Therapeutic Footwear
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Therapeutic footwear is made or chosen for feet at risk of problems or with a changed shape. It is mostly used by people with diabetes who have nerve damage in their feet. It spreads pressure out, makes room for deformity and helps prevent foot ulcers (open sores). Guidelines recommend it for people at high risk, though how much it reduces ulcers is still uncertain. It is not the first choice for healing an ulcer you already have. How well it works depends on a good fit and on wearing it as advised.
What is it?
Therapeutic footwear is footwear made or chosen for feet that are at risk of problems or have changed shape. It is mostly used by people with diabetes who have neuropathy (nerve damage that dulls feeling in the feet). It aims to take pressure off risky spots and to prevent problems that can lead to amputation.
It works in two ways. It spreads out and reduces the pressure under your foot when you walk. It also leaves room for foot deformity, such as bunions or hammertoes.
Custom-made footwear is made for you from your own measurements. Ready-made therapeutic footwear is mass-produced, with extra depth, support or other features. Names and definitions vary, so ask your podiatrist or orthotist what your footwear includes.
What is it used for?
The main use is preventing foot ulcers, and stopping them coming back, in people with diabetes. Guidelines recommend footwear that has been shown to relieve pressure under the foot while walking for people at high risk. They also recommend custom footwear for high-risk people with significant neuropathy, foot deformities or a previous amputation.
It is also used for foot problems in adults with rheumatoid arthritis, where it makes space for deformity and eases pressure that can cause pain, skin damage and ulcers. Therapeutic footwear is also used for other conditions, including other kinds of arthritis, nerve conditions, injuries, deformities present from birth and sports injuries. How well it works for each of these isn't clear yet.
It is not the main treatment for healing an ulcer you already have. Other devices do that job better (see "How well does it work?").
Is it right for me?
Therapeutic footwear is aimed mainly at adults with diabetes who have:
- neuropathy
- a changed foot shape
- a past ulcer or amputation
Custom footwear is commonly prescribed after an ulcer has healed. People at moderate to high risk of ulcers are advised to wear properly fitting footwear that makes room for the foot. Adults with rheumatoid arthritis and foot deformity may also benefit.
Most of the advice here is about adults with diabetes. Nothing is known about children. If you have another condition, ask a health professional for advice that suits you.
Footwear alone is not the right choice for an active ulcer on the sole of the foot. For an ulcer in the forefoot or midfoot, a knee-high device that can't be taken off is the first choice. Other care may also be needed. This can include scans and checks for infection, treatment to improve blood supply, or sometimes surgery if an ulcer won't heal. Don't swap a prescribed offloading device for ordinary or therapeutic shoes unless your foot team says so.
What happens?
Your footwear is matched to your risk of ulcers and to any foot deformities. It is individual to you and checked by a team of health professionals. Trained staff assess your feet, fit the footwear, show you how to use it and follow you up. It is more than a one-off purchase, and you may need basic advice or rehabilitation as well.
Good footwear fits properly and fastens snugly so your foot doesn't slide. It makes room for any deformity, and for any inserts. It should also be easy to put on and take off.
Common features include:
- a removable insole, which adds depth or lets custom insoles fit
- adjustable laces or straps
- wide, deep toe boxes
- a wide heel base
- a soft ankle cuff with rolled seams, to stop rubbing
- a rocker sole (a curved sole that helps your foot roll forward)
Some clinics can measure the pressure inside your shoe as you walk. This helps confirm the footwear is working, and the shoes can be adjusted afterwards. One pressure testing session took an average of 53 minutes. Ask whether it is available to you.
There is no set number of visits. Ask your podiatrist or orthotist what schedule suits you.
Footwear is one part of looking after your feet. You will also keep up foot care, avoid walking without suitable foot protection, and have any early skin problems treated. Your feet are checked for loss of feeling and blood flow problems once a year if your risk is very low, and more often if your risk is higher.
How well does it work?
Some design features clearly lower pressure under the foot in people with diabetic neuropathy. These include arch shaping, padding behind the ball of the foot and openings in the insole. Lower pressure doesn't by itself prove fewer ulcers, though, because no pressure level that causes ulcers has been set.
For preventing ulcers, the picture is encouraging but uncertain. Combined results point towards fewer first ulcers and fewer returns of ulcers, but the true effect could be small or even none. Therapeutic shoes alone may not clearly reduce ulcers in people with a past ulcer and no severe deformity. Careful foot care from health professionals may matter as much or more. Special footwear may still help people who don't get that kind of close care, and people with severe deformity.
For healing an active ulcer, any offloading device is probably better than therapeutic footwear. Devices that can't be taken off heal more ulcers than ones that can.
For adults with rheumatoid arthritis, a guideline reports less pain and better physical function than with standard footwear. The strength of the evidence ranges from moderate to very low.
How much you wear it matters a great deal. Wearing it for at least 60 to 80 per cent of the time you are up and about is described as a critical factor. In one group of people with diabetes, neuropathy and a past ulcer, custom footwear was worn about 71 per cent of the time on average. That was 61 per cent at home and 87 per cent away from home.
Risks and side effects
The main risk is poor fit. Footwear that doesn't fit is one of the most common causes of foot problems in people with diabetes. Nerve damage can hide a blister or a pebble in your sock, so a cut or sore can form without you feeling it.
Some styles carry extra risk if your feet are numb:
- Thongs with straps can cause ulcers through movement and rubbing.
- Sandals without a heel cup or strap can slip off without you noticing.
- Open therapeutic sandals leave your toes and part of the top of your foot unprotected from knocks and from stones.
- Closed shoes in hot weather may raise the risk of fungal infection, and the heat and sweat inside the shoe might itself raise ulcer risk.
- Gumboots and water shoes sold to the public may cause ulcers in some cases and do not reduce pressure under the foot.
Ask your foot team what is safe for you. Check your feet every day and each time you take your shoes off. Look for broken skin, blisters, redness, heat or swelling.
Afterwards
Wear your footwear as often as your podiatrist or orthotist advises, indoors as well as out. Keep going to your follow-up visits. Footwear can be adjusted after pressure measurements and when it wears out. There is no set review or replacement time, so ask when yours should be checked.
Tell your podiatrist or orthotist if the shoes are uncomfortable, hard to wear or you don't like how they look. They can often adjust them, and you are more likely to wear shoes that suit you.
People at higher risk are more likely to have a serious foot problem, so talk to your foot team about your risk level and what to do if a problem appears. Footwear doesn't replace foot checks and professional foot care. Keep up both.
When to see a podiatrist
Book an appointment if
Your footwear rubs or presses anywhere (stop wearing it and contact the person who fitted it promptly), it is uncomfortable or hard to put on, or you can't wear it as advised. Also book if you have diabetes with numb feet, a changed foot shape or a past ulcer and haven't had a foot risk check or a footwear plan.
Seek prompt assessment if
your foot becomes red, hot, swollen or more painful, you notice a new break or wound, new redness or discolouration, or new or unexplained pain, a wound or blister isn't healing, or there is oozing, discharge or a bad smell. See your podiatrist, foot care team or GP today, and within 24 hours at the latest, and don't wait to see if it settles. If your GP can't see you today, go to an urgent care clinic or an after-hours GP. If you have a foot wound or infection and you also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, this could be sepsis: call your local emergency number.
Frequently asked questions
Can I wear therapeutic footwear indoors?
Yes, and it is a good idea, because people tend to wear it least at home. Walking barefoot or in unsuitable footwear leaves your feet unprotected. Special therapeutic indoor footwear with similar pressure-relieving features exists, and providing it has been reported to help people wear footwear indoors. Ask your podiatrist or orthotist.
Do rocker-sole shoes help?
A rocker sole may reduce the pressure under the front of the foot in people with diabetic neuropathy. How well it works depends on the angle, position, height and material, so it needs to be set up for your foot. No standard design has been set.
What is the difference between therapeutic footwear, shoe modifications and orthoses?
They are related but different. Therapeutic footwear is built or chosen for your foot. Shoe modifications change an existing shoe, for example with flares for stability, extended shanks (stiffer soles), rocker soles or reshaping to fit a deformity. Orthoses are custom inserts that cushion, support or redistribute weight. Your podiatrist can explain which combination suits you.
What if I find the shoes unattractive or too expensive?
You are not alone. Many people with rheumatoid arthritis, particularly women, find therapeutic footwear unacceptable because of how it looks, its price or limited availability. Tell your podiatrist or orthotist, because ready-made shoes that don't suit you can make foot problems worse. They can look at other options or adjust what you have.