Footwear assessment

What is a footwear assessment?

A footwear assessment is a structured check of the shoes you actually wear, and of how well they suit your feet and your health. The aim is to find poorly fitting shoes before they cause pain, wounds or other problems.

Shoes that don't fit are one of the most common causes of foot problems¹. Shoes that are the wrong size or too shallow are common in adults and children, and are linked with foot pain². Poorly fitting shoes can also raise your risk of falls or injury³.

A podiatrist can look at fit, general features, structure, how much the shoe controls foot movement, and cushioning⁴. If you can't buy shoes that fit, even after trying wider-fit styles, an orthotist (a practitioner who makes and fits supports and special footwear) may decide you need orthopaedic footwear⁵.

Who needs one, and how often?

The clearest advice is for people with diabetes. Their feet should be checked when diabetes is diagnosed and then every year, and each foot is classed as low, moderate or high risk of ulceration (foot sores)⁶. Higher-risk feet are checked more often⁷. How often a low-risk foot is rechecked varies, from every year to every 2 years⁶⁸, so your podiatrist will set your interval.

If you don't have diabetes, it's sensible to have your feet measured whenever you buy new shoes, because feet change shape over the years and can get longer and wider³. Have them checked again if the shape, size or symptoms of your feet change.

What happens during a footwear assessment?

Your podiatrist looks at the shoes you wear, usually with a checklist so nothing is missed. They check things like the sole, the fastening, the upper and wear marks².

They then measure both feet and have you try on both shoes, because most people's feet are slightly different sizes¹. They check for about 1 cm, or a thumb's width, between your longest toe and the end of the shoe¹³, and a comfortable, snug fit around the heel³.

Width is harder to get right than length. It can be measured by tracing your foot and shoe, or with a ruler, callipers or a measuring device⁹. Some clinics use 3D scanners¹⁰.

What do the results mean, and what happens next?

Your podiatrist compares your shoes with a few points: about 1 cm of toe space, a snug, firm heel, a broad, stable heel under 2.5 cm, and a firm lace or strap fastening high across the foot¹¹¹. Pointed toe boxes and high heels squash the toes and can change the shape of bones or joints¹. Slip-on shoes are poor for your feet because they're either too small or held on by curling your toes¹¹. The usual next step is advice to change your shoes.

If you have diabetes, the findings are read alongside your foot risk category⁶. With a moderate or high risk, you'll be advised to wear properly fitting, accommodative (roomy and supportive) therapeutic footwear⁷. Therapeutic footwear can reduce the chance of an ulcer coming back after a previous one¹².

How reliable is it? Checks of things like sole material, fastening and wear on the upper agree well between assessors¹³. Judging fit and measuring foot and shoe length are the weaker parts². A reliable check doesn't prove it predicts ulcers, falls or pain, so a footwear score alone shouldn't be used to rule out risk in a high-risk foot¹³.

What are its limits, and are there alternatives?

Footwear assessment is one part of a wider foot check, alongside looking at wounds, circulation, nerves, foot mechanics and skin¹⁴. Width is hard to measure reliably⁹, and a visual check depends on the examiner's experience¹⁰. You or a family member can learn to check shoe length, but width needs a professional's help¹⁵.

Shoes alone don't settle everything. Therapeutic footwear may reduce the risk of a first ulcer in people with diabetes at risk, but this isn't certain¹⁶. If you already have a foot ulcer, the first choice is a knee-high device that takes pressure off it. Fitted footwear with felted foam is only a third choice, when no devices are available¹⁷. Most of this research is in adults with diabetes, so how far it applies to children or other conditions isn't clear yet.