Lateral Flare:
A lateral flare is a footwear modification where the outer edge of the shoe’s sole is widened to increase the base of support. This added width helps control excessive outward (lateral) movement of the foot and enhances overall stability during gait.
Who May Need This Modification:
Lateral flares are commonly used for people with lateral ankle instability, recurrent ankle sprains, cavovarus or supinated foot posture, or those who consistently load the outside border of their feet. They assist in improving balance and reducing the risk of ankle rolling.
What to Look Out For:
Suitable footwear should have a firm midsole and stable outsole that can safely accommodate the added material. Avoid shoes with very soft, curved, or highly flexible soles, as these reduce the effectiveness of the flare. Ensure the shoe has enough outsole thickness to allow proper bonding of the modification.
Medial Flare:
A medial flare is a footwear modification where the inner border of the shoe’s sole is widened to create a broader base of support on the medial (inside) side of the foot. This reduces excessive inward foot movement and increases stability during stance and gait.
Who May Need This Modification:
This modification is beneficial for individuals with excessive pronation, flat feet, posterior tibial tendon dysfunction, medial ankle instability, or those who collapse through the inside border of their feet. It helps improve alignment and reduce strain on supporting soft tissues.
What to Look Out For:
Select footwear with a firm, stable midsole that can securely accommodate the added medial material. Shoes with very soft or highly flexible soles are not ideal, as they can reduce the effectiveness of the flare. Ensure there is adequate outsole thickness for secure bonding of the modification.
Forefoot Wedge (Medial or Lateral)
Forefoot Wedge:
A forefoot wedge involves adding angled material under the forefoot to tilt the foot either medially or laterally. This helps adjust forefoot alignment and modifies pressure distribution during the push-off phase of gait.
Who May Need This Modification:
Forefoot wedges are commonly used for forefoot varus or valgus deformities, metatarsalgia, excessive loading on one side of the forefoot, or to support improved toe-off mechanics. They can also benefit individuals with instability or altered forefoot biomechanics.
What to Look Out For:
Suitable footwear should have a firm and stable forefoot sole to ensure the wedge sits securely. Avoid shoes with minimal forefoot structure, as they may compress or distort around the wedge. Ensure the shoe fits well after the modification, as wedges may subtly alter forefoot volume.
Carbon Fibre Shank and Rocker Modification:
A carbon fibre shank and rocker is a footwear modification where a rigid carbon fibre plate is inserted through the midsole to limit forefoot bending, paired with a rocker sole that promotes smooth forward motion. Together, they reduce pressure on the forefoot and assist with propulsion by allowing the shoe—not the foot—to perform the bending during gait.
Who May Need This Modification:
This modification is often recommended for individuals with forefoot pathologies such as metatarsalgia, hallux rigidus/limitus, midfoot arthritis, plantar plate injuries, or those requiring reduced toe-off loading. It is also helpful for people who benefit from greater stability and reduced midfoot strain.
What to Look Out For:
Footwear should have adequate depth and sole thickness to house the carbon shank and allow safe shaping of the rocker. A firm, stable midsole is essential to prevent collapse around the plate. Avoid shoes with overly flexible soles, minimal cushioning, or highly curved profiles, as these can compromise both the rocker function and shank stability.
Heel Lift Modification:
A heel lift is a footwear modification where additional material is added beneath the heel section of the shoe to elevate it by a specific height. This reduces tension on the Achilles tendon and calf complex, improves alignment, and assists with smoother heel-to-toe transition during gait.
Who May Need This Modification:
Heel lifts are commonly prescribed for individuals with Achilles tendinopathy, calf tightness, leg length discrepancy, plantar fasciitis, or symptoms aggravated by excessive heel strain. They help decrease tensile load through the posterior chain and can improve comfort and walking efficiency.
What to Look Out For:
Footwear should have a firm, supportive heel counter and stable midsole to ensure the lift sits securely without causing instability. Adequate internal depth is important so the lift does not cause heel slippage or rubbing. Avoid shoes with very soft or unstable heel cushioning, as these can compress under the lift and reduce its effectiveness.
Footwear Build-Up Modification:
A footwear build-up modification involves adding material to the sole of a shoe—either fully or partially—to increase its overall height. This adjustment can be applied to one shoe or both, and can be localised (e.g., forefoot or rearfoot only) or full-length depending on the clinical need. The build-up restores alignment, improves gait symmetry, and reduces compensatory strain through the lower limbs and spine.
Who May Need This Modification:
Build-ups are most commonly recommended for individuals with a structural leg length discrepancy, significant pelvic tilt, or gait abnormalities caused by lower-limb shortening. They can also assist people recovering from surgery or trauma where one limb is functionally shorter, helping reduce pain, improve balance, and normalise walking patterns.
What to Look Out For:
Footwear must have a firm, stable sole that can securely accommodate additional materials without deforming. Adequate sole thickness is important to maintain structural integrity after the build-up. Avoid shoes with very soft, compressible outsoles or highly curved rocker profiles, as these can make the modification unstable. It is also important that the upper provides sufficient support to maintain proper fit after the height change.
Shoe Stretch Modification:
A shoe stretch modification involves applying controlled heat and pressure to specific areas of the shoe upper to increase width, depth, or relieve pressure over prominent anatomical areas. This targeted stretching helps improve comfort and reduces irritation without altering the shoe’s structural integrity.
Who May Need This Modification:
Shoe stretching is commonly used for individuals with bunions, hammertoes, prominent metatarsal heads, claw toes, tailor’s bunions, wider forefeet, or sensitivity over bony prominences. It is also beneficial for people who experience rubbing, pressure points, or difficulty achieving adequate width in standard footwear.
What to Look Out For:
Footwear should have an upper made from stretchable, heat-mouldable materials such as leather or certain synthetics. Shoes with very rigid, plastic, or mesh-only uppers are less suitable, as they may not stretch effectively or may lose shape. Ensure that stretching does not compromise support, and check that seams or stitching will not create new pressure areas after the modification.
Velcro Extensions
Velcro Extensions:
Velcro extensions involve lengthening existing Velcro straps or adding extra strap material to improve closure reach across the foot. This allows for easier fastening and accommodates increased foot volume or swelling.
Who May Need This Modification:
This modification is ideal for individuals with oedema, high-volume feet, arthritis, limited hand dexterity, or those who struggle to secure standard straps. It improves comfort, adjustability, and ease of donning/doffing.
What to Look Out For:
Footwear with sturdy, good-quality straps and upper materials works best for extensions. Avoid shoes with flimsy or narrow straps that may not hold securely once extended. Ensure the extension does not interfere with walking mechanics or create excess slack that could catch on clothing or surfaces.