Efficacy of Heel Lifts for Managing Midportion Achilles Tendinopathy (The LIFT Trial): A Participant- and Outcome Assessor-Blinded Randomized Controlled Trial.

Abstract

OBJECTIVE: To evaluate the efficacy of heel lifts in people with midportion Achilles tendinopathy. DESIGN: This was a parallel-group randomized, sham-controlled, participant- and assessor-blinded trial conducted at a single center (Victoria University, Institute for Health and Sport, Melbourne, Australia). METHODS: One hundred and eight participants (38 females and 70 males; mean age, 48 years; standard deviation, 10 years) with midportion Achilles tendinopathy, diagnosed clinically and confirmed by ultrasound, were randomly allocated to either a heel lift (n = 54) or sham intervention (n = 54) group. The primary outcome was pain intensity (11-point numerical rating scale) at 12 weeks. Differences between groups were analyzed using an intention-to-treat approach with analysis of covariance. RESULTS: There was 100% follow-up of participants at 12 weeks. Pain intensity reduced by a mean of 3.7 points in the heel lifts group and 2.5 points in the sham intervention group. On average, there was a significant between-group difference in favor of heel lifts for reducing pain intensity (adjusted mean difference, -0.9; 95% confidence interval [CI]: -1.7, -0.2; P = .02), which approximated, but did not meet the predetermined minimum important difference of 1.5 points. The primary analysis was not robust to sensitivity analysis when controlling for expectation (adjusted mean difference -0.7; 95% CI: -1.5, 0.0; P = .06). CONCLUSION: In adults with midportion Achilles tendinopathy, heel lifts demonstrated greater efficacy than a sham intervention for reducing pain intensity at 12 weeks, but this benefit was small and may not be clinically meaningful. These results do not support the use of heel lifts for the primary management of Achilles tendinopathy. J Orthop Sports Phys Ther 2025;55(9):1-10. Epub 1 August 2025. doi:10.2519/jospt.2025.13422.