Orthotics alone are unlikely to resolve Achilles tendonitis. A systematic review with meta-analysis found moderate to high level evidence of no difference in pain or function between people who used orthoses and those who didn’t. The strongest evidence points to exercise-based rehabilitation as the primary driver of recovery, with orthotics playing a supporting role at best. That said, the picture isn’t entirely black and white, and certain foot types may benefit more than others.
What the Evidence Actually Shows
The most rigorous look at this question comes from a meta-analysis that pooled results across multiple studies. Researchers found no meaningful improvement in pain or function when orthotics were added to a treatment plan for Achilles tendonitis. Based on that evidence, the authors recommended against using orthoses as a standalone treatment to improve pain and function.
A separate study tested custom foot orthoses against sham (fake) orthoses in people with midportion Achilles tendonitis who were also doing eccentric calf exercises. The custom orthotics performed no better than the shams. This is a telling finding: it suggests that when you’re already doing the right exercises, adding orthotics on top doesn’t move the needle.
That doesn’t mean orthotics are useless in every scenario. One study found that a short course of physiotherapy combined with arch-support insoles reduced pain in most patients within just four weeks, even without cutting back on running. The key detail is that the insoles were part of a broader program, not the sole intervention.
Why Orthotics Are Prescribed Anyway
The theory behind orthotics for Achilles tendonitis is straightforward. When your foot rolls inward excessively during walking or running (overpronation), it forces your heel bone to tilt outward. That tilt creates an uneven pull on the Achilles tendon, increasing strain on the tissue. Orthotics aim to correct that alignment and distribute the load more evenly.
There’s a biological reason to take overpronation seriously. Research measuring blood flow in the Achilles tendon found that people with overpronated feet had significantly reduced blood supply to the middle portion of the tendon compared to people with normal foot alignment. Poor blood flow to the tendon is one of the factors that makes it vulnerable to injury and slow to heal. So while orthotics may not directly fix tendonitis, correcting the mechanical problem that contributed to it has some logical basis, particularly for people whose foot mechanics are clearly off.
Who Might Benefit Most
If you have visible overpronation or flat feet, orthotics are more likely to play a useful supporting role. One practical way to test this before investing in custom devices: antipronation taping. A physical therapist can tape your foot to temporarily limit pronation. If your symptoms improve with the tape, that’s a reasonable predictor that orthotics will help you.
For people with neutral foot alignment and no obvious biomechanical issue, the evidence suggests orthotics won’t add much to your recovery. Your time and money are better spent on a structured exercise program.
Custom vs. Prefabricated Orthotics
Custom orthotics cost significantly more than off-the-shelf options and are inconsistently covered by insurance. A study comparing the two in 238 patients found that both groups reported significant improvement in pain and function from baseline. Custom orthotics scored slightly higher on patient satisfaction (8.1 out of 10 versus 7.5) and showed a small edge in physical function at follow-up. But there was no significant difference between the two groups in pain, mobility, or overall foot and ankle function.
In practical terms, a good prefabricated orthotic gets you most of the way there. If you’re considering orthotics as part of your Achilles tendonitis treatment, starting with a quality over-the-counter option is reasonable before committing to the higher cost of custom devices.
Heel Lifts as a Simpler Option
Simple heel lifts raise your heel slightly inside your shoe, which reduces the stretch on the Achilles tendon during standing and walking. They’re inexpensive and widely available. A study in children with heel-related pain (calcaneal apophysitis, not Achilles tendonitis specifically) compared heel lifts to custom orthotics over 12 weeks. Both groups improved, but custom orthotics produced substantially better results: 70 to 90 percent of children in the custom orthotic group improved, compared to only 20 to 30 percent in the heel lift group.
While this study involved a different condition in a younger population, the mechanics are related. A heel lift alone may provide some short-term relief by reducing tendon tension, but it doesn’t address underlying alignment issues the way a full orthotic can.
What Actually Works for Recovery
Exercise is the cornerstone of Achilles tendonitis treatment. Eccentric calf exercises, where you slowly lower your heel below the level of a step, are the most studied and consistently recommended approach. Expect at least three months of dedicated physical therapy before seeing meaningful improvement, and mild to moderate cases typically take three to six months to resolve fully. Severe or chronic cases can take longer.
The most effective treatment plans combine loading exercises with activity modification. You don’t necessarily have to stop running or exercising entirely, but you may need to temporarily reduce intensity or volume. Adding orthotics or insoles to this foundation can help manage symptoms and correct contributing biomechanical factors, but they aren’t a substitute for the work of rehabilitation.
Potential Downsides of Rigid Bracing
It’s worth distinguishing between shoe inserts (orthotics and heel lifts) and more rigid ankle-foot braces, which are sometimes used after Achilles tendon surgery or severe injuries. Rigid braces protect the tendon by restricting motion and reducing muscle activity, but that comes at a cost. Animal and human studies show that immobilizing the calf muscles, especially in a shortened position, accelerates muscle atrophy. Brace designs that allow more ankle movement result in less reduction in muscle activity and less calf shortening, which helps preserve muscle mass during recovery.
Standard shoe orthotics don’t carry this risk. They don’t restrict your ankle motion or significantly reduce muscle activation. If anything, they allow you to stay active with less discomfort, which supports the loading and exercise that drive tendon healing.