Custom-made footwear isn't for everyone—but for some people, it's the only solution that works. This guide helps you understand when custom footwear becomes medically necessary and what conditions benefit most from bespoke pedorthic care.
What Makes Footwear "Custom"?
Custom footwear is made specifically for your feet using precise measurements, 3D scans, or plaster casts. Unlike prefabricated "medical grade" shoes that come in standard sizes and widths, custom footwear is built from scratch to match your unique foot shape, address specific conditions, and accommodate any orthoses or braces you wear.
Conditions That Often Require Custom Footwear
High-Risk Diabetic Foot
Patients with diabetes who have neuropathy (loss of feeling), previous ulcers, or significant foot deformity are at high risk for serious foot complications. Custom footwear provides:
- Pressure redistribution to prevent ulcer formation
- Accommodation for deformities without friction
- Seamless interiors to minimize injury risk
Charcot Foot (Charcot Arthropathy)
Charcot foot causes bones to weaken and fracture, often resulting in severe deformity. Standard footwear cannot accommodate the resulting "rocker bottom" shape. Custom footwear with specialized midsole construction provides the necessary support and protection.
Neurological Conditions
Conditions like cerebral palsy, stroke, multiple sclerosis, and muscular dystrophy often require custom footwear because:
- Feet may develop contractures or unusual shapes
- AFOs or other braces need to be accommodated
- Gait patterns require specialized sole designs
Severe Arthritis
Rheumatoid arthritis and other inflammatory conditions can cause significant joint destruction and deformity. When the forefoot becomes severely affected with hallux valgus, claw toes, or metatarsal subluxation, custom footwear protects vulnerable areas and reduces pain.
Other Indicators for Custom Footwear
- Significant leg length discrepancy (typically >2cm) requiring built-up footwear
- Partial foot amputation requiring custom fit and modified sole
- Severely different sized feet (more than 2 sizes different)
- Post-surgical reconstruction with altered foot anatomy
- Congenital abnormalities like club foot or vertical talus
- Lymphoedema causing significant foot/leg swelling
When Prefabricated Options May Suffice
Not everyone needs custom footwear. Medical-grade prefabricated shoes are often appropriate for:
- Mild to moderate foot conditions without severe deformity
- Diabetic patients without neuropathy or history of ulcers
- People who need extra depth/width but have relatively normal foot shape
- Those requiring custom orthoses that fit in prefabricated shoes
The Honest Truth
At Walk Easy, we always recommend the least complex solution that meets your needs. If prefabricated footwear will work, we'll tell you. Custom footwear is more expensive and takes longer to make—it should only be recommended when it's genuinely the best option for your situation.
How to Get Assessed
If you're unsure whether you need custom footwear, a pedorthic assessment is the first step. During this appointment, we'll:
- Review your medical history and current conditions
- Examine your feet, legs, and current footwear
- Assess your gait (walking pattern)
- Discuss your goals and daily activities
- Recommend the most appropriate footwear solution