# Footwear modifications

> Footwear modification means changing an existing shoe, such as adding a raise, wedge, flare or rocker sole, to ease pain, reduce pressure or improve walking. It's best studied for preventing repeat foot ulcers in adults with diabetes. It only helps when worn, and not every shoe can be adapted.

Guide in [Treatments](https://footanklelowerlimb.com.au/learn/topics/treatments), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/footwear-modifications
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026.
Next review by 27 October 2027.

- **It means changing an existing shoe,** usually on the outside, such as adding a raise, wedge, flare or rocker sole.
- **It's best studied in adults with diabetes** who have had a foot ulcer, though even there the certainty is low.
- **Not every shoe can be adapted,** and an orthotic or footwear service should do it, not you at home.
- **It only protects when you wear it,** including around the house.

## What are footwear modifications, and how do they work?

Footwear modification (also called shoe adaptation) means changing an existing shoe, usually on the outside, rather than making a new one [1]. Common changes are a raise (for a shorter leg), a rocker sole (a curved sole that reduces pressure on the ball of the foot), a wedge or flare (to shift your weight line), and a socket for a calliper [2]. The aims are to relieve pain, reduce pressure, protect the bottom of the foot, or improve comfort, stability and how you walk [2][3].

In healthy people, rocker soles change how the ankle and knee move [4]. Changes like this don't prove you will feel better, so it's worth asking whoever recommends a change what it's meant to achieve. Please don't modify shoes yourself.

## What are they used for, and how well do they work?

The best-supported use is helping prevent a foot ulcer coming back in adults with diabetes who have had one. Therapeutic footwear (shoes made or chosen to protect the foot) can reduce repeat ulcers, but the certainty is low [5], and one older trial found no significant benefit [6]. It works best when it's worn consistently [7].

For knee osteoarthritis, a lateral wedge insole (an insole thicker on the outer edge) reduces load on the knee [8] but doesn't ease pain more than a plain insole [9]. In adults with hallux rigidus (a stiff big toe joint), orthoses (shoe inserts) reduced pain [10]. Heel lifts may ease Achilles tendinopathy (a sore tendon above the heel) a little more than calf exercises, though the difference may be too small to notice [11].

It isn't clear yet how well modifications work for leg length differences or in children, so an individual assessment matters.

## Is it right for me?

It's best studied in adults with diabetes who have had a foot ulcer or are at high risk of one [12]. If that's you, the footwear should be matched to your ulcer risk and any foot deformity, and checked by a team of health professionals [7].

Not every shoe can be adapted. Services prefer enclosed, well-fitting shoes with a firm sole and a low, broad heel [3].

> [!see] If you have diabetes
> Also if you have reduced feeling in your feet or poor circulation: have a podiatrist or foot protection service assess your feet before you rely on modified shoes.

## What happens when my shoes are modified?

**Before.** Bring comfortable shoes in good condition, with a secure fastening and no excess wear on the soles, and ask whether your pair can be adapted [2]. New shoes can be adapted if you've tried them on and found them comfortable first [2].

**During.** The service adds the change, such as a raise, rocker sole, wedge or flare, to your shoe [2]. For adults with diabetes, the clinician sets the pressure targets and prescription, so there's nothing for you to measure [7]. How many visits you need depends on the service, so ask how often your footwear will be reviewed.

**After.** Wear new or adapted shoes for short periods at first, then build up [12]. If you've been given therapeutic footwear for diabetes, wear it whenever you're on your feet, at home too, instead of slippers [12].

## What are the risks and side effects?

Good information on side effects is limited. New aches in the back, hips, knees, feet or ankles, or blisters, can happen with heel lifts [11]. Rocker soles change how your joints move and how you walk [10][13]. Steeper wedge insoles are often harder to tolerate [9].

For people with diabetes, the main risk is skin damage from rubbing or pressure, and from not wearing the footwear enough. If new footwear causes rubbing, discolouration or new pain, contact the orthotic department or your podiatrist straight away [12]. Check inside your shoes daily for stones or other small objects, check nothing sharp has pierced the sole, and don't take out insoles unless you've been advised to [12]. If you have diabetes or reduced feeling, check the skin of your feet daily too.

## How do they compare with other options?

To prevent repeat ulcers in adults with diabetes, custom in-shoe orthoses based on pressure measurements led to fewer ulcers than standard orthoses [14]. Therapeutic footwear with custom insoles is described as the most effective preventive step [7]. Careful foot care from health professionals may matter more than the footwear itself [6].

For healing an open neuropathic ulcer under the forefoot or midfoot in diabetes, footwear isn't the first choice. Guidelines recommend a non-removable knee-high offloading device first, with fitted footwear and felted foam only a third choice [15].

For knee osteoarthritis, don't expect a wedge insole on its own to relieve pain; ask about other options. It also helps to ask how footwear changes fit with orthoses, exercise and foot care.

## When to see a podiatrist

Ask a podiatrist about footwear changes if you have diabetes and have had a foot ulcer, or if you're not sure a change would suit you.

See a podiatrist if your modified shoes rub or cause new pain, so the change can be reviewed.

See your GP or a podiatrist the same day if you have diabetes and notice a wound, sore, blister or colour change on your foot, including discolouration after wearing new shoes. The same applies if anyone has spreading redness, heat, swelling or pus in the foot, or a foot that's hot, swollen or changing shape. Don't wait to see whether it settles. 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.

## Common questions

### Can any pair of shoes be adapted or raised?

No. Services prefer enclosed shoes that fasten securely with laces or Velcro, with a firm, solid sole and heel unit, a heel no higher than 3 cm and a heel base as wide as the shoe. Trainers or shoes with air bubbles or gel in the heel, thin soles, stitching through the sole, or hollowed or heavily patterned soles are usually unsuitable.

### Why do I need to wear my therapeutic footwear indoors?

Many people take more steps at home than away from it, and going barefoot, in socks or in slippers leaves your feet open to injury. Slippers don't protect the feet well enough. If you have diabetes, therapeutic footwear only protects your feet while you're wearing it, so it helps to wear it whenever you're up and about.

## Further reading

- [Footwear modifications on Clindice](https://clindice.com/footwear-modifications)
- [Information about your insole or foot orthoses](https://www.esht.nhs.uk/wp-content/uploads/2020/09/0840.pdf), NHS
- [Orthotics – SMART Centre](https://www.smart.scot.nhs.uk/service/orthotics/), NHS
- [Adaptations to your own footwear :: Royal National Orthopaedic Hospital](https://www.rnoh.nhs.uk/patients-and-visitors/patient-information-guides/adaptations-your-own-footwear), NHS
- [How to choose footwear for adaption](https://elht.nhs.uk/services/orthotics/patient-information/how-choose-footwear-adaption), NHS
- [NHS Highland - Orthotics patient information - footwear suitable for adaptations](https://www.nhshighland.scot.nhs.uk/media/dnbi3f5y/nhs-highland-orthotics-patient-information-footwear-suitable-for-adaptations.pdf), NHS

## Sources

1. How to choose footwear for adaptation · NHS. https://publicdocuments.sth.nhs.uk/pil1307.pdf
2. How to choose footwear for adaption · NHS. https://elht.nhs.uk/services/orthotics/patient-information/how-choose-footwear-adaption
3. Orthotics patient information - footwear suitable for adaptations · NHS Highland. https://www.nhshighland.scot.nhs.uk/media/dnbi3f5y/nhs-highland-orthotics-patient-information-footwear-suitable-for-adaptations.pdf
4. Effects of rocker-bottom shoes on the gait biomechanics of running and walking: A systematic review · Munim F, Jor A, Pollen TN et al. · Gait & Posture · 2025. https://doi.org/10.1016/j.gaitpost.2025.04.019
5. 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
6. Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial · Reiber GE, Smith DG, Wallace C et al. · JAMA · 2002. https://doi.org/10.1001/jama.287.19.2552
7. Therapeutic footwear in patients with diabetes: a position statement from the Italian diabetic foot study group · Giurato L, Scatena A, De Giglio R et al. · Acta Diabetologica · 2026. https://doi.org/10.1007/s00592-026-02722-4
8. Therapeutic significance of insoles in patients with knee osteoarthritis · Jindasakchai P, Angthong C, Panyarachun P et al. · European Review for Medical and Pharmacological Sciences · 2023. https://doi.org/10.26355/eurrev_202306_32619
9. Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis: a meta-analysis · Parkes MJ, Maricar N, Lunt M et al. · JAMA · 2013. https://doi.org/10.1001/jama.2013.243229
10. The role of orthotic devices in managing hallux rigidus: A systematic review and meta-analysis of clinical and biomechanical outcomes · Khaliliyan H, Ansari M, Bahramizadeh M et al. · Foot (Edinburgh, Scotland) · 2026. https://doi.org/10.1016/j.foot.2026.102264
11. Efficacy of heel lifts for lower limb musculoskeletal conditions: A systematic review · Bourke J, Munteanu S, Merza E et al. · Journal of Foot and Ankle Research · 2024. https://doi.org/10.1002/jfa2.12031
12. Therapeutic footwear for diabetic patients · NHS. https://publicdocuments.sth.nhs.uk/pil3209.pdf
13. The impact of custom-made rocker sole shoes on biomechanical parameters of the lower limb during gait and running: A systematic review · Arazpour M, Aboutorabi A, Ahmadi Bani M et al. · Journal of Bodywork and Movement Therapies · 2026. https://doi.org/10.1016/j.jbmt.2025.11.007
14. Prevention of recurrent foot ulcers with plantar pressure-based in-shoe orthoses: the CareFUL prevention multicenter randomized controlled trial · Ulbrecht JS, Hurley T, Mauger DT et al. · Diabetes Care · 2014. https://doi.org/10.2337/dc13-2956
15. 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

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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.