The effects of off-the-shelf in-shoe heel inserts on forefoot plantar pressure

Off-the-shelf heel inserts are used widely without adequate scientific information regarding their effects upon the forefoot. The aim of this study was to assess whether the use of in-shoe heel inserts affects the plantar pressure distribution under the forefoot. Thirty-five asymptomatic volunteers consented to participate. Six brands of off-the-shelf heel inserts were tested. Subjects walked along a 10 m walkway with no inserts and then with each pair of inserts, in a randomised order. The Pedar® system was used to record in-shoe plantar pressure data. The results confirmed that heel inserts increased pressure under the metatarsal heads and altered the biomechanics of the foot even in asymptomatic subjects. The findings suggested that heel inserts should be used with caution especially in people predisposed to foot problems. The classification of these inserts as an over-the-counter product may need to be reviewed.