• 'Look like hospital shoes'

• Unacceptable appearance

• Excessive time to receive shoes

• Limited colours, styles, materials and durability.

It is better to compromise on design and issue a pair of shoes which are suboptimal but will be worn by the patient than to issue 'optimal' shoes which stay in the back of the wardrobe.

What to do if patients refuse to wear suitable shoes

• Try to limit the amount of walking patients do in unsuitable shoes

• If patients wear slip-on shoes, the heels should be as low as possible to avoid weight being thrown forward onto the metatarsal heads. If patients are accustomed to wearing high heels and agree to adopt a lower style, the heels should be lowered gradually to avoid damage to the Achilles tendon

• If shoes are particularly damaging, try to persuade patients to accept an alternative style

• Ascertain reasons for non-acceptance. Are they spurious or sound?

• Ask another patient who wears special shoes, of similar age, background and lifestyle, to talk to the patient

• Re-educate the patient and explain the importance of special shoes. Try to find a compromise or alternative in every case.

Management of specific deformities

The management of the following deformities will be discussed: claw toes, prominent metatarsal heads, fibrofatty padding depletion (FFPD), hallux rigidus/limitus, hallux valgus and foot drop.

Claw toes

They should be accommodated in shoes with a wide, deep toe box to reduce pressure on the dorsum of the toes. This may be achieved in high-street shoes, but often extra-depth shoes or bespoke shoes are needed. If the deformity is not 'fixed' a silicone rubber device (toe prop) can correct toe position and off-load the apices.

Prominent metatarsal heads

These can be accommodated in an extra-depth stock shoe with a cushioning insole. However, where the medial longitudinal arch is high and the metatarsal heads are extremely prominent, a cradled insole with sinks and bespoke shoes will be needed.

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