Why are my athletic shoes twisting my ankle?

What’s a Varus Heel and Why Should I Care?

The shoe industry is driven by fads. (but you already knew that) A couple years ago the latest fad was the varus heel. It hasn’t died out yet so let me tell you a little bit about it.

When you look at a shoe from the back you can draw an imaginary line down the center of the heel. If that shoe was sitting on the ground the line made a perpendicular with the ground. That was called a neutral heel. The idea of the varus heel was to build up the side of the heel on the inside of the shoe (on the big toe side of the foot) to stop the foot from pronating or flattening out too much. So far so good — but just like every fad tends to get carried away so too did the varus heel fad. So while many people could benefit from a 4° varus heel we started to see even higher varus heels that started to cause trouble.

Even a normal varus heel for a person that does not need one can cause an ankle sprain. Even recently I had a patient who regularly walks on a sidewalk which is angled. When she wore her new varus heel shoes on this sidewalk she developed acute pain in one foot. You guessed it – the pain was in the foot where the angle of the sidewalk added to the varus heel and twisted her foot. Another problem we see with varus heel shoes is that when you add an aftermarket insole whether it be an OTC insole or a custom-made orthotic the additional support plus the varus heel can twist your foot and ankle. Remember most inserts and orthotics are designed for neutral heel shoes. These images may just explain why those new shoes hurt so much!

varus heelThis looking at a left heel showing pronation.  A shoe like the  Adidas on the right is designed to bring this heel in line with the leg. Too much though can cause an ankle sprain.


This is an example of a (left) varus heel shoe.varus heel shoe