Bespoke Shoes Built Around Orthotic Insoles

If you wear orthotic insoles, the shoes have to be designed around their volume. An orthotic takes up space inside the shoe, changes the position of the foot and can affect the instep, the heel and how high the foot sits in the pair, so in bespoke its volume is built into the last from the start.

This article is for general information. The workshop does not diagnose or replace a doctor: diagnosis, treatment and any correction are decided by a medical specialist. Bespoke shoes are made to follow a doctor’s recommendations.

An orthotic takes up room, and that is the key point

Everything on this page comes down to one value: the volume inside the shoe. An orthotic does not add it, it takes it away. It is thicker than the insole the shoe was designed for, and its profile lifts the foot.

Hence a situation familiar to almost everyone who has been prescribed orthotics. A pair that was fine becomes tight with the orthotic in. It presses over the instep, the toes touch the end, the heel rises and starts to come out of the counter. The shoe has not changed; the volume inside it has.

This is not about bad insoles or bad shoes. It is arithmetic: the last was built for an insole of a certain thickness, and something else was put inside.

What changes when an orthotic goes in

Four things change, each with its own effect.

Volume over the instep. The foot is raised, so there is less room between it and the top of the shoe. This is the most common complaint: pressure from above, laces that will not close.

Effective length. Lifted by the orthotic’s profile, the foot shifts slightly forward, and the toes lose some of their room.

The heel’s position in the counter. The heel sits higher, but the counter is as tall as before. It grips less well, and the heel slips out as you walk, especially in loafers and other shoes without fastenings.

The shape of the support. The orthotic touches the foot where nothing touched before: under the arch, under the heel, sometimes under the metatarsal heads. That is its purpose, but the shoe must make room for that profile without squeezing the foot elsewhere.

Partial inserts, such as half-insoles and heel lifts, have their own quirk: they raise the foot unevenly. The heel goes up and the forefoot does not. For fit this matters more than it seems: the counter works less well and the angle of the foot changes.

What bespoke does

The idea is simple and the execution needs precision: room for the orthotic is built into the last in advance rather than taken from the foot later. The table lists the main decisions and why each is needed.

Why a bigger pair does not solve it

This is the most common attempt, and it works only partly.

A size mainly adds length. Foot length and ball girth are not proportional, and when lasts are graded, height is usually scaled like width although it should grow less. So a bigger pair adds little volume on top, and on top is exactly where room is short once an orthotic is inside.

The second effect is slipping. The foot moves forward, and the orthotic moves with it, so its profile no longer lines up with the areas it was designed for. Arch support shifted by a centimetre no longer supports the arch.

The third is the heel: a bigger pair holds it worse even without an orthotic, and with the heel raised it slips out of the counter more easily still.

So a size solves a length problem, and this problem is one of volume. That is why shoes for orthotics are either made deep from the start, as in ready-made extra-depth ranges, or built to measure.

Extra-depth ready-made shoes or bespoke

There is a real choice, and it is not always bespoke.

Ready-made extra-depth shoes with a removable insole cover many cases: you take out the standard insole, put in your orthotic, and the volume works. If your foot is within the ready-made range in girth, it makes sense to start there: it is quicker and cheaper.

Bespoke is needed when the volume is still not enough: the foot does not match the last in girth, the orthotic is thick or has a high profile, an orthosis has been prescribed, the feet differ, or a particular counter height is needed for the raised heel.

An honest principle for the measuring visit: if the problem is solved by a removable insole in a deep ready-made pair, the shoemaker should say so rather than take an order that has an easier answer.

Which styles take an orthotic

The style matters more here than people think, because of how the shoe holds the foot.

An open-laced derby is the easiest. The quarters are free and open wide, so the volume lost over the instep is partly recovered through adjustment, and the shoe goes on more easily with an orthotic inside.

An oxford works, but with less range: the quarters are stitched under the vamp. With a thick orthotic, the last is built with that in mind rather than “as usual”.

Ankle boots are often more comfortable than shoes: longer lacing, more adjustment, and a higher upper holds the raised heel better.

Monk straps adjust more coarsely, since the step between strap holes is larger than between eyelets. With an orthotic you notice it: one hole is too loose, the next too tight.

Loafers and court shoes are the hardest. They stay on by fit alone, and the orthotic lifts the heel and takes away the counter’s grip. It can be done, but the counter height and girths are calculated for the raised foot, and more fittings are usually needed.

Shoes without a heel counter hardly work with an orthotic at all: nothing holds the raised heel.

A common mistake: trimming the orthotic to fit the shoe

When a prescribed orthotic does not fit a pair, it is tempting to trim it round the edge. Sometimes that is acceptable, if it is a few millimetres round the perimeter and the profile is untouched. More often trimming spoils exactly what the orthotic was made for.

The support profile is designed to sit at particular points under the foot: the arch, the heel, the metatarsal heads. Cutting the edge shifts the whole insert inside the shoe, and the profile no longer lines up. The cut edge also becomes a ridge that rubs.

The right order is the reverse: not the orthotic adjusted to the shoe, but the shoe built or chosen for the orthotic. If you already have a pair that fits in every other way, it is wiser to replace its standard insole with a thinner one than to cut the prescribed insert.

The special case is when a prescribed insert does not fit any pair sold anywhere. That is the main reason for bespoke in this situation, and it is best discussed with the insert in your hand.

How it is worked out at the measuring

Bring all the inserts you use or have been prescribed. Their thickness in different areas, the height of the profile and how much they lift the foot are measured. Without the insert, the calculation is approximate, and the error usually shows on the finished pair.

Your old shoes are examined with the insoles inside, the way you wear them. A crushed or displaced insole, a worn heel lining, a stretched instep, wear along the edge of the insert all show where the volume does not match.

Measurements are taken by the last maker or someone he trained, and the girths are taken on the understanding that an insert will be inside. The height to which the orthotic lifts the heel is recorded separately, because the counter height depends on it.

The trial shoes are fitted with the orthotic inside, never without it; otherwise the test is meaningless. The shoemaker watches while you walk: does the heel hold, is there pressure from above, does the insert lie flat without curling at the edges. The real pair is started only once it is comfortable with everything in place.

Timing: about six weeks for the last and four to make the pair, with one or two fittings in between.

When the orthotic changes but the pair stays

An orthotic wears out faster than shoes, and that is worth planning for.

The material compresses and deforms, and the profile flattens. Makers often suggest replacing prefabricated insoles every few months, although measurements show that even after a year of wear they redistribute pressure only slightly worse. It is better to judge by their condition than by the calendar.

The practical consequence for the design: a pair with a removable insole is better. Then a worn orthotic is replaced and the shoes stay. If the insert is glued in, replacing it becomes a rebuild.

And one rule about replacements: a new orthotic of a different thickness changes the volume the pair was built for. If you switch to a different model, bring the pair and the new insert together; sometimes choosing an insole of a different thickness makes everything work again.

When to see a doctor

The doctor prescribes the orthotic, and which one you need is the doctor’s question. See one if the orthotic causes pain that was not there before, if it rubs along its edge, if sores appear that do not heal, if sensation is reduced, in which case shoes and inserts should be chosen with a specialist, or if the orthotic was prescribed long ago and your condition has changed.

The workshop does not prescribe orthotics or diagnose. Its job is to make sure what was prescribed fits and works where it was designed to.

The first days of wear and care

A pair with an orthotic feels different: there is contact under the arch or the heel where there was none. A few days of getting used to it are normal. Pressure at one point, a lasting mark on the skin or rubbing along the edge of the insert are not; take the pair back to the shoemaker.

A good habit is not to change shoes and orthotics at the same time if something bothers you, or you will not know which of the two is the cause.

Care: take the orthotic out and dry it separately, especially if your feet sweat, because damp material deforms faster. Treat the leather upper with firm creams; liquid emulsions seep into micro-cracks and break the leather down from within.

— Orthotic insoles increase the size and volume a shoe needs. Put an orthotic into shoes you wear with a plain insole, and they will almost certainly be tight. So in bespoke this must be allowed for: the volume is always increased for an orthotic.