Diabetic Foot Australia guideline
Table 1: List of definitions related to footwear for people with diabetes
Term
Abnormal foot shape
Bespoke footwear
Custom-made footwear
Custom-made insole
Custom-made medical
grade footwear
Customised insole
Depth-inlay footwear
Depth footwear
Extra-depth footwear
Footwear modification
In-shoe orthosis/orthotic
Liner
Medical grade footwear
Metatarsal pad
Metatarsal bar
Off-the-shelf footwear
Orthopaedic footwear
Pedorthic footwear
Pedorthic footwear
modification
Pre-fabricated medical
grade footwear
Pre-fabricated insole
Shoe insert
Shoe last
Therapeutic footwear
Toe orthosis
Definition
A foot shape that cannot be accommodated in pre-fabricated footwear. This includes, but is not limited to, feet
with: hallux valgus, clawed/hammer toes, severe pes-planus or cavus foot type, abnormally wide feet, flat foot,
minor amputation or Charcot foot.
Synonym for “Custom-made medical grade footwear”.
Synonym for “Custom-made medical grade footwear”.
An insole that is custom-made to the individual’s foot using a 2D or 3D impression of the foot, and that is
often built-up in a multi-layer construction. This may also incorporate other features, such as a metatarsal
pad or metatarsal bar. The insole is designed to conform to the shape of the foot, providing cushioning and
redistribution of plantar pressure.
Footwear uniquely manufactured for one person, when this person cannot be safely accommodated in prefabricated
medical grade footwear. It is made to accommodate deformity and relieve pressure over at-risk sites
on the plantar and dorsal surfaces of the foot. In-depth assessment, multiple measurements, impressions or a
mould, and a positive model of a person’s foot and ankle are generally required for manufacture.
Term to denote a pre-fabricated insole to which minor modifications specific to a person’s foot may have been
made. This term is not synonymous with “Custom-made insole”.
Synonym for Extra-depth footwear.
Synonym for Extra-depth footwear.
Footwear constructed with additional depth and volume in order to accommodate deformity such as claw/
hammer toes and/or to allow for space for a thick insole. Usually a minimum of 5 mm (~3/16″) depth is added
compared to pre-fabricated footwear. Even greater depth is sometimes provided in footwear that is referred to as
double depth or super extra-depth.
Modification to existing footwear with an intended therapeutic effect, e.g. pressure relief.
Term used for device put inside the shoe to achieve pressure reduction or alteration in the function of the foot.
Can be pre-fabricated or custom-made.
Synonym for insole.
Footwear that meets the specific needs of a person. Can be either pre-fabricated (see “Pre-fabricated medical
grade footwear”) or custom-made (see “Custom-made medical grade footwear”).
Small pad placed proximal to the metatarsal head to relieve focal pressure and transfer load more proximally.
Bar extending across part of or the entire forefoot placed proximal to the metatarsal heads to relieve focal
pressures and transfer load more proximally.
Readily available footwear that has not been modified and has no intended therapeutic functions.
Synonym for “Custom-made medical grade footwear”.
Synonym for “Medical grade footwear”. Can be either pre-fabricated (in that case synonym for “Pre-fabricated
medical grade footwear”) or custom-made (in that case synonym for “Custom-made medical grade footwear”).
Synonym for “Footwear modification”.
Pre-fabricated footwear that meets the specific needs of a person, on the basis of footwear that provides extra
depth, multiple width fittings and features designed to accommodate a broader range of foot types. Other
features may include modified soles, fastenings and smooth internal linings. This type of footwear is usually
available at specialty shoe shops.
An “off-the-shelf” flat or contoured insole made without reference to the shape of the patient’s foot.
Synonym for insole or in-shoe orthosis.
Last used to make footwear. The upper of the footwear is moulded or pulled over the last. The last shape defines
the footwear shape including the outsole shape, heel pitch and toe spring. For off-the-shelf or pre-fabricated
footwear generically generated lasts in different sizes are used.
Generic term for footwear that is designed to allow some form of treatment. May refer to both custom-made or
pre-fabricated medical grade footwear.
Synonym for “In-shoe orthosis”, but specifically for the toe.
Several healthcare disciplines may be involved in the provision of footwear for people with diabetes. Having a common vocabulary is essential for
clear communication. We propose to use the following definitions, obtained from [15, 16, 32, 33] and authors’ expert opinion.
44 Pedorthic Footcare Association | www.pedorthics.org