Use of Heel Lifts Post Total Knee Replacement

 Recovering from a total knee arthroplasty (TKA) is a major milestone, but it can come with a literal "hitch in your giddy-up." One of the most common complaints post-surgery is the feeling that one leg is suddenly longer than the other.

While it’s often a temporary sensation, a true Limb Length Discrepancy (LLD) can sometimes occur. Here is how a simple tool—the heel lift—can be a game-changer for your recovery.

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Why Does One Leg Feel Longer After Surgery?

Before reaching for a lift, it’s important to understand why this happens. There are two main types of LLD:

1. Functional Discrepancy: This is the most common. Before surgery, your knee may have been bowed or collapsed (varus/valgus deformity). Once the surgeon straightens the joint, the leg is physically longer than it was pre-op. Your pelvis and muscles, used to the "shorter" crooked leg, need time to recalibrate.

2. Structural Discrepancy: This is a literal difference in the bone measurements. While surgeons strive for perfect symmetry, minor variations in hardware placement or bone resection can result in a slight millimetric difference.

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How Heel Lifts Help

If your physical therapist, chiropractor or physician confirms a discrepancy, a heel lift (a firm insert placed inside the shoe of the shorter leg) provides several key benefits:

1. Realigning the Pelvis

When legs are uneven, the pelvis tilts to compensate. This tilt creates a "functional scoliosis" in the spine, which often leads to lower back pain. A heel lift levels the "foundation," allowing the pelvis to sit neutrally.

2. Normalizing Gait Mechanics

Walking with uneven legs causes a "limp" or a "vaulting" gait, where you hop slightly over the longer leg. This puts undue stress on the hip and ankle of the prosthetic side. A lift smoothens the transition from heel-strike to toe-off.

3. Reducing "Edge Loading"

A balanced gait ensures that weight is distributed evenly across the new polyethylene plastic spacer in your knee. By correcting LLD, you prevent uneven wear and tear on your new implant, potentially extending its lifespan.

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Tips for Using Heel Lifts Correctly

• Start Small: Don't try to correct a 10mm gap overnight. Start with a 3mm or 6mm lift to let your soft tissues adapt.

• The "Wait and See" Rule: Most surgeons recommend waiting 6 to 12 weeks post-op before committing to a permanent lift. Often, the "long leg" feeling disappears once the swelling goes down and hip muscles loosen up.

• Firmness Matters: Use a lift made of firm rubber or leather. Soft foam compresses under your weight, rendering the correction useless while you walk.

• Check Your Shoes: Ensure the lift doesn't push your heel so high that your foot slips out of the shoe. You may need shoes with a deeper "heel cup" or removable insoles

Atlas Biomechanics is an USA based manufacturer of Heel Lifts. They are the most prescribed heel lifts by medical professionals.  

Measure Your Own Limb Length Discrepancy at Home

 Do you feel like your belt is always slightly tilted? Do you notice that one pant leg consistently frays at the heel while the other stays clean? Or perhaps you experience chronic lower back pain that only seems to strike on one side? How about hip, knee or ankle pain only on one side?

You might be dealing with a Limb Length Discrepancy (LLD). While many people have a slight difference in leg length, a discrepancy of more than 3mm to 10mm can lead to compensatory pain in the hips, knees, and spine. That’s were heel lift in your shoe may make a huge difference.

While a professional scan (like an X-ray or EOS scan) is the only way to get a definitive measurement, you can perform a preliminary check at home using these three simple methods.

Before You Start: Understanding “Functional” vs. “Structural”

Before grabbing your tape measure, it is important to know there are two types of LLD:

Structural: The actual bone (femur or tibia) is shorter.

Functional: The bones are equal, but a pelvic tilt or muscular imbalance makes one leg appear shorter.1

Method 1: The “Level Pelvis” Mirror Test

This is the easiest visual check and requires only a full-length mirror and a stiff, flat object (like a hardcover book or a clipboard).

Strip down to your underwear and stand in front of a mirror on a hard, level floor (no carpet).

Find your “hip bones” (the Anterior Superior Iliac Spine). These are the bony protrusions at the very front of your pelvis.

Place the book/level across both bones. If the book is perfectly horizontal, your legs are likely even. If the book tilts to one side, that side is likely the shorter limb.

The “Shim” Test: If you see a tilt, place thin magazines or floor tiles under the foot of the “short” side until the book becomes level. Measure the height of the magazines—this is a rough estimate of your discrepancy.

Method 2: The Tape Measure Technique

For this method, you will need a friend to help, as it’s nearly impossible to get an accurate reading while bending over.

Lie flat on your back on a firm surface.

Bridge up: Lift your hips off the ground, then set them back down. This “resets” the pelvis. Have your friend gently pull on both ankles to ensure you are straight.

Measure from Hip to Ankle: Have your friend measure from the bony point of your hip (the ASIS mentioned above) to the inner ankle bone (medial malleolus).

Compare: Write down the measurement for both sides. A difference of $1/4$ inch ($~6mm$) or more is usually considered clinically significant.

Method 3: The “Wear Pattern” Audit

Sometimes your gear tells the story your eyes miss. Lay out your most-worn items:

Shoes: Look at the outsoles. Does one shoe show significantly more wear on the heel or the outer edge than the other?

Jeans: Check the hems. Is one side tattered while the other is pristine?

The “Seam” Test: Put on a pair of leggings or trousers with a clear side seam. Stand straight and see if the seams line up evenly at the ankles.

Home measurements are excellent for identifying a potential problem, but they are prone to human error. If you find a discrepancy:

Do not immediately buy a large heel lift. Sudden corrections to the short leg can shock your spine.

Consult a professional. A medical professional can determine if the issue is structural (requiring a lift) or functional (requiring stretching and realigning).

Atlas Biomechanics is a USA based manufacturer of Heel Lifts. The most prescribed heel lift in the USA.

Custom Support in Minutes: Using Atlas Biomechanics’ Heat Moldable Orthotics

 For patients and practitioners seeking a fast, effective, and customizable solution for foot pain and biomechanical issues, heat-moldable orthotics from Atlas Biomechanics offer a compelling alternative to traditional lab-made orthotics. These devices combine the benefits of a semi-custom fit with the convenience and affordability of a prefabricated product. By providing a personalized foundation for the feet, they can address a wide range of conditions and improve overall body alignment.

The Problem with One-Size-Fits-All Solutions

Generic, off-the-shelf insoles often fall short. While they may provide some cushioning, they are not designed to address the specific contours and biomechanical needs of an individual’s foot. For conditions like plantar fasciitis, heel spurs, or chronic arch pain, a truly supportive device must conform to the unique shape of the foot to properly distribute pressure and provide targeted support.

The Atlas Biomechanics Advantage

Atlas Biomechanics’ heat-moldable orthotics bridge the gap between generic inserts and expensive, time-consuming lab orthotics. Here’s a breakdown of the key advantages they offer:

1. True Customization, On-the-Spot: Unlike off-the-shelf inserts, these orthotics can be molded directly to the patient’s foot. With the use of a simple heat gun, the semi-rigid material softens and becomes pliable. The practitioner then guides the patient’s foot into a neutral, corrected position while the orthotic cools and hardens, capturing the precise contours of the arch, heel, and metatarsals. This process, which can take as little as 10 minutes, ensures a total-contact fit that is unique to the individual.

2. A Fraction of the Cost and Time: Traditional custom orthotics require a lengthy process of casting, lab fabrication, and multiple office visits. This often results in a high cost for the patient and a significant wait time for the finished product. Atlas Biomechanics’ heat-moldable orthotics eliminate this long and costly process. By allowing for in-office fabrication, they provide a much more affordable and immediate solution, increasing patient satisfaction and compliance.

3. Thin Profile, Versatile Fit: Atlas Biomechanics manufactures its orthotic arch supports with a thin profile, typically around 1.3 mm. This design is a significant advantage, as it allows the orthotics to fit comfortably in a wide variety of footwear, from athletic shoes and ski boots to dress flats and heels. This versatility means patients don’t have to compromise on style to get the support they need.

4. Addressing a Range of Conditions: The ability to customize the orthotic’s shape makes it an effective tool for treating a number of common foot ailments. By providing a solid arch support and a firm heel cup, these orthotics can help manage:

• Plantar Fasciitis and Heel Spurs: By supporting the arch, they reduce the strain on the plantar fascia ligament.
• Achilles Tendinitis: They can help correct overpronation, which is often a contributing factor to Achilles pain.
• Low Back and Knee Pain: By addressing issues at the foundation of the body, such as leg length discrepancies or overpronation, they can improve overall body alignment and alleviate pain in the knees and lower back.

5. Re-moldable and Adaptable: A major benefit of heat-moldable technology is that the orthotics are reheat-formable. This means that if the patient’s foot shape or needs change over time, the orthotic can be reheated and remolded. This adaptability ensures a long-lasting and effective device that can be fine-tuned as part of ongoing care.

In conclusion, Atlas Biomechanics’ heat-moldable orthotics offer a professional-grade, custom solution that is both practical and effective. They allow practitioners to provide immediate, high-quality care, while offering patients a comfortable, versatile, and affordable path to pain relief and improved foot health.

Atlas Biomechanics manufactures heat moldable orthotics.

How Heel Lifts Treat Limb Length Discrepancy After Hip Replacement Surgery

 Hip replacement surgery is a life-changing procedure that can restore mobility and relieve chronic pain. However, a common post-operative challenge for some patients is a limb length discrepancy (LLD), where one leg ends up being slightly shorter than the other. This can occur due to a number of factors, including the type of implant used, the surgical technique, or pre-existing conditions. While a small discrepancy may go unnoticed, a more significant difference can lead to a cascade of biomechanical issues, including back pain, hip pain, and an altered gait.

A simple and effective solution exists to address this issue: Atlas Biomechanics' heel lift.

The Effects of Unequal Leg Length

When one leg is shorter, the body compensates in various ways to maintain balance. The pelvis tilts, the spine curves to one side (a functional scoliosis), and the shoulders may become uneven. This forced asymmetry places unnatural stress on the joints and muscles, particularly in the lower back, hips, and knees. This can lead to:

Chronic Pain: The uneven loading can cause chronic pain in the hips and lower back as the body struggles to adapt.

Gait:  A patient with limb length descrepancy may develop a limp or an inefficient walking pattern, which can increase the risk of falls and further joint stress.

Postural: Over time, the body’s compensatory mechanisms can lead to poor posture and muscular imbalances, affecting the entire kinetic chain.

How a Heel Lift Restores Harmony

A heel lift is a wedge-shaped insert placed inside the shoe of the shorter leg. By raising the heel, this seemingly minor adjustment has a profound impact on the body’s alignment and function.

1. Equalizing Leg Length: The primary function of the heel lift is to physically equalize the length of the two legs. By adding height to the shorter side, it brings the pelvis back into a level position. This foundational correction is the key to addressing all the subsequent issues.

2. Correcting Posture and Spinal Alignment: With the pelvis level, the spine can straighten, and the compensatory curves are no longer needed. This reduces the strain on the back muscles and vertebrae, often providing immediate relief from back pain and improving overall posture.

3. Restoring Natural Gait: When the legs are of equal functional length, the patient’s walking pattern becomes more symmetrical and fluid. The limp disappears, and the stride becomes more balanced, reducing the risk of falls and making daily activities more comfortable.

The Importance of Proper Diagnosis and Prescription

While heel lifts are an effective solution, their use requires a precise approach. A doctor or physical therapist will use specialized measurements, such as a standing X-ray or a scanogram, to accurately determine the exact leg length discrepancy.

Accurate Measurement: The height of the heel lift must be carefully calibrated to match the measured discrepancy. Using a lift that is too high or too low can be just as problematic as having no lift at all, as it could introduce new imbalances.

Gradual Introduction: In some cases, a professional may recommend starting with a slightly smaller lift and gradually increasing the height as the body adapts. This helps the muscles and joints adjust slowly and comfortably to the new alignment.

Part of a Comprehensive Rehabilitation Plan

It’s important to understand that a heel lift is a powerful tool within a broader rehabilitation strategy. While it addresses the physical discrepancy, a patient may also benefit from a physical therapy program to:

Strengthen Core Muscles: To support the new, corrected posture.

Improve Flexibility: To release tight muscles that may have developed during the period of LLD.

Retrain Gait: To help the patient relearn a normal, balanced walking pattern.

In conclusion, for patients facing limb length discrepancy after hip surgery, a heel lift is not just a shoe insert—it’s a critical component of their recovery. By restoring physical symmetry, it alleviates pain, corrects posture, and allows patients to regain the balanced, pain-free mobility that hip surgery was intended to provide.

Atlas Biomechanics manufactures heel lifts in several heights and materials. We produce cork heel lifts, rubber heel lifts, adjustable heel lifts and heel wedges here in the USA.

Significate Reduction of Achilles Tendonitis with Heel Lift Use

Insertional Achilles tendinopathy is a painful common condition, frequently called Achilles tendonitis among patients. One of the most effective treatment is to add a heel lift to the patient's shoe. This will decrease the stress of the Achilles from the calcaneus (heel) bone. 

In the February 2024, Orthopedic Journal of Sports Medicine had a study of the use of heel lifts among Achilles tendonitis patients. Their conclusion was; "using heel lifts not only improved symptom severity after 2 weeks but also immediately reduced pain during gait and had a positive impact on gait pattern and speed."

Atlas Biomechanics heel lifts for Achilles tendonitis are dispensed by the orthopedic, physical therapy and other medical professionals for several years with positive results. Professionals appreciate the different materials and heights available. Their heel lifts come in either rubber, cork or EVA. Heel lift corrections come in 3mm (1/8 inch), 6mm (1/4 inch), 9mm (3/8 inch) and 12mm (1/2 inch). The most common heel lift correction for Achilles tendonitis among our dispensing physicians is 6mm (1/4 inch) cork/rubber blend.

When dispensing a heel lift, one should place the lift under the patient's shoe insole, thus allowing the heel lift a more stable base and prevents it from moving. Normally, the medical professional will start with a 6mm correction in both limbs. If using only on the affected limb, lower back or knee pain can occur. As the patient starts to heal then the lifts are replaced with 3mm (1/8 inch) correction until the Achilles tendinopathy is 100% resolved.

Teri Green

Atlas Biomechanics

About Atlas Biomechanics: We are a woman owned sports medical manufacturer of heel lifts, foot pads and heat moldable orthotics.

How Heel Wedges Treat Over Pronation

 Heel wedges can help treat overpronation by providing an elevated angle to the heel, which encourages a more neutral foot position during walking or running. This elevation can reduce stress on the arch and help align the ankle and foot properly, decreasing excessive inward rolling of the foot. By promoting better biomechanics, heel wedges can enhance comfort and reduce the risk of injuries associated with overpronation.

Heel wedges can be particularly beneficial for individuals with flat feet or low arches, as they help provide additional support and cushioning. By redistributing weight across the foot and preventing excessive pronation, heel wedges can also alleviate discomfort and improve overall gait. Additionally, they can be used in conjunction with other treatments, such as physical therapy, for a comprehensive approach to managing overpronation.

The long-term benefits of using heel wedges include improved foot alignment, reduced risk of injuries associated with overpronation, decreased discomfort in the feet and lower limbs, and enhanced overall biomechanics during movement. Additionally, heel wedges can help alleviate conditions such as plantar fasciitis and shin splints by promoting a more natural gait and distributing weight evenly across the foot.

Varus/Valgus Heel Wedges can be used for pronation or supination problems of the foot and ankle. Heel Wedges are designed to help align the calcaneus (heel) during ambulation to limit excessive pronation or supination. They improve foot function by stabilizing weak, rotating ankles.

The valgus heel wedge is useful for patients with medial osteo-arthritis provided it is used with an understanding of the indications and its limitations. Research shows that patients with early medial compartment osteo-arthritis of the knee were treated with lateral heel wedges and were followed for a period of 7 years and 5 months to 12 years. Those who were treated with valgus heel wedges showed a significantly greater improvement in pain score than those treated with analgesics only.

Atlas Biomechanics heel wedges correct your foot posture and alleviate discomfort with our Heel Wedge, designed to address pronation (varus) or supination (valgus) issues. This 4-degree wedge gently tilts your foot, promoting proper alignment and reducing strain on your ankles, knees, and hips. Crafted from durable materials, it's lightweight and easily fits into most shoes, providing customized support for your unique needs. Whether you're an athlete, office worker, or simply seeking relief from foot pain, our Heel Wedge offers a practical solution. Enhance your comfort and stride with this versatile orthotic accessory. Fabricated from Urethane which will not compress over time. Will last for years.

How Heel Lifts Treat Achilles Tendoinitis

 Heel lifts can be a part of the treatment plan for Achilles tendonitis, but it's essential to note that they are just one component of a comprehensive approach. Achilles tendonitis requires a multi-faceted treatment strategy that typically involves rest, stretching, strengthening exercises, footwear adjustments, and sometimes medical interventions like physical therapy or even surgery in severe cases. Here's how you can incorporate heel lifts into the treatment plan:

Consultation with a Healthcare Professional: Before starting any treatment, it's crucial to get an accurate diagnosis from a healthcare professional. They can evaluate the extent of your Achilles tendonitis and recommend the appropriate treatment plan.

Understanding Heel Lifts: Heel lifts are inserts placed inside your shoes to elevate the heel slightly. They help reduce strain on the Achilles tendon by reducing the amount of stretch it experiences with each step.

Choosing the Right Heel Lifts: There are different types of heel lifts available, including over-the-counter inserts and custom-made orthotics. Your healthcare professional can advise you on the best type for your condition. The most common heel lift height to treat Achilles tendonitis is 6mm ( 1/4").

Gradual Adjustment: When you start using heel lifts, it's essential to gradually adjust to them. Begin by wearing them for short periods, and then gradually increase the duration as your comfort level improves.

Proper Footwear: Heel lifts work best when used in conjunction with supportive footwear. Choose shoes with good arch support and cushioning to further reduce strain on the Achilles tendon. Place the heel lift under the shoe's insole so it sits firmly. 

Stretching and Strengthening Exercises: Alongside heel lifts, it's crucial to incorporate stretching and strengthening exercises into your routine. Calf stretches and eccentric heel drop exercises can help improve flexibility and strength in the Achilles tendon and calf muscles.

Rest and Ice: Rest is crucial for allowing the Achilles tendon to heal. Ice packs can help reduce inflammation and pain. Apply ice to the affected area for 15-20 minutes several times a day, especially after activities that aggravate the tendonitis.

Monitor Progress: Keep track of your symptoms and progress over time. If you experience persistent pain or if your symptoms worsen, consult your healthcare professional for further evaluation and treatment adjustments. As the Achilles tendonitis starts to feel improved, many health professionals will dispense a shorter heel lift. If started with a 6 mm ( 1/4" ) lift, then switch out to a 3 mm ( 1/8" ) heel lift.

Remember, Achilles tendonitis can take time to heal, and it's essential to be patient and consistent with your treatment plan. Additionally, if you experience severe or persistent pain, consult your healthcare professional for personalized guidance and treatment recommendations.

Atlas Biomechanics manufactures heel lifts in heights of 3 mm ( 1/8" ), 6 mm ( 1/4" ), 9 mm ( 3/8" ) and 12 mm ( 1/2" ). 

Teri Green

Atlas Biomechanics