Why Your Shoes Wear Out on the Outside Heel

Flip over your favorite sneakers and check the heels. If the back outer corner is worn smooth, you're in good company. That is where most shoes wear first, and most of the time it's normal. Sometimes, though, the wear keeps going. It runs up the whole outer edge, the heel counter starts to tilt, and your ankles roll more than they should.

This guide explains how to tell normal heel wear from a foot that rolls outward, which doctors call supination. We cover what high arches and repeated ankle sprains have to do with it, and when it can point to a nerve problem. We also go through what helps, from shoes and exercises to custom orthotics.

Some Outer-Heel Wear Is Normal

Most people land on the heel, and the heel lands tipped slightly onto its outer edge. McPoil and Cornwall (1994) filmed healthy young adults as they walked. The heel was tilted slightly outward just before it touched down, and then it rolled in. So the outer back corner takes the first hit, step after step.

A small study of work shoes found the worn spot sat toward the outer side of the heel. It matched the area that touches down first better than the area in contact later (Bharthi and colleagues, 2022).

Runners are no different. Kasmer and colleagues (2013) watched almost 2,000 runners pass a point early in a marathon. In that race, more than nine out of ten landed on their heels.

So a smooth patch at the back outer corner, with even wear across the ball of the foot, is the pattern we expect. It's not a sign that something is wrong with your feet.

When Outside Wear Means Something More

The picture changes when the wear doesn't stop at the heel. Look for these signs.

• The wear runs along the whole outer edge, from the heel toward the little toe.
• The heel counter tilts outward when you look at the shoe from behind.
• The upper bulges over the outside of the sole, as if the foot keeps sliding that way.
• The inner edge of the sole looks almost new.
• Your ankles roll or sprain easily, or you have pain on the outer side of the foot or ankle.

One of these alone doesn't mean much. When several show up together, your foot may be spending more time on its outer edge.

What Supination Means

Every foot rolls in and out a little with each step (Cornwall and McPoil, 1999). Rolling outward is called supination, and some of it is normal. It's how the foot firms up for push-off. Doctors think trouble is more likely when a foot stays rolled out for much of the step. A foot like that tends to stay stiff, so more of the load lands on the heel and the outer edge.

This is common in feet with high arches. Doctors call a high-arched foot a cavus foot. Buldt and colleagues (2018) reviewed the studies that measure pressure under the foot. In high-arched feet, pressure was higher at the heel and the outer part of the forefoot. Pressure also traveled along a path closer to the outer edge. That may be part of why shoes wear there. In that review, though, foot shape explained only a small part of the differences in pressure.

A high arch is not always obvious. Manoli and Graham (2005) called the mild form "the underpronator" and wrote that it is common and often missed. A simple exam in the office can often show it.

A high arch is also not automatically a problem. Nielsen and colleagues (2014) followed 927 new runners for a year in neutral running shoes. Runners with high-arched or rolled-out feet did not get hurt significantly more often than runners with average feet. The group with very high arches was small, so the answer for them is less certain. What matters is whether your feet hurt, and whether your ankles stay steady.

Common Causes of Outer-Edge Wear

A High-Arched Foot

Some people simply have high arches, often in both feet. The foot tends to be stiff, and it touches the ground over a smaller area than an average foot. Hard skin can build up under the ball of the foot and along the outer edge, where the pressure is highest.

Ankles That Roll

Some research links high arches with ankle sprains. Morrison and Kaminski (2007) reviewed the studies on what makes people sprain their ankles. A high-arched foot with the heel tipped inward was one of the few foot shapes linked to ankle sprains. People whose ankles keep giving way also tend to load the outer edge. Morrison and colleagues (2010) found they landed more on the outer side of the foot when running barefoot. The study can't tell which came first.

Tendon Trouble on the Outside of the Ankle

The peroneal tendons run behind the bony knob on the outside of the ankle. They help keep the foot from rolling outward. Brandes and Smith (2000) reviewed 22 patients with damage to one of these tendons. Most of them had high arches with the heel tipped inward.

A Nerve Problem

This cause is less common, but it matters. High arches in both feet can be the first sign of an inherited nerve condition. Nagai and colleagues (2006) reviewed 148 children seen at a specialist clinic for high arches with heels tipped inward on both sides. Most of them turned out to have an inherited nerve disease. Children sent to a specialist may not be typical, but the authors advised checking every child with this foot shape for it.

In adults, arches that seem to be getting higher over time, curling toes, weak ankles or tripping all deserve a nerve exam. So do numbness, or a family history of a nerve disease.

What Helps

The Right Shoes

Many stability shoes are built to limit how far the foot rolls inward. In one trial, shoes built to control inward roll lowered injury risk overall. The benefit was clear only in runners with flatter, rolled-in feet (Malisoux and colleagues, 2016). In runners whose feet roll outward, the result was unclear.

For a foot that rolls outward, a cushioned neutral shoe is a reasonable choice. Look for a heel counter that stays upright when you press it and a sole that feels stable under you. Replace the shoes once the outer edge is worn down at an angle, because a slanted heel no longer sits level under your foot. Our guides to everyday athletic shoes for women and for men cover fit.

Balance and Ankle Exercises

If your ankles keep rolling, exercise and bracing both have research behind them. A large overview of earlier reviews found moderate evidence that balance and strength training helps prevent repeat sprains. It found strong evidence for bracing (Doherty and colleagues, 2017). One trial followed 522 athletes who had sprained an ankle. Those given a home balance program had fewer repeat sprains over the next year than those who weren't (Hupperets and colleagues, 2009).

Our rehab guides for a sprained ankle, peroneal tendinitis and a high-arched foot show the exercises. Stop any exercise that causes sharp pain, and don't start them on a fresh sprain until it has been examined.

Custom Orthotics

For this foot type, custom orthotics have good trial evidence (Hawke and colleagues, 2008). Burns and colleagues (2006) gave 154 people with painful high-arched feet either custom orthotics or fake inserts. The custom orthotics eased pain and improved function more. They also lowered pressure under every region of the foot. A Cochrane review found no other treatment shown in a trial to ease high-arched foot pain (Burns and colleagues, 2007).

A store-bought arch support may fit a high arch poorly. The arch of the insert can sit too low, or the heel cup can be too shallow to hold the heel. A custom functional orthotic is shaped to your own arch, and it can be built to spread load away from the outer edge and the ball of the foot. Our guide to how custom orthotics work explains how they're made.

Custom orthotics are not the first step for everyone. On their own, they won't fix an ankle that keeps giving way. That needs balance work, a brace, or both. They're also not a treatment for a nerve condition, which needs its own workup first. If you have numbness or diabetes, any insert needs a careful fit and regular skin checks. If an insert causes new pain or blisters, stop wearing it and call us.

When to See a Podiatrist

Make an appointment if any of these sound familiar.

• Ankle sprains that keep happening, or an ankle that often gives way.
• Pain along the outer edge of the foot, or behind the bony knob on the outside of the ankle.
• Arches that seem to be getting higher, toes that are starting to curl, or weakness in the ankles.
• Tripping more than you used to, or numbness in your feet.
• A child with high arches in both feet, especially if a parent has a nerve condition.

Bring the shoes you wear most. Dr. Patish will look at the wear, check your arches and ankles, and watch you walk. Then he'll recommend what fits your situation, whether that's exercises, a brace, different shoes or a custom orthotic. You can request a visit online. For a full map of wear patterns, see our guide to shoe wear patterns and what they mean.