Therapeutic footwear

What is therapeutic footwear?

Therapeutic footwear (also called medical or orthopaedic footwear) is made for feet that are at risk or have changed shape. It's mainly used by people with diabetes and nerve damage (neuropathy) in their feet. It aims to take pressure off problem areas and prevent problems that can lead to amputation¹.

It works by spreading out and reducing pressure under the foot, and by leaving room for foot deformity¹². Common features include extra depth with a removable insole, adjustable closures, wide and deep toe boxes, and rocker soles (curved soles that rock the foot forward as you step)¹. It can be custom-made for you, or ready-made with extra depth and support². Most of the information here is about adults with diabetes.

What is it used for, and does it work?

Its main use is preventing foot ulcers (open sores) in people with diabetes, and stopping them coming back. Guidelines recommend it for people at high risk³⁴. The evidence is weaker than those recommendations suggest. Results lean towards fewer ulcers, but they're uncertain⁵, and a trial in adults with a past ulcer didn't show a clear benefit over usual footwear⁶.

Some design features do lower pressure under the foot in adults with diabetic neuropathy⁷. Lower pressure isn't proven to mean fewer ulcers, though⁷. For healing a sore you already have, offloading devices are probably better⁸.

In adults with rheumatoid arthritis, therapeutic footwear can reduce pain and improve physical function compared with standard footwear, although the quality of that evidence is mixed². Wearing the footwear as advised is a key factor in how well it works⁹.

Is it right for me?

It's aimed mainly at adults with diabetes who have neuropathy, a changed foot shape, or a past ulcer or amputation⁴¹⁰. Guidelines advise properly fitting, accommodative (roomy and cushioned) footwear for people at moderate-to-high risk³. Some adults with rheumatoid arthritis use it too, though many find it unacceptable because of looks, price or availability². If that's you, tell your podiatrist.

Footwear alone isn't enough if you have an active ulcer, an infection or poor blood supply to the foot. An active ulcer needs assessment by a health professional, who will choose the offloading⁸, and poor blood supply may need its own treatment⁴. For children, and for conditions other than diabetes and rheumatoid arthritis, individual advice from a podiatrist is the best way forward.

What happens when I get therapeutic footwear?

Expect a process rather than a one-off purchase. Trained staff assess your feet, fit the footwear, show you how to use it and follow up¹. It's matched to your risk level and foot shape, and checked by a team of health professionals⁹. It should fit snugly, with room for bony deformities and any insoles¹. Some clinics can test the pressure inside the shoe to check it's working¹⁰.

One guideline says wearing it for at least 60–80% of your daily active time is a key factor⁹. No standard number of appointments or review times has been set, so ask what wearing schedule and reviews to follow. If the footwear is uncomfortable or hard to wear, tell your podiatrist or orthotist so they can adjust it.

What are the risks?

The main risk is poor fit, which is one of the most common causes of foot problems in people with diabetes¹¹. With numb feet, a blister or a pebble in your shoe can go unnoticed and lead to cuts and sores¹².

Some styles add risk if your feet are numb¹³:

• flip flops with straps can cause ulcers through movement and rubbing;
• sandals leave the toes and top of the foot open to injury from things like stones;
• closed shoes in hot climates may raise the risk of fungal infection;
• gumboots and water shoes sold to the general public may cause ulcers and don't reduce pressure.

Ask your foot team what's safe for you. If your shoes rub or press, stop wearing them and contact the person who fitted them¹¹¹.

How does it compare with other options?

For healing a sore, any offloading device is probably better than therapeutic footwear, and non-removable devices likely heal more sores than removable ones⁸. If you have an active ulcer, your foot team will choose the device. Please don't swap it for ordinary or therapeutic shoes without their advice.

For prevention, footwear is a recommended option³. It works best as one part of a plan alongside daily foot checks and professional foot care⁶. Ask your foot team how footwear fits into yours.