Footwear advice

What is footwear advice?

Footwear advice is guidance on choosing and wearing shoes that suit your feet, so they help keep your feet healthy and comfortable rather than adding stress and pressure¹. It looks at fit (length, width and depth), a secure fastening, and features such as support and curved rocker soles.

Shoes that don't fit properly are one of the most common causes of foot problems², and well-fitting, supportive shoes should make your feet more comfortable³. A podiatrist can check your shoes against your feet and explain what to look for when you shop.

What is footwear advice used for, and does it work?

The strongest case is for people with diabetes. Guidelines recommend teaching people at risk of a foot ulcer (a sore that is slow to heal) not to walk without suitable foot protection, and advise those at moderate to high risk to wear properly fitting therapeutic footwear (shoes designed to protect the foot). After an earlier ulcer under the foot, footwear that relieves pressure while you walk is advised to help stop it coming back⁴. The recommendation is strong, though the quality of the supporting evidence is low⁵.

For adults with rheumatoid arthritis, therapeutic footwear is linked with less pain and better physical function than standard shoes, though the evidence is graded moderate to very low quality⁶. For other conditions, treat footwear advice as sensible practice rather than a proven treatment on its own. Poorly fitting shoes can make a foot problem hard to improve, even with podiatry treatment⁷.

Is footwear advice right for me?

General advice suits almost anyone, because properly fitting shoes help avoid foot discomfort and deformity⁸.

If you have diabetes at moderate or high risk of a foot ulcer, especially after a past ulcer, you need a podiatrist's input and ongoing foot care, not general shoe advice alone⁴⁹. Ill-fitting footwear is one of the most common causes of foot wounds in diabetes¹. If you've been given prescription shoes, wear only those and follow your podiatrist's or orthotist's instructions⁹.

If you have rheumatoid arthritis with foot deformity, ready-made shoes can fit poorly and cause pressure areas, pain and skin damage, so ask for professional footwear advice. Shoes with space for the deformity may be needed⁶.

What happens during footwear advice?

It's mostly a fitting check rather than a course of treatment. Shoes should be the right length, width and depth for your foot, with an adjustable fastening such as laces, straps or velcro that holds it firmly². Check for about a thumb's width beyond your longest toe, a snug heel, and enough depth and width for your toes¹.

It's good practice to have your feet measured before buying¹⁰. Fit shoes to your larger foot, and if you're getting insoles, take them along to try in the shoes¹¹. Wear new shoes for an hour or two at first, then build up over a couple of weeks¹⁰. If you have diabetes, check your feet and shoes before and after each wear while you break them in; some adjustment is often needed at first⁵.

What are the risks of footwear advice?

The main problems come from shoes that fit poorly or don't suit you. They can cause pressure, rubbing, corns and ingrowing toenails⁷, and raise the risk of falls or injury¹.

New shoes can rub. If new or prescribed shoes rub or cause redness, especially with diabetes or rheumatoid arthritis, stop wearing them for long periods and contact your podiatrist or orthotist⁵⁶. Older people should be wary of very soft midsoles, which may worsen balance and raise the risk of a fall¹².

How does it compare with other options?

The comparisons available are about devices and special footwear, not general footwear advice, and they come from different groups of adults, so they may not carry across between conditions.

• Diabetic foot ulcers: non-removable offloading devices (such as a cast) are likely better for healing than other options¹³. Simple, removable offloading footwear may be a low-cost choice for preventing new or recurrent ulcers¹⁴.
• Plantar heel pain (pain under the heel): orthoses (shoe inserts) weren't better than fake inserts or other simple treatment for pain and function in adults¹⁵.

Ask your podiatrist which option suits your condition. If a device is suggested for diabetes, its benefits, risks and any reasons not to use it should be discussed with you first⁵. If you're given insoles, choose shoes with removable insoles so they fit¹¹.