankle — and less pull means less stress on the posterior tibial tendon trying to counteract it.

Shifts your weight back. The elevated heel moves your center of gravity slightly backward, which can reduce the collapse of your arch during standing and walking.

Easier toe-off. By shortening the lever arm of your foot, heel lifts can make it easier to push off with your toes, reducing the work your posterior tibial tendon has to do.

When Heel Lifts Can Help

Heel lifts tend to be most helpful in these situations:

  • Early-stage PTTD where the tendon is irritated but not severely damaged
  • Mild cases with minimal flatfoot deformity
  • As a temporary measure during flare-ups
  • In combination with other treatments like orthotics or physical therapy

They’re not a magic fix, but they can be one piece of the treatment puzzle.

How to Use Heel Lifts

If you’re considering heel lifts, here’s what to know:

Start small. Begin with a 1/4 inch lift (about 6mm). You can gradually increase to 1/2 inch (about 12mm) if needed. Going too high too fast can cause new problems.

Use in both shoes. Only using a heel lift in one shoe will create a leg length difference, which can lead to hip and back problems.

Remove existing insoles. Many shoes come with thick insoles. Removing them gives you room to add the heel lift without making your shoes too tight.

They take adjustment. Give yourself a week or two to get used to them. Your calves might feel tighter initially.

Potential Drawbacks

Heel lifts aren’t right for everyone:

  • Calf tightness can become a problem if used long-term
  • Not a standalone solution — they address symptoms, not the underlying tendon issue
  • May not help advanced cases where significant arch collapse has occurred
  • Can feel unnatural at first, affecting your gait

The Bottom Line

Heel lifts are a simple, inexpensive worth trying if you have mild to moderate PTTD. They’re not a replacement for proper treatment — physical therapy to strengthen your posterior tibial tendon should still be the foundation of your rehab — but they can make daily activities more comfortable while you’re working on building tendon strength.

Talk to your podiatrist or physical therapist about whether heel lifts make sense for your specific situation. They can help you figure out the right height and how to incorporate them into your overall treatment plan.