If you’re dealing with Achilles tendinopathy, you’re probably willing to try anything that promises relief—ice, exercises, massage guns, or maybe even orthotics. As a physiotherapist, I get a lot of questions about shoe inserts: Are they worth it? Do they speed up recovery? Should I be using them long-term?
The short answer is: orthotics can be helpful for some people in certain situations, but they’re not a cure-all. In this post, I’ll break down what the research says, how long they help for, and whether custom orthotics are better than store-bought options.
Understanding Achilles Tendinopathy
Achilles tendinopathy refers to irritation, degeneration, or thickening of the Achilles tendon. It’s typically caused by overuse, repetitive loading, or sudden spikes in activity, common in runners, walkers, and people who spend long hours on their feet.
Symptoms usually include pain and stiffness in the back of the ankle, especially with walking, running, or getting out of bed in the morning. The condition is load-sensitive, meaning how much strain you put through the tendon can either help or hinder healing.
Why Orthotics Might Help
Orthotics are inserts that go into your shoes to change how force is distributed through your foot and lower leg. For Achilles tendinopathy, the potential benefits include:
✅ Load Modification
Orthotics can slightly alter ankle mechanics to reduce strain on the Achilles tendon, especially during walking and running. Some designs aim to reduce dorsiflexion (upward ankle movement), which can decrease tendon loading during heel strike and push-off.
✅ Heel Lifts and Offloading
Inserts with heel lifts can temporarily shorten the Achilles tendon, reducing the stretch and force through it. This can give the tendon a chance to settle during a flare-up or while starting a loading program.
✅ Support for Overpronation
For patients with excessive foot pronation (flattening of the arch), orthotics may help stabilize the foot and ankle, potentially reducing abnormal tendon stress. But this only applies to people who actually have that mechanical issue—it’s not a universal fix.
👉 This systematic review (2018) in the British Journal of Sports Medicine found that foot orthoses can help with pain and function in Achilles tendinopathy, but effects vary by individual.
How Long Do Orthotics Actually Help?
This is a common question—and the answer isn’t crystal clear. Most of the benefits from orthotics appear to be short-term. In many studies, symptom relief tends to occur within 6 to 12 weeks, especially when orthotics are combined with a gradual exercise program.
However, the long-term benefits fade if orthotics are used in isolation. As the tendon becomes more resilient through loading and strengthening, the need for offloading support generally decreases. In other words, orthotics may help you get through the painful phase, but they’re unlikely to solve the problem alone.
If you’re still relying on orthotics six months in without doing any rehab, it’s time to reassess the plan.
Are Custom Orthotics Better Than Over-the-Counter?
This is where it gets interesting. Custom orthotics are often more expensive, but the research doesn’t consistently show they’re more effective.
Several studies—including a 2021 review in The Journal of Foot and Ankle Research—have found minimal clinical differences between custom and prefabricated orthotics for conditions like Achilles tendinopathy. For many patients, a well-fitting off-the-shelf insert combined with activity modification is just as effective.
The exception? People with significant structural or biomechanical issues (like a leg-length discrepancy or severe foot deformity) might benefit more from a custom design.
👉 Here’s the full 2021 review on orthotics from JFAR
What the Research Shows
The evidence is mixed but cautiously supportive. Here’s a quick snapshot:
- Morrison et al. (2021) concluded that custom or prefabricated orthoses may reduce pain and improve function in the short term, especially when used alongside rehab. (PubMed)
- Silbernagel et al. (2015) emphasized that loading programs are the foundation of rehab, and orthotics should be considered an adjunct treatment.
- A 2022 RCT in Foot & Ankle International showed that heel lifts offered short-term pain relief but didn’t show sustained benefits past 12 weeks. (FAI Journal)
When Orthotics Are Worth Considering
Orthotics might be helpful if:
- You have a high pain level that limits walking or daily activity
- You’re struggling to tolerate an eccentric loading program
- You have clear foot mechanics issues like overpronation or leg-length asymmetry
- You’re in the early stage of a tendinopathy flare-up
When They Might Not Be Necessary
Orthotics are probably not worth the time or expense if:
- You’re already tolerating exercise well
- Your pain is mild and improving
- You don’t have any obvious foot or gait issues
- You’re using them as your only strategy instead of addressing tendon loading
Final Thoughts
Orthotics can provide useful support for Achilles tendinopathy, especially early on. They help reduce strain, offload the tendon, and may ease pain so you can stay active. But they’re not a long-term solution, and the evidence doesn’t strongly favor custom over off-the-shelf options for most people.
If you decide to use orthotics, use them as part of a broader rehab plan—not instead of one. Long-term progress comes from loading, strengthening, and staying active, not just supporting your feet.
