# Footwear assessment > A footwear assessment is a structured check of the shoes you wear and how well they suit your feet and your health. It aims to find poor fit before it causes pain or wounds, and it leads to advice on better shoes. It matters most if you have diabetes. Guide in [Checks and tests](https://footanklelowerlimb.com.au/learn/topics/checks-and-tests), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/footwear-assessment Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026. Next review by 27 October 2027. - **It checks your shoes and how they suit your feet,** to find poor fit before it causes pain or wounds. - **Fit is the main thing:** about 1 cm between your longest toe and the end of the shoe, and a snug heel. - **People with diabetes need it most,** with reviews timed to their foot risk. - **Shoes are one part of a foot check,** and a podiatrist can add more. - **A wound on a foot with diabetes shouldn't wait:** get it seen the same day. ## 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 problems [1]. Shoes that are the wrong size or too shallow are common in adults and children, and are linked with foot pain [2]. Poorly fitting shoes can also raise your risk of falls or injury [3]. A podiatrist can look at fit, general features, structure, how much the shoe controls foot movement, and cushioning [4]. 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 footwear [5]. ## 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 often [7]. How often a low-risk foot is rechecked varies, from every year to every 2 years [6][8], 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 wider [3]. Have them checked again if the shape, size or symptoms of your feet change. > [!see] If you have diabetes > If you've lost feeling in your feet, have had a foot wound, or have a foot deformity, ask a podiatrist to review your shoes rather than judging them yourself. ## 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 marks [2]. They then measure both feet and have you try on both shoes, because most people's feet are slightly different sizes [1]. They check for about 1 cm, or a thumb's width, between your longest toe and the end of the shoe [1][3], and a comfortable, snug fit around the heel [3]. 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 device [9]. Some clinics use 3D scanners [10]. ## 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 foot [1][11]. Pointed toe boxes and high heels squash the toes and can change the shape of bones or joints [1]. Slip-on shoes are poor for your feet because they're either too small or held on by curling your toes [11]. The usual next step is advice to change your shoes. If you have diabetes, the findings are read alongside your foot risk category [6]. With a moderate or high risk, you'll be advised to wear properly fitting, accommodative (roomy and supportive) therapeutic footwear [7]. Therapeutic footwear can reduce the chance of an ulcer coming back after a previous one [12]. How reliable is it? Checks of things like sole material, fastening and wear on the upper agree well between assessors [13]. Judging fit and measuring foot and shoe length are the weaker parts [2]. 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 foot [13]. ## 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 skin [14]. Width is hard to measure reliably [9], and a visual check depends on the examiner's experience [10]. You or a family member can learn to check shoe length, but width needs a professional's help [15]. 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 certain [16]. 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 available [17]. Most of this research is in adults with diabetes, so how far it applies to children or other conditions isn't clear yet. ## When to see a podiatrist See a podiatrist if you can't find shoes that fit, or your shoes keep causing problems. When you break in new or orthopaedic shoes, wear them for short periods at first. Check your feet for redness, blisters, swelling, warmth, cuts or pressure marks that are still there 20 minutes after you take them off. If you notice any, stop wearing them and contact your podiatrist or orthotist straight away [5][1]. Check inside your shoes each day for grit or loose objects [5]. See your GP or a podiatrist the same day if you have diabetes and a wound, sore, blister or colour change on your foot, or if you notice spreading redness, heat, swelling or pus in your foot [18]. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic. Until you're seen, cover any wound with a suitable dressing, keep it dry and take pressure off it [19]. Go to the nearest emergency department if you have diabetes and a foot infection that's spreading fast, with a fever and feeling very unwell, or if skin on your foot turns black (gangrene) [19]. Call 000 and ask for an ambulance if a foot wound comes with confusion or slurred speech, severe shivering or muscle pain, passing little or no urine, severe breathlessness, or mottled or discoloured skin. Call too if your leg or foot suddenly turns cold and pale or blue, with pain or numbness [19]. ## Common questions ### How do I know if my shoes fit properly? Have your feet measured and try on both shoes, as most people's feet are slightly different sizes. Aim for about 1 cm, or a thumb's width, between your longest toe and the end of the shoe, with a snug heel that doesn't rub. Wear new shoes around the house for short periods first and watch for redness. ### Are slip-on shoes or slippers bad for my feet? Slip-on shoes are often kept on either by being too small or by curling your toes, and neither is good for your feet. Shoes with a firm, adjustable lace or strap fastening high across the foot hold your foot better. Poorly fitting footwear can also raise your risk of falls. ### How high should a heel be? A heel lower than about 2.5 cm that is broad and stable suits most feet. Heels that are too high, and pointed toe boxes, squash your toes together and can change the shape of your bones or joints over time. A podiatrist can help you choose what suits your feet. ### Why do my feet seem to change size as I get older? Feet naturally change shape over the years and can get longer and wider. In older people the heel can become wider and the feet flatter and wider. That's why it helps to have your feet measured each time you buy new shoes, rather than assuming your size stays the same. ## Further reading - [Footwear assessment on Clindice](https://clindice.com/footwear-assessment) - [Diabetes and what it means to your feet - NHS Lanarkshire](https://www.nhslanarkshire.scot.nhs.uk/services/podiatry/diabetes/), NHS - [Diabetic Foot Exam: MedlinePlus Medical Test](https://medlineplus.gov/lab-tests/diabetic-foot-exam/), MedlinePlus - [Standards for the Foot Health Workforce](https://www.hee.nhs.uk/sites/default/files/HEE_Foot_Health_Standards_2021.pdf), NHS - [Looking after your foot in remission | Information Site](https://mydiabetesmyway.scot.nhs.uk/resources/internal/looking-after-your-foot-in-remission/), NHS - [Services and therapies :: Portsmouth Hospitals University NHS Trust](https://www.porthosp.nhs.uk/departments-and-services/rheumatology/services-and-therapies), NHS ## Sources 1. Footwear advice · NHS. https://www.oxfordhealth.nhs.uk/wp-content/uploads/sites/47/2024/02/Podiatry-Footwear-advice.pdf 2. Evaluation and optimisation of a footwear assessment tool for use within a clinical environment · Ellis S, Branthwaite H, Chockalingam N · Journal of Foot and Ankle Research · 2022. https://doi.org/10.1186/s13047-022-00519-6 3. Footwear advice - NHS Lanarkshire · NHS Lanarkshire · 2020. https://www.nhslanarkshire.scot.nhs.uk/services/podiatry/footwear-advice/ 4. Repeatability and reliability of the footwear assessment tool in Spanish patients: A transcultural adaptation · Navarro-Flores E, Losa-Iglesias ME, Casado-Hernández I et al. · Journal of Tissue Viability · 2023. https://doi.org/10.1016/j.jtv.2022.12.006 5. Orthopaedic Footwear · Dorset County Hospital. https://dchft.nhs.uk/leaflets/orthopaedic-footwear/ 6. Diabetic Foot Referral Pathway Algorithm · NHS. https://devonformularyguidance.nhs.uk/documents/Referral-Documents/Specialty-supporting-information/Endocrinology-Diabetic-Medicine/TSD-Diabetic-foot-referral-pathway.pdf 7. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update) · Bus SA, Sacco ICN, Monteiro-Soares M et al. · Diabetes/metabolism Research and Reviews · 2024. https://doi.org/10.1002/dmrr.3651 8. Diabetic foot management | Right Decisions · NHS · 2024. https://www.rightdecisions.scot.nhs.uk/nhs-borders-clinical-guidelines/diabetes-and-endocrinology/diabetic-foot-guidance/diabetic-foot-management/ 9. Diabetes Foot Ulcer Prevention: A Review of Footwear Width Assessment for At-Risk Feet · Jones PJ, Rowlands AV, Davies MJ et al. · Journal of Foot and Ankle Research · 2025. https://doi.org/10.1002/jfa2.70071 10. Foot shape assessment techniques for orthotic and footwear applications: a methodological literature review · Danckaers F, Stanković K, Huysmans T et al. · Frontiers in Bioengineering and Biotechnology · 2024. https://doi.org/10.3389/fbioe.2024.1416499 11. Footwear · Oxfordshire Podiatry. https://oxfordhealth.nhs.uk/podiatry/foot-health/footwear/ 12. Prevention of foot ulcers recurrence in patients with diabetes: a systematic review and meta-analysis of randomized controlled trials for the development of the italian guidelines for the treatment of diabetic foot syndrome · Da Ros R, Volpe A, Bordieri C et al. · Acta Diabetologica · 2024. https://doi.org/10.1007/s00592-024-02353-7 13. Development and evaluation of a tool for the assessment of footwear characteristics · Barton CJ, Bonanno D, Menz HB · Journal of Foot and Ankle Research · 2009. https://doi.org/10.1186/1757-1146-2-10 14. Gulf regional guidelines for managing diabetic foot ulcers: assessment, treatment and prevention of recurrence · Janahi N, Al Mahrizi AS, Ben Nakhi M et al. · Journal of Wound Care · 2026. https://doi.org/10.12968/jowc.2026.0559 15. Effectiveness of diabetes footwear fit assessment by people with diabetes and their family or partners: A reliability study · Jones PJ, Bullock J, Weaving L et al. · Diabetic Medicine · 2025. https://doi.org/10.1111/dme.70065 16. Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta-analysis · van Netten JJ, Raspovic A, Lavery LA et al. · Diabetes/metabolism Research and Reviews · 2024. https://doi.org/10.1002/dmrr.3652 17. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update) · Bus SA, Armstrong DG, Crews RT et al. · Diabetes/metabolism Research and Reviews · 2024. https://doi.org/10.1002/dmrr.3647 18. Diabetic foot | Right Decisions · NHS. https://www.rightdecisions.scot.nhs.uk/borders-ref-help-toolkit/diabetes/diabetic-foot/ 19. Foot ulceration | Right Decisions · NHS. https://www.rightdecisions.scot.nhs.uk/borders-ref-help-toolkit/podiatry/foot-ulceration/ --- This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.