Moulded insoles

These are mainly used to prevent recurrence of ulcers. They are designed to redistribute weightbearing away from vulnerable pressure areas and at the same time provide a

Diabetic Foot Care

Fig. 4.9 Cradled insole with excavated sink filled with Neoprene over the mid-foot to accommodate plantar deformity.

suitable cushioning and total contact with the sole. These insoles may occupy too much space for them to be accommodated in anything but bespoke shoes, although an extra-depth stock shoe can sometimes accommodate the insole if the foot itself has a reasonably normal shape.

A plaster cast is taken of the foot to represent the overall contours including the sole. The cast is filled with a foam to make a last, over which the insoles are moulded, and shoes constructed.

A variety of polyethylene foams, microcellular rubbers and ethyl vinyl acetate (EVA) foams are used to construct moulded insoles which are usually made of two or three layers of different densities, with the most compressible at the foot-insole interface.


Closed cell polyethylene foam, e.g. Plastazote:

• Easily mouldable

Open cell polyurethane, microcellular rubber, e.g. Poron, or closed cell, rubber-like polymers, e.g. Neoprene:

• Not mouldable

• Excellent shock absorption

• Good long-term resilience, and will not bottom out. EVAs, e.g. Nora or Evalon range of different densities of EVAs:


Various designs of moulded insoles are in use, including a design that forms a cradle by extending the insole up the sides of the foot.

Recently, EVA insoles have been used. These insoles have a top layer of low-density EVA for cushioning, followed by two to four layers of medium-density EVA and a base layer of high-density EVA, with the most dense and rigid layer acting as a cradle. Under particularly high-pressure areas, areas of the insole can be excavated out to form a 'sink' which is filled in with pressure-relieving material (Fig. 4.9).

Alternatively, the Tovey insole uses a high-density Plastazote material for the cradle. Pressure areas are marked on this and these areas are cut away to be filled in with Neoprene cushioning. The whole cradle is covered with an upper layer of Neoprene cushioning.

Composite moulded insoles can also be made, with an upper layer of low-density Plastazote and a lower layer of polyurethane rubber.

Fig. 4.9 Cradled insole with excavated sink filled with Neoprene over the mid-foot to accommodate plantar deformity.

Bespoke shoes

This footwear is custom-made for the patient and involves the production of a last which is specific to that individual's foot. Bespoke shoes can house cradled insoles. The shoes may be adapted to redistribute pressures further, and this can be carried out with rocker soles and metatarsal bars.

When first issued these shoes will need to be worn for short periods only. Their main role is prevention of recurrence.

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