Part of Achilles tendinopathy
Achilles tendonitis shoes and heel lifts: what actually matters
Warning signs, and when to get help
Do shoes matter with Achilles tendonitis, and what actually changes?
They matter for comfort and for how much the tendon is asked to do between exercise sessions. They do not heal anything, and the loading program is still the treatment.
Two things happen to an Achilles tendon inside a shoe. One is the amount it has to lengthen and work as you push off, which a heel height changes. The other is pressure, and this is the part shoe guides miss. At the tendon insertion, compressive forces on the tendon and the heel bone from footwear, or from activities that put the ankle in a bent-up position such as running uphill, may contribute to the development of pain (Silbernagel and colleagues, 2020). So the back of the shoe is not a comfort detail when your pain is on the bone.
So there is a short list to check, and nothing else on a shoe box tells you much:
- Some heel height rather than a flat sole.
- A back that does not press on the sore spot.
- Enough cushioning for the floors you actually walk on, particularly first thing.
- A shoe you have worn for months, which asks nothing new of the tendon.
None of those is a brand. We name no brands, models, retailers or prices anywhere on this site, and in this case that restriction is also the honest answer: the published advice is about features, not products.
What to look for in a shoe
The Guy's and St Thomas' NHS leaflet advises supportive footwear rather than flat shoes, and heel height is where to start. For pain at the very back of the heel, the Kent Community Health NHS leaflet goes further and names a figure: avoid flat shoes and wear shoes with a 2 cm heel, which the leaflet also gives as three quarters of an inch. Keep those two statements separate in your head, because one is general footwear advice for Achilles tendinopathy and the other is a heel height for insertional pain specifically, which is not a running shoe specification.
Then the back of the shoe, the part that wraps your heel. AAOS OrthoInfo says shoes that are softer or open at the back of the heel can reduce irritation. If pressing the back of your heel is what you notice most, a stiff heel counter is the thing to change, and a shoe that is open at the back, or soft and flexible there, is often an immediate improvement. This is also why the smartest shoe in the wardrobe is frequently the worst one.
Cushioning is judged against your own floors, not the carpet in a shop. The NHS heel pain advice is wide, comfortable shoes with a low heel and a soft sole, plus soft insoles or heel pads, and it warns against walking or standing for long periods, especially barefoot. Hard tile and wood floors at home do more of the day's loading than most people expect, and a cushioned slipper by the bed earns its place. Morning pain, night splints and sleeping with Achilles tendonitis covers the first steps of the day in detail.
Fit at the heel is the last thing to check. A shoe that slips at the heel makes the tendon work harder to keep it on, and a shoe that grips too tightly rubs the sore spot. Neither is good, and the test is a short walk rather than standing still in a shop.
Do heel lifts help, and how do you use one?
They help some people feel better while the tendon settles, and this is the one piece of footwear advice on the page with a randomized trial behind it. Rabusin and colleagues (2021) gave 100 people with midportion Achilles tendinopathy either 12 mm in-shoe heel lifts for both feet or an eccentric calf exercise program, for 12 weeks. The lift group improved more on the Achilles symptom score, by 9.6 points, which fell just short of the 10 point difference the researchers had decided in advance would be the smallest a patient would notice. Their conclusion was careful: there is uncertainty in that estimate and patients may not feel a worthwhile difference between the two.
The 2024 US clinical practice guideline lists heel lifts as an option on weak evidence, and describes what they do in one useful phrase: they temporarily reduce how far the ankle bends up during activity (Chimenti and colleagues, 2024). Temporarily is the operative word. A lift is something to use while the tendon settles, not a permanent change to every shoe you own.
The trial ran 12 weeks, it compared a lift against a program, not against nothing, and it does not tell you how either group's calf strength looked a year later. Strength is what readiness for running and sport gets judged on, so a lift is worth trying and the loading program stays.
The Dutch multidisciplinary guideline is more reserved than that trial. It starts treatment with education, loading advice and progressive calf muscle strengthening exercises for at least 12 weeks, and lists inlays among the extra options to consider only when 3 months of that has not helped, with the uncertainty about what they add discussed openly instead of glossed over (de Vos and colleagues, 2021).
OrthoInfo says heel lifts can take some strain off the tendon. The Kent leaflet suggests a silicone heel cushion or cup for insertional pain. Silbernagel and colleagues (2020) describe limiting how far the ankle bends up by putting a lift under the heel while doing the heel raises themselves, and give that lift as 0.5 to 1 inch, which they convert to 1.3 to 2.5 cm.
Four heel heights have now appeared on this page and they are not interchangeable, so here is which is which. Supportive rather than flat is general footwear advice for Achilles tendinopathy and carries no figure at all (Guy's and St Thomas'). A 2 cm heel, which the leaflet also gives as three quarters of an inch, is a shoe heel height for pain at the insertion specifically, meant to cut the compression between tendon and heel bone (Kent).
A 1.3 to 2.5 cm lift under the heel is a prop used during a heel raise to stop the ankle bending up so far, not something worn through the day (Silbernagel and colleagues, 2020). And 12 mm is the thickness of the in-shoe lift one trial issued to people with midportion pain, worn in both shoes for 12 weeks (Rabusin and colleagues, 2021). Taking the figure from the wrong row is how somebody with insertional pain ends up copying a midportion trial, or wearing an exercise prop to work.
A lift on one side only tilts your pelvis at every step, and the new ache in the back or the other knee a fortnight later is not a coincidence. So use one in both shoes. The Kent leaflet says this plainly, to avoid a leg length discrepancy that could cause back pain, and the trial above issued its lifts for both feet rather than for the sore side only.
If you have diabetes or reduced feeling in your feet, a new lift, cushion or insole changes where the pressure sits inside a shoe, and a foot that cannot feel rubbing can break the skin before you notice. Have it fitted by your podiatrist or foot team, check your skin daily for the first couple of weeks, and read the diabetes lines on the warning list at the end of this page, which say what to act on and how fast.
Expect it to change symptoms rather than to settle the whole problem. The trial measured pain and function at 12 weeks, not a cure, and nothing we can cite says a lift prevents a rupture, rebuilds calf strength or shortens the overall course.
How long to keep it in has no clear answer in the sources. The trial fitted lifts for 12 weeks, and in practice they are used while symptoms are settling and then reduced gradually, in the same spirit as any other temporary support, with your physio or podiatrist setting that. If you have had one in for months and the tendon is no better, that is a reason to get reassessed, not to buy a thicker one. Why Achilles pain is not getting better works through the usual reasons.
Custom insoles, taping and other orthoses come up in the same conversation. They are things a physio or podiatrist may assess and may use, and we are not going to put a type, a dose or a promise against them here, because the sources we cite do not support one.
Which shoes make Achilles pain worse?
Roughly in the order they turn up in clinic: nothing at all is the one most people have not counted as footwear. Barefoot on a hard floor is where it bites, and the NHS advice for heel pain specifically warns against long spells of standing or walking with nothing on your feet. Completely flat shoes come next while the tendon is sore, and both NHS leaflets steer away from them.
A firm, high back is pressure straight onto the painful spot, hour after hour, when the pain is on the bone at the back of the heel. Then there is the shoe you bought this week, which changes the geometry under your foot so that the tendon has to adapt to that on top of everything else. What a shoe cannot do needs saying as well: no shoe treats or cures a tendinopathy, and no shoe protects a tendon from tearing.
Insertional pain and the back of the shoe
If your sore spot is on the bone at the very back of the heel, rather than in the cord of the tendon a few centimeters higher, the shoe advice shifts from heel height alone to heel height plus pressure. Bone spurs often form on the back of the heel with insertional Achilles tendinitis (OrthoInfo), which is part of why the back of a shoe is so often the thing a reader notices. The Kent leaflet also advises avoiding walking uphill or on inclines and sticking to flat ground, for the same reason: a bent-up ankle presses the tendon into the bone. Insertional or midportion Achilles tendinopathy explains how to tell which you have and why the handling differs, and heel drops explained covers the exercise change that goes with it, including keeping the calf raise on a step at step level rather than letting the heel sink below it.
Changing shoes without setting the tendon off
Overlap the old and the new pair instead of retiring the old one. A new shoe for the shorter walks and the familiar pair for the long days gives the tendon a gradual introduction, and if the tendon gets stiffer in the mornings you know which pair to blame. Change one thing at a time, keep it for two weeks, and take your reading the next morning rather than at the end of the first day, which tells you very little. Going flatter is the change to make slowest of all, and the one not to make while the tendon is sore at all.
Indoors counts as footwear too. If you are home all day on hard floors, what you put on in the morning matters more than the shoe you wear for an hour outside. For running shoes specifically, the training week and the surface interact with all of this, and Achilles pain when running covers that side. If your pain is under the heel rather than behind it, heel pain in the morning and the plantar fasciitis program are the better pages, because the footwear priorities are not identical.
When to see a physio, podiatrist or doctor
See a physio (physical therapist), podiatrist or doctor if the pain is severe, stops you walking normally, keeps getting worse, or has not improved after a few weeks of looking after it yourself. A clinician can confirm whether the sore spot is the insertion or the midportion, which changes the shoe advice, and can look at a lift or an insole on your actual foot rather than in theory.
Footwear history is the part of the story that usually goes unsaid: what you stand on all day, what you wear indoors, and whether anything about your shoes changed in the weeks before the pain started. That last one explains a surprising number of sore tendons and almost nobody volunteers it. The warning signs below have their own timings and those come first, ahead of any shopping.
Related exercise programs
Warning signs
Get emergency help now
- You felt a sudden pop or snap at the back of your ankle, it felt as if someone hit or kicked you in the calf, or walking or rising onto your toes on that leg suddenly became weak or difficult. Stop exercising and go to an urgent care center or emergency department the same day, even if you can still walk, as this can be a torn (ruptured) Achilles tendon. This page does not cover a rupture.
Get help now, day or night
- Your tendon pain or swelling started while you were taking a fluoroquinolone antibiotic, such as ciprofloxacin or levofloxacin, or in the months after a course. Contact your doctor straight away. The UK medicines regulator (MHRA) advises stopping the antibiotic at the first sign of tendon pain or swelling and talking to your doctor. Hold off the calf exercises until you have been checked.
Get help today
- A calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
- The tendon or heel is hot, red and swollen, or you have a fever or feel unwell. Get medical help the same day, and go to an emergency department if you feel very unwell. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- The pain started with a fall or a blow to the back of the ankle, and there is bruising or you cannot put weight on the foot. Get it checked the same day.
- Same day: you have diabetes or numb feet and find a new blister, cut or sore on your foot, especially one you did not feel, a wound that smells or is leaking, or new pain in your foot that you cannot explain. Get it seen by your doctor or foot team the same day. If you also have a fever or feel very unwell, redness is spreading up your foot or leg, or part of your foot or a toe turns black, go to an emergency department.
- Same day: a burn, a scald or a blister on your foot or lower leg from hot water, a hot floor or pavement, a hot water bottle, an electric blanket, a heat pad, or sitting with your feet near a fire or radiator. Keep your weight off that foot and get it seen by your doctor or foot team the same day, however small the mark looks and even if it does not hurt. A foot that cannot feel heat can be burned deeply before you notice, and a burn on a numb foot can turn into an ulcer. If you also have a fever or feel very unwell, redness is spreading up your foot or leg, or part of your foot or a toe turns black, go to an emergency department.
- The pain is there at night or at rest as well as with activity and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Your heel or Achilles pain comes with back pain and stiffness that is worse in the morning and at night, or with painful, swollen joints elsewhere, or both heels became painful without an obvious reason. The same applies if you also have psoriasis, Crohn's disease or ulcerative colitis, or have had a red, painful, inflamed eye (iritis). This is not an emergency, but see your doctor in the next week or two, as it can be a sign of an inflammatory arthritis such as ankylosing spondylitis.
- You have numbness, tingling, burning or loss of feeling in the foot, often along the outer edge. Book an assessment with a doctor or physio in the next week or two. If it came on over hours or days, started after an injury, is spreading, or comes with weakness in the foot, get medical advice the same day.
- The pain is there at night or at rest as well as with activity and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- The pain is there at night or at rest as well as with activity and keeps getting worse. See your doctor within a few days.
Common questions
What shoes should I wear with Achilles tendonitis?
Something with a little heel, not a flat sole, a back that does not dig into the sore spot, a cushioned sole for hard floors, and a shoe you have already broken in. The Guy's and St Thomas' NHS leaflet puts it as supportive footwear rather than flat shoes. We do not recommend brands or models, partly because this site names no products and partly because the features above are what the advice is actually about. If you want one change that pays off quickly, it is usually having something on your feet indoors instead of going barefoot on tile or wood.
Do heel lifts help Achilles tendonitis?
More than we used to say. AAOS OrthoInfo says heel lifts can take some strain off the tendon, and a randomized trial has now tested them: 100 people with midportion Achilles tendinopathy were given either 12 mm in-shoe heel lifts for both feet or an eccentric calf exercise program, and at 12 weeks the heel lift group had improved more on the Achilles symptom score, by 9.6 points, a shade under the 10 point gap the researchers had set in advance as the smallest that would matter to a patient. Their own conclusion keeps the brakes on: there is uncertainty in that estimate, and patients may not notice a worthwhile difference between the two (Rabusin and colleagues, 2021). For pain at the very back of the heel, the Kent Community Health NHS leaflet suggests a shoe with a heel of about 2 cm, or a silicone heel cushion or cup, used in both shoes so you do not end up with one leg effectively longer than the other. Silbernagel and colleagues (2020) describe a different use again: a lift under the heel, 0.5 to 1 inch or 1.3 to 2.5 cm, to limit how far the ankle bends up during the heel raises themselves rather than through the day.
How much heel drop is good for Achilles tendonitis?
No clinical source we can cite gives a millimeter figure for shoe heel drop, and the numbers circulating in shoe guides come from product marketing rather than from a guideline. What is sourceable is the direction: the two NHS leaflets both steer away from flat shoes, and Kent names a heel of about 2 cm for pain at the back of the heel. That is a heel height for a specific type of Achilles pain, not a running shoe specification, so do not read the two as the same claim.
Are flat shoes or zero drop shoes bad for my Achilles?
They are the shoes the NHS leaflets advise against while a tendon is sore, which is not the same as calling them harmful in general. The point is change rather than morality: a sudden switch to a flatter shoe asks the calf and tendon for more at every step than they were used to. If you already live in flat shoes and your tendon is sore, adding a little heel for a few weeks is a reasonable thing to try. If you want to go flatter long term, do it when the tendon is quiet and over months rather than over a weekend.
Should I wear a heel lift in both shoes?
Yes. The Kent leaflet is specific about it: use one in both shoes to avoid a leg length discrepancy. A lift in one shoe only raises one hip relative to the other every time you take a step, and people turn up a fortnight later with a sore back or knee on top of the original problem. If a clinician has deliberately given you a single lift for another reason, follow them instead.
Can I wear flip flops or slippers with Achilles tendonitis?
Slippers with a cushioned sole and some heel are one of the more useful things to have by the bed. Flat, thin flip flops are the opposite: no heel, no cushioning, and your toes have to grip to keep them on. The NHS advice for heel pain is wide, comfortable shoes with a low heel and a soft sole, and it specifically warns against long spells of walking or standing with nothing on your feet. A backless slipper or a clog with some heel suits a sore insertion better than a shoe with a firm back pressing on it.
References
- Guy's and St Thomas' NHS Foundation Trust. Achilles tendinopathy. Patient information, resource number 4609/VER3. Last reviewed October 2024. https://www.guysandstthomas.nhs.uk/health-information/achilles-tendinopathy
- Kent Community Health NHS Foundation Trust. Achilles insertional tendinopathy. Patient leaflet 01271. Published 2 December 2024. https://www.kentcht.nhs.uk/leaflet/achilles-insertional-tendinopathy/
- American Academy of Orthopaedic Surgeons. Achilles tendinitis. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/achilles-tendinitis/
- Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. Journal of Athletic Training. 2020;55(5):438-447. https://doi.org/10.4085/1062-6050-356-19
- Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision - 2024. Journal of Orthopaedic and Sports Physical Therapy. 2024;54(12):CPG1-CPG32. https://doi.org/10.2519/jospt.2024.0302
- Rabusin CL, Menz HB, McClelland JA, Evans AM, Malliaras P, Docking SI, Landorf KB, Gerrard JM, Munteanu SE. Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (HEALTHY): a randomised trial. British Journal of Sports Medicine. 2021;55(9):486-492. https://doi.org/10.1136/bjsports-2019-101776
- Rabusin CL, Menz HB, McClelland JA, Evans AM, Landorf KB, Malliaras P, Docking SI, Munteanu SE. Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (the HEALTHY trial): study protocol for a randomised trial. Journal of Foot and Ankle Research. 2019;12:20. https://doi.org/10.1186/s13047-019-0325-2
- de Vos RJ, van der Vlist AC, Zwerver J, Meuffels DE, Smithuis F, van Ingen R, van der Giesen F, Visser E, Balemans A, Pols M, Veen N, den Ouden M, Weir A. Dutch multidisciplinary guideline on Achilles tendinopathy. British Journal of Sports Medicine. 2021;55(20):1125-1134. https://doi.org/10.1136/bjsports-2020-103867
- NHS. Heel pain. Page last reviewed 24 October 2025. https://www.nhs.uk/symptoms/foot-pain/heel-pain/
- National Institute for Health and Care Excellence. Diabetic foot problems: prevention and management. NICE guideline NG19. Published 26 August 2015, last updated 11 October 2019. https://www.nice.org.uk/guidance/ng19
- Medicines and Healthcare products Regulatory Agency. Fluoroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate. Drug Safety Update. 22 January 2024. https://www.gov.uk/drug-safety-update/fluoroquinolone-antibiotics-must-now-only-be-prescribed-when-other-commonly-recommended-antibiotics-are-inappropriate
- NHS. Deep vein thrombosis (DVT). Page last reviewed 30 April 2026. https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/
- NHS. Symptoms: Ankylosing spondylitis. Page last reviewed 5 January 2023. https://www.nhs.uk/conditions/ankylosing-spondylitis/symptoms/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-16.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.