Why Does My Heel Lift Inside My AFO or Shoe?

Your heel should normally remain fully seated at the back and bottom of a rigid ankle-foot orthosis and securely positioned inside the footwear.

Heel lift occurs when the heel repeatedly rises:

• Away from the bottom of the AFO
• Away from the rear of the brace
• Out of the heel section of the shoe
• Upwards when the knee bends
• Forwards during walking
• When the foot-drop support applies tension

A small amount of movement may occur with certain soft textile supports, but the foot should not repeatedly slide, rub or lose its stable position.

Persistent heel lift can reduce the effectiveness of the brace and may cause:

• Heel rubbing
• Blisters
• Pressure around the ankle bones
• Toe crowding
• The foot sliding forwards
• The calf section pulling away
• Poorer toe clearance
• The brace rotating
• Changes in knee position
• Reduced walking stability

NHS AFO fitting guidance consistently emphasises that the heel should be firmly positioned at the back and bottom of the orthosis before the straps are secured.

Is the Heel Lifting Inside the AFO or Inside the Shoe?

First, identify where the movement is occurring.

The heel is lifting inside the AFO

The heel moves away from the brace itself, even though the AFO may remain inside the shoe.

Possible causes include:

• The heel was not fully seated
• The ankle or heel-retaining strap is loose
• The AFO is too large
• The footplate is incorrectly positioned
• The foot cannot comfortably reach the intended ankle angle
• A sock is folded beneath the heel
• The shoe is pushing the brace forwards
• The foot is sliding inside the AFO
• The brace no longer matches the shape of the leg

The heel and AFO are lifting inside the shoe

The foot and brace remain together, but the complete unit moves inside the footwear.

Possible causes include:

• The shoe is too loose
• The shoe is too long
• The fastening is insufficient
• The heel counter is soft or collapsed
• The shoe is too deep around the heel
• The original insole has been removed unnecessarily
• The footwear is worn
• The shoe opening cannot be secured around the AFO

The heel is lifting with a textile support

A textile device may pull the forefoot upwards through an external strap rather than holding the heel inside a rigid shell.

Heel lift may occur when:

• Lifting tension is excessive
• The shoe is loose
• The foot is not securely fastened
• The attachment point is too high or incorrectly positioned
• The foot is being pulled upwards more strongly than the shoe can contain it
• The support is unsuitable for the amount of weakness or instability present

The solution depends on which of these movements is happening.

Refit the Brace From the Beginning

Do not try to correct heel lift by pulling one strap tighter while standing.

Sit in a stable chair and refit the complete system.

1. Open the footwear fully

Loosen:

• Laces
• Touch-close straps
• Zips
• Any adjustable tongue section

The shoe must open widely enough for the heel and AFO to reach the rear.

2. Check the sock

Make sure the sock:

• Is smooth
• Is dry
• Has no folds beneath the heel
• Has no bulky rear seam
• Extends above the brace edges
• Is the thickness normally used with the AFO

3. Position the foot inside the AFO

Guide the foot so that:

• The toes follow the footplate
• The foot is centred
• The ankle is not twisting
• No strap is trapped underneath
• The heel is directed towards the rear

4. Bend the knee

Bending the knee can help bring the heel backwards and downwards into the brace.

5. Press the heel back and down

The heel should contact:

• The bottom of the AFO
• The rear of the heel area
• The intended surface of the shoe

There should not be a large visible or palpable gap beneath or behind it.

6. Secure any ankle or heel-retaining strap

Fasten the lower strap while keeping the heel seated.

7. Secure the calf strap

The calf strap should stabilise the upper section without being used to force the heel down.

8. Fasten the footwear securely

Close the laces or straps around the foot and brace.

9. Stand carefully and test

Walk a short distance on a level surface and check whether the heel remains seated.

Why Is Bending the Knee Helpful?

When the knee is straight, tightness through the calf or Achilles area may pull the heel upwards.

Bending the knee can make it easier to:

• Bring the heel backwards
• Lower it into the brace
• Position the ankle more accurately
• Secure the retaining strap
• Avoid fastening the AFO around a lifted heel

Do not force the ankle into a position it cannot reach comfortably.

If the heel only reaches the bottom when substantial force is applied, the issue may involve:

• Limited ankle movement
• Calf tightness
• Spasticity
• A fixed plantarflexed position
• Pain
• An unsuitable AFO angle

This needs professional assessment rather than stronger strap tension.

Could the Ankle Be Too Stiff To Sit Fully in the AFO?

Yes.

Some AFOs are designed around a particular ankle position. If the ankle cannot reach that position, the heel may remain elevated.

This can occur with:

• Calf tightness
• Achilles tightness
• A fixed plantarflexion contracture
• Increased muscle tone
• Spasticity
• Joint stiffness
• Pain
• Swelling
• A change since the brace was supplied

Signs include:

• A persistent gap beneath the heel
• The toes being pushed forwards
• The calf section pulling away
• The foot feeling forced
• The heel immediately rising again
• The knee changing position when the heel is pushed down

Do not overtighten straps to force a stiff ankle into the brace.

A clinician may need to review:

• Ankle range of movement
• Stretching or physiotherapy
• The AFO angle
• Heel accommodation
• Whether a different brace design is needed

Is the AFO the Correct Size?

A brace that is too large may allow:

• Heel movement
• The foot to slide forwards
• Rotation
• Gaps around the ankle
• Excessive movement inside the shoe
• The calf section to sit incorrectly

A brace that is too small may prevent the heel from reaching its intended position because:

• The footplate is too short or narrow
• The ankle section is too restrictive
• The heel cup does not match the foot
• The toes are crowded
• The calf section is pulled forwards
• The foot cannot enter the brace fully

Do not move to a smaller size simply to hold the heel more firmly.

Use the measurement method for the exact product and check both the foot and lower-leg fit.

Make Sure You Have the Correct Left or Right AFO

Many rigid AFOs are supplied as separate left- and right-foot versions.

Using the wrong side can prevent the heel from sitting correctly because the:

• Footplate shape is reversed
• Ankle contours do not align
• Upright sits incorrectly
• Arch position does not match
• Brace rotates
• Foot is pushed towards one side

Check the label and product orientation before making other changes.

The Orthotix Ankle Foot Orthosis Extra is supplied in separate left- and right-foot variants.

Is the Footplate Lying Flat?

The AFO footplate should sit flat inside the shoe.

It may lift, buckle or move when:

• The shoe is too narrow
• The footplate is too wide
• The shoe has a curved internal base
• An insole beneath the AFO is uneven
• The footplate has not been trimmed correctly
• The shoe is too short
• The footplate is damaged
• Debris is trapped underneath

A distorted footplate can tip the brace and prevent the heel sitting down.

Remove the AFO from the shoe and check that:

• The base is clean
• The footplate lies flat
• It is not curled
• It is not cracked
• It is positioned fully towards the rear
• The shoe does not squeeze its sides

Do not trim or heat the AFO yourself unless this has been specifically authorised and you are suitably qualified.

Can a Footplate That Is Too Long Cause Heel Lift?

Yes.

If the footplate presses against the front of the shoe, it may prevent the complete AFO from sitting fully backwards.

This can cause:

• The brace to move forwards
• The heel to lift
• Toe crowding
• The calf section to pull away
• Difficulty fastening the shoe

The Ankle Foot Orthosis Extra has a trimmable footplate, but trimming should preserve the correct shape and support. Significant adjustment is best completed by an orthotist or another suitably qualified professional.

Can a Footplate Be Too Short?

A footplate that has been excessively shortened may provide less control beneath the foot and allow movement within the footwear.

Do not continue trimming a footplate merely because fitting is difficult.

The issue may instead involve:

• Shoe width
• Shoe depth
• Shoe length
• Heel height
• Insole thickness
• AFO positioning

Is the Footwear Too Loose?

Loose footwear is a common cause of heel lift.

The shoe should hold the:

• Foot
• AFO
• Heel

together as one stable unit.

A shoe may be too loose if:

• The heel rises with every step
• The shoe slips off
• The fastening reaches its limit without becoming secure
• The foot slides forwards
• There is excessive space behind the heel
• The AFO moves from side to side
• The shoe feels unstable during turning

Secure lace-up or adjustable touch-close footwear is generally more suitable than loose slip-ons or backless shoes for an in-shoe AFO.

Is the Shoe Too Long?

A much longer shoe is sometimes chosen to create space for an AFO, but additional length can worsen heel movement.

An excessively long shoe may:

• Allow the foot to slide forwards
• Leave space behind the heel
• Make the heel counter ineffective
• Increase the chance of catching the toe
• Allow the AFO to move
• Affect walking stability

The extra space often needs to come from:

• Greater width
• Greater depth
• A wider opening
• Adjustable fastening
• A removable insole

rather than substantially more length.

Can the Shoe Be Too Tight and Still Cause Heel Lift?

Yes.

A tight shoe may squeeze the AFO and prevent it from reaching the rear of the footwear.

It may also:

• Distort the footplate
• Push the brace forwards
• Compress the sides of the foot
• Prevent the heel from dropping down
• Crowd the toes
• Make the laces difficult to secure correctly

The shoe should be wide and deep enough for the foot and AFO without distortion.

Check the Heel Counter

The heel counter is the structured rear section of the shoe.

A stable heel counter helps:

• Hold the heel
• Control movement
• Keep the shoe on the foot
• Stabilise the AFO
• Reduce rubbing

Heel lift is more likely with:

• Backless footwear
• Soft slippers
• Collapsed shoe backs
• Stretch-only heel sections
• Worn trainers
• Shoes repeatedly stepped into without opening the fastening

Choose footwear with an enclosed and supportive rear section.

Fasten the Shoe, Not Just the AFO

A correctly fitted brace may still move if the shoe is not secured.

Laces or touch-close straps should be tightened progressively from the front of the foot towards the ankle.

The footwear should feel:

• Secure
• Stable
• Comfortable
• Free from painful pressure
• Tight enough to hold the heel
• Loose enough to avoid numbness or swelling

Do not leave the shoe loose because the AFO already feels firm.

The brace and shoe perform different roles.

Could Removing the Shoe Insole Cause Heel Lift?

Possibly.

Removing a removable insole can create useful space for an AFO, but it can also make the footwear too deep around the heel.

This may leave:

• Excess vertical space
• Less heel contact
• A loose fit
• The foot lower than the shoe was designed for
• A different relationship between the heel and fastening

If the shoe becomes too loose after the insole is removed, it may require:

• Different footwear
• A thinner compatible insole
• Professional footwear adjustment
• A review of the AFO and shoe combination

Do not add random heel lifts or thick insoles without advice, as these can change the AFO angle and knee position.

Does Heel Height Matter?

Yes.

An AFO is designed to work with a particular relationship between the heel and forefoot.

A shoe with a very different heel height may alter:

• The ankle angle
• The position of the heel
• The pressure beneath the footplate
• Knee movement
• Balance
• The way the brace sits against the calf

Heel lift may occur when the footwear pitch does not suit the AFO.

Avoid switching between very different shoe heel heights without checking the fit and walking pattern.

Should You Use a Heel Grip Inside the Shoe?

Ordinary adhesive heel grips are not always appropriate with an AFO.

They may:

• Take up space in the wrong area
• Push the heel forwards
• Alter the brace position
• Create pressure
• Detach during use
• Increase rubbing

A small footwear adjustment may occasionally be recommended by a qualified professional, but improvised additions should not replace assessment of the actual cause.

Would a Heel-Retaining Strap Help?

A heel-retaining strap may help when the foot is correctly sized and positioned but requires additional support to remain fully seated.

The strap normally passes across the ankle or heel area to help:

• Hold the heel backwards
• Reduce upward movement
• Keep the foot aligned with the AFO
• Improve stability
• Reduce rubbing caused by repeated motion

The Ankle Foot Orthosis Extra includes an optional heel-retaining strap for wearers who need additional stability.

A heel strap is less likely to solve the problem when:

• The shoe is too large
• The AFO is the wrong size
• The ankle cannot reach the intended position
• The footplate is distorted
• The footwear is pushing the AFO forwards
• The brace is worn or damaged

The strap should hold the heel rather than painfully compress the front of the ankle.

How Tight Should a Heel-Retaining Strap Be?

It should feel secure without causing:

• Pain
• Numbness
• Tingling
• Deep marks
• Swelling
• Skin pinching
• Pressure over tendons
• Restricted circulation

The strap should lie flat and any padding should remain centred.

Do not tighten it progressively throughout the day without first checking whether swelling or movement is changing the fit.

Why Does My Heel Lift More When I Bend My Knee?

Knee bending changes tension through the calf, Achilles tendon and ankle.

Heel lift during sitting, stairs or crouching may indicate:

• Calf tightness
• Limited ankle range
• The AFO ankle angle is unsuitable
• The heel strap is loose
• The footwear is not holding the rearfoot
• The brace is moving inside the shoe
• The AFO is too rigid for the available movement

Some movement may be more obvious during:

• Walking uphill
• Climbing stairs
• Sitting down
• Rising from a chair
• Squatting
• Entering a car

A professional gait assessment may be needed if heel lift appears during specific parts of walking rather than during simple standing.

Why Does My Heel Lift Only When Walking Quickly?

Faster walking increases the forces acting through the foot and brace.

Heel lift may become noticeable because:

• The shoe fastening is insufficient
• The AFO moves during swing
• The foot slides forwards
• Lifting tension is excessive
• Calf tightness becomes more influential
• The brace does not provide enough control
• The wearer’s gait changes with speed

Do not simply tighten every component before walking faster.

The support may require reassessment for the activity level involved.

Can Textile Foot Drop Supports Cause Heel Lift?

Yes.

A textile support such as Boxia® or StepUp® applies upward assistance to the front of the foot.

If the shoe is not secure, the lifting force may raise the heel rather than improving toe clearance.

Check that:

• The shoe has an enclosed heel
• The fastening is secure
• The shoe is the correct length
• The lifting strap is not excessively tight
• The footwear attachment is centred
• The foot is not being pulled diagonally
• The heel remains in contact with the shoe

Boxia uses an adjustable elastic traction strap connected to suitable footwear and does not occupy the same in-shoe space as a rigid footplate.

StepUp uses a textile strap system that can provide dorsiflexion assistance with or without footwear.

Could the Lifting Strap Be Too Tight?

Yes.

Excessive lifting tension may:

• Pull the forefoot sharply upwards
• Lift the heel
• Distort the shoe
• Pull the cuff down
• Cause pressure over the ankle
• Make standing less stable
• Change foot contact with the ground

Use the minimum tension required to provide useful toe clearance.

If very strong tension is needed, the device may not provide sufficient structural control for the presentation.

Could the Lifting Strap Be Too Loose?

A loose strap usually causes inadequate toe clearance rather than heel lift, but it may allow:

• Delayed support
• Strap movement
• Uneven pulling
• The attachment to shift
• The foot to move unpredictably

The complete support should be adjusted while seated and tested over a short, familiar distance.

Can Swelling Cause Heel Lift?

Yes.

Swelling can change the fit of the foot, ankle, brace and shoe during the day.

The shoe may become tighter across the forefoot while the heel position changes.

Signs include:

• Increasing strap marks
• Difficulty fastening the shoe
• Toe pressure
• A throbbing sensation
• Numbness
• The brace becoming difficult to remove
• The heel sitting differently later in the day

Repeated swelling should be assessed rather than managed only by changing strap tension.

Seek prompt medical advice if swelling is sudden, severe, painful or associated with a major change in skin colour or temperature.

Can Weight Loss or Muscle Loss Affect Heel Position?

Yes.

Changes in foot or leg volume can make a previously suitable AFO loose.

This may follow:

• Weight loss
• Muscle wasting
• Reduced swelling
• Neurological change
• Surgery
• Prolonged illness
• Changes in activity

The brace may then require:

• New straps
• Professional padding
• Modification
• Replacement
• A different design

Do not add thick foam or folded socks to fill the space yourself.

Can Weight Gain Make the Heel Sit Incorrectly?

Yes.

Increased foot, ankle or calf volume may prevent the brace from reaching its intended position.

The AFO may feel extremely tight while the heel remains lifted.

Signs include:

• Straps barely reaching
• The ankle sitting too far forwards
• Shoe fastening becoming difficult
• Toe crowding
• Pressure around the ankle
• The heel immediately rising again

A larger brace is not automatically the correct solution. The complete fit and control requirements need to be reviewed.

Could the Brace Be Worn or Damaged?

Inspect the AFO for:

• Cracks
• White stress marks
• A warped footplate
• Loose rivets
• Worn straps
• Compressed padding
• Weak touch-close fastening
• Sharp edges
• A heel strap that has stretched

Inspect the shoe for:

• A collapsed heel counter
• Worn lining
• A compressed sole
• Broken fastening
• Uneven wear
• A stretched opening

A previously stable heel may begin lifting when either the brace or footwear deteriorates.

Can Heel Lift Cause Red Marks?

Yes.

Repeated vertical movement can create friction around:

• The heel
• The Achilles area
• The ankle bones
• The front of the ankle
• The calf strap
• The top of the foot

Remove the brace and inspect the skin if movement occurs.

Light temporary marks may occur with a close-fitting orthosis, but persistent redness, pain, blisters or broken skin require review.

Why Do My Toes Hit the End of the Shoe?

Heel lift and forward sliding often occur together.

When the heel rises, the foot may travel forwards and cause:

• Toe pressure
• Nail irritation
• Rubbing
• Curling of the toes
• Crowding against the shoe
• Reduced walking comfort

Do not automatically buy a much longer shoe.

First check:

• Heel position
• Fastening
• Shoe width and depth
• AFO size
• Footplate position
• Whether the ankle can sit correctly

Can Heel Lift Affect the Knee?

Yes.

An AFO influences the relationship between the foot, ankle and lower leg.

When the heel is not seated, the effective angle of the brace may change and contribute to:

• Knee hyperextension
• The knee feeling less stable
• Altered stride length
• Hip hiking
• Increased fatigue
• Reduced balance

The Royal National Orthopaedic Hospital and other NHS orthotic services note that an AFO may influence posture and joints above the ankle, so fit problems should not be treated as isolated footwear issues.

When Should You Stop Using the AFO?

Stop and obtain advice if heel lift is accompanied by:

• Persistent pain
• Blistering
• Broken skin
• Numbness
• Tingling
• Swelling
• Skin discolouration
• A cold foot
• An unusually hot area
• Increasing toe pressure
• Loss of balance
• Worsening knee control
• More trips or falls

Do not continue tightening the brace over a damaged or painful area.

Do Not Modify the Brace Yourself

Avoid:

• Heating the plastic
• Cutting the heel area
• Grinding the footplate
• Drilling new strap holes
• Gluing in foam
• Adding folded socks
• Using safety pins
• Shortening straps with knots
• Adding an ordinary footwear heel lift
• Bending carbon components

A small alteration can change:

• Foot position
• Ankle angle
• Knee movement
• Pressure distribution
• Shoe fit

Contact the supplier or an orthotist where adjustment is needed.

When Should the AFO Be Professionally Reviewed?

Arrange a review if:

• The heel cannot be fully seated
• It lifts despite correct fitting
• The ankle feels forced
• The foot slides forwards
• The toes repeatedly hit the shoe
• A heel strap does not solve the movement
• The shoe cannot be fastened securely
• The AFO appears too large or small
• The brace has become damaged
• The fit has changed with swelling or weight
• The knee feels different
• Walking has become less stable
• Spasticity or stiffness has increased
• The AFO was custom-made or prescribed

Take the following to the appointment:

• The AFO
• Your usual socks
• Your regular footwear
• Any replacement straps
• A second shoe option where available

The problem should be assessed as a complete brace-and-footwear system.

Simple Heel-Lift Checklist

Before walking, confirm that:

• You have the correct AFO and side
• The sock is smooth
• The foot is centred
• The heel is fully back and down
• The ankle or heel strap lies flat
• The calf strap is secure
• The footplate lies flat
• The AFO sits fully inside the shoe
• The shoe is the correct length
• The shoe is wide and deep enough
• The heel counter is supportive
• The footwear fastening is secure
• The insole arrangement is appropriate
• Textile lifting tension is not excessive
• The heel remains down over several steps
• There is no pain, rubbing or numbness

Recommended AFO With Optional Heel Retention

The Ankle Foot Orthosis Extra, SKU AFX, is a reinforced prefabricated leaf-spring AFO designed to assist dorsiflexion in suitable cases of flaccid foot drop.

Its features include:

• Injection-moulded polypropylene construction
• Carbon-fibre composite reinforcement
• A low-profile leaf-spring design
• A trimmable footplate
• An open heel
• A detachable padded calf band
• An optional heel-retaining strap
• Separate left- and right-foot versions
• Small through X Large sizing
• Compatibility with suitable supportive footwear

The optional heel-retaining strap may help keep the foot positioned for a suitable wearer, but the AFO must still be correctly sized and used with secure footwear.

The brace contains latex.

It is intended for appropriate flaccid-foot-drop presentations and may not provide sufficient control for significant spasticity, fixed ankle restriction, severe side-to-side instability or complex knee involvement.

Can an AFO Cure Foot Drop?

No.

An AFO assists or controls the foot while it is being worn. It does not repair the nerve, muscle, brain or spinal condition causing the weakness.

Treatment may also involve:

• Physiotherapy
• Investigation of nerve compression
• Functional electrical stimulation
• Treatment of an underlying neurological condition
• Falls prevention
• Walking aids
• Surgery in selected cases

The NHS lists braces and splints among the possible treatments used to hold the foot in a more suitable position.

When Should Foot Drop Be Medically Assessed?

Arrange a GP appointment if you have difficulty lifting the front of your foot or toes, particularly when the weakness is new, unexplained or worsening.

Seek further assessment if:

• Both feet are affected
• Numbness is increasing
• Weakness is spreading
• You are tripping more frequently
• Your brace has become less effective
• Symptoms followed surgery or injury

Call 999 if sudden weakness occurs with:

• Facial drooping
• Arm weakness
• Slurred or confused speech

Seek urgent medical assessment if new foot or leg weakness occurs with:

• Severe or worsening back pain
• Numbness around the genitals or buttocks
• Difficulty starting or controlling urination
• Loss of bladder or bowel control
• Rapidly worsening weakness

Do not rely on tighter footwear or an AFO strap to manage a new or progressive neurological change.