Footwear Advice

What is it?

Footwear advice is guidance on choosing and wearing shoes that suit your feet. The aim is for your shoes to help keep your feet healthy and pain-free, instead of adding pressure and stress to them.

It focuses on fit: the right length, width and depth, and a fastening that holds your foot firmly. It also looks at features such as supportive soles and rocker soles (soles with a curved shape).

Footwear that doesn't fit properly is one of the most common causes of foot problems. Think of footwear advice as sensible, practical care rather than a treatment that has been proven on its own.

What is it used for?

Diabetes. This is where footwear matters most. Reduced feeling in the feet (neuropathy) is common in people with diabetes, so your feet may not warn you when a shoe is causing damage. Ill-fitting shoes are one of the most common causes of foot wounds in diabetes. Guidelines strongly recommend teaching people at risk of a foot ulcer (an open sore) not to walk without suitable foot protection. For people at moderate or high risk, they recommend properly fitting therapeutic footwear (specially chosen or prescribed shoes). The certainty behind this advice is rated as low, but the recommendation itself is strong.

If you have had an ulcer under your foot before, guidelines advise therapeutic footwear that is known to take pressure off the sole of your foot when you walk. This is prescribed footwear, not general shoe advice.

Rheumatoid arthritis. For adults with foot deformity, ready-made shoes may fit poorly. Therapeutic footwear is linked to less pain and better physical function than standard shoes.

Corns and ingrowing toenails. Ill-fitting shoes can cause both, and well-fitting shoes help to prevent and treat them.

Heel pain. Supportive shoes with a firm or rocker sole, avoiding flat or slip-on shoes, and insoles or heel raises of 5 to 10 mm are listed for adults with foot and heel problems. Shoe inserts (orthoses) haven't been shown to work better than sham or other simple treatments for plantar heel pain.

Healing an existing diabetic foot ulcer. Devices that can't be taken off, such as a cast, are likely to heal most ulcers under the foot better than other options. Whether custom-made temporary footwear heals ulcers as well as a cast isn't yet clear.

Is it right for me?

General footwear advice suits almost anyone, because properly fitting shoes help avoid foot discomfort and problems. It matters most if you have diabetes, rheumatoid arthritis or another foot disorder.

If you are at moderate or high risk of a diabetic foot ulcer, especially if you have had one before, general shoe advice isn't enough. You need your podiatrist's input and regular, risk-based foot care.

If you have rheumatoid arthritis and a foot deformity, ask for professional footwear advice. Ready-made shoes can cause pressure areas, pain and skin damage on deformed feet, and you may need shoes designed to give your feet more room.

If your podiatrist or orthotist has supplied prescription shoes, wear only those shoes and follow their instructions. Court shoes and slip-on shoes are only for short periods, because they don't fit well and give no support.

What happens?

Footwear advice is mostly a fitting check, not a course of treatment. No set number of sessions applies. Your podiatrist will look at your shoes and your feet, and show you what to look for.

At the shop, check that:

• the shoe is the right length, width and depth, with a rounded front deep enough for your toes
• there is a gap of about 1 cm between your longest toe and the end of the shoe (a thumb's width is a handy check, and some guides give 6 to 10 mm)
• the heel fits snugly and doesn't press on bony parts such as your ankle bone
• the fastening (laces, straps, buckles or velcro) can be adjusted to hold your foot firmly

Good habits when buying shoes:

• Have your feet measured before you buy.
• Fit the shoe to your larger foot.
• Take out the base insole of the shoe and stand your foot on it. It should be as wide as your foot, with about a thumb's width beyond your longest toe.
• If you are getting insoles or orthoses, wait for them and take them along to try in the shoes. Choose shoes with removable insoles.

For most people, lightweight shoes with a soft midsole (the layer between the sole and your foot) and a curved rocker sole feel the most comfortable. Very soft, floppy shoes give no support, and thin, hard soles give too little cushioning.

Break new shoes in slowly. Wear them for an hour or two at first, then build up over a couple of weeks.

If you have diabetes, your podiatrist will also teach you foot self-care, in a way that suits your culture, reading skills and learning style. Check your feet and your shoes before and after each wear while you break in new or prescribed footwear, looking for rubbing, redness or any injury. Some adjustment is often needed at first. Wear prescribed footwear whenever you are on your feet. Your podiatrist will talk with you about the benefits, risks and limits of any device before you start using it.

How well does it work?

What you can expect depends on your condition. Well-fitting supportive shoes should make your feet more comfortable, and well-fitted, lightweight shoes with soft midsoles and curved rocker soles are generally rated the most comfortable.

For people with diabetes, properly fitting footwear and therapeutic footwear are a recommended part of preventing ulcers and stopping them coming back. For adults with rheumatoid arthritis, therapeutic footwear is linked to less pain and better function than standard shoes, although how sure we can be about this ranges from moderate to very low. Custom-made options tailored to your needs are stressed.

For plantar heel pain, shoe inserts haven't been shown to reduce pain or improve function more than other simple treatments. Many foot problems also improve over time without treatment.

It isn't known how much footwear advice alone changes pain or function.

Risks and side effects

Footwear advice itself is low risk. The harm comes from shoes that fit poorly or aren't suitable:

• Pressure, rubbing and blisters. A pointed toe box squashes your toes together and can change the shape of bones or joints. A very high heel pushes your foot forward and crushes your toes. Plastic or rubber shoes don't breathe and may cause blisters.
• Toe damage, corns and callus. Slip-on shoes and court shoes are often kept on by curling the toes. They have to be wedged on, which can damage the toes or cause corns and callus.
• Falls and injury. Poorly fitting shoes, and shoes with worn, cracked or loose soles, can reduce your grip and raise your risk of a fall. High or semi-high heels have been involved in stair falls, when the heel catches on the edge of a step. Older people should be careful with very soft midsoles, which may worsen balance.
• Skin damage and ulcers. In rheumatoid arthritis, foot deformity and rubbing from shoes can damage the skin and lead to ulcers, and the risk rises with age and how long you have had the disease. In diabetes, early wear-in problems are unlikely, but some adjustment is often needed at first.

If new or prescribed shoes cause rubbing or redness, especially if you have diabetes or rheumatoid arthritis, stop wearing them for long periods and contact your podiatrist or orthotist.

Afterwards

Check the soles of your shoes regularly. Replace shoes when they are worn and the wear can't be repaired.

Wear well-fitting shoes consistently, and keep building up wear time slowly with any new pair. If you have diabetes, keep checking your feet every day, because reduced feeling means they may not warn you of a problem.

If a foot problem isn't improving, arrange a review with your podiatrist. Poorly fitting shoes can make a foot problem hard to improve, even with podiatry treatment.

When to see a podiatrist

When to book

Book an appointment with your podiatrist if new or prescribed shoes rub or leave redness (stop wearing them for long periods until you have been seen), if a foot problem isn't improving, or if you have diabetes or rheumatoid arthritis and want footwear suited to your feet. Book one too if you are unsure about footwear or the advice isn't helping.

When to get help sooner

Call your local emergency number if your leg, foot or toes suddenly turn cold and pale or blue, with pain or numbness. The following needs urgent medical assessment: see your GP today, or go to an urgent care clinic or the nearest emergency department, if you have an acute injury or suddenly can't put weight on your foot, severe pain that doesn't ease, a fever, weight loss, night pain that keeps you awake and keeps getting worse, or redness, heat and swelling in your foot. If you have diabetes and notice a wound, redness, swelling, a hot foot or any sign of infection, contact your GP, podiatrist or diabetic foot team straight away. If you have diabetes and your foot becomes painful or swells quickly, or you feel unwell, go to the nearest emergency department. Footwear advice should never delay any of this.

Frequently asked questions

Do insoles replace good shoes?

No. Insoles sit inside your shoes, so the shoes still need to fit well. If you are getting insoles or orthoses, choose shoes with removable insoles, and take your insoles along to try them in the shoes before you buy.

Is it OK to leave my top laces loose if that feels comfortable?

It's best not to. In running shoes, leaving the top eyelets unlaced feels the most comfortable but is the least stable way to lace. Use the fastening to hold your foot firmly, and ask your podiatrist if a fully laced shoe is uncomfortable.

Why does my podiatrist ask about my shoes?

Because shoes that fit poorly can make a foot problem hard to improve, even when your podiatrist is treating it. Looking at what you wear every day helps your podiatrist choose treatment that can work.

Further reading

• Footwear advice NHS
• The role of a podiatrist healthdirect
• Purchasing off-the-shelf orthotic aids and how to manage common foot pains :: Dorset HealthCare University NHS Foundation Trust NHS