Common Footwear Modifications

Footwear modifications are adjustments made to a shoe to improve comfort, alignment, or load distribution. These modifications can be especially helpful for managing foot pain, improving walking efficiency, and supporting specific conditions. Below are some of the most common types and what they are designed to accomplish.

Shoe Lifts

A shoe lift is used when one leg is shorter than the other. The lift is added either inside the shoe or built into the sole on the outside. By raising the shorter side, the pelvis becomes more level, and walking becomes more balanced. This can help reduce pain in the lower back, hips, knees, and feet.

• Inside the shoe: Useful for small differences (usually up to ~6 mm).
• Built onto the sole: Used for larger differences to avoid crowding the foot inside the shoe.

Metatarsal Pads

A metatarsal pad is a small, dome-shaped pad placed just behind the ball of the foot. It does not go under the painful spot directly — instead, it lifts and spreads the metatarsal heads to redistribute pressure more evenly. When placed correctly, they reduce the sensation of “walking on a pebble” and improve comfort during push-off.

Metatarsal pads are commonly used for:

• Metatarsalgia (pain in the ball of the foot)
• Morton’s neuroma
• Forefoot overload with walking or running
  

Forefoot Rockers

A forefoot rocker is a curved shape built into the sole of the shoe near the toe area. The rocker helps the foot “roll” forward during walking instead of relying on the toes and forefoot to bend. Many running shoes now have built-in rockers, but they can also be added to certain shoes as a modification.

Forefoot rockers are especially helpful for:

• Big toe arthritis (hallux rigidus)
• Forefoot pain when pushing off
• Plantar plate strains and sesamoiditis
• High-volume walking or running to reduce forefoot load
  
  

Medial and Lateral Wedges

A wedge tilts the foot slightly to adjust how weight is distributed. Wedges can be placed inside the shoe, under the insole, or built into the sole.

• Medial wedge: Lifts the inside edge of the foot. Useful for reducing excessive pronation or supporting issues like posterior tibial tendon dysfunction.
• Lateral wedge: Lifts the outside edge. Useful for reducing pressure through the inside of the knee or addressing certain foot/ankle alignment patterns.
  
  

Medial and Lateral Buttresses

A buttress is extra material added to the side of the shoe to limit motion. Buttresses are especially useful when significant ankle instability or deformity requires more control than an insole alone can provide.

• Medial buttress: Supports the inside of the shoe to prevent collapse or inward rolling of the foot.
• Lateral buttress: Supports the outside of the shoe to prevent excessive outward movement.