Charcot Foot – Moving into Orthotic Footwear

Charcot foot is a problem that people can encounter especially if they have diabetes. Charcot foot makes the bones of your foot soft. To protect and support your foot during this time, you will have been in a plaster cast and/or a pneumatic boot (ie an Aircast boot) for several months now, regularly having the temperature of your feet checked. When there is less than 2 degrees centigrade temperature difference between your feet, it means the bones and soft tissue are no longer being attacked and at risk of further deformation. At this stage you will be assessed for orthotic footwear and advised on beginning to put weight through your foot again.

Why do I need special footwear?

Because of the way that charcot changes the bones in your feet, you may be left with decreased movement, a change in foot shape, or even too much movement in some joints.

This means you can be at risk of areas of high pressure under your foot which can be a problem for people with diabetes as it can cause foot ulcers or joint damage. To help with this, special orthotic footwear and insoles may be made to protect your feet.

Will I get a choice of style for my new footwear?

Because your foot has been kept immobile in a pneumatic boot or cast for a long time, it is very important that your first pair of footwear is very supportive. This will usually mean that you have to have sturdy leather boots initially, to protect the foot. Sometimes additional ankle and leg supports are required. Your orthotist will discuss this in more detail.

How long will it take to get my new footwear?

The footwear will be made especially for your foot shape. After measuring your feet, we always arrange for an initial fitting appointment. At this stage, the footwear is half-finished. It takes around four to six weeks to get the shoes to this stage. The orthotist will check the fit of the footwear so they can advise the shoemaker of any changes that are required. The footwear is usually completed around four to six weeks later. You will then have a final fitting appointment with the orthotist. If there are any complications with your foot during this time, timescales may be increased.

How do I get used to my new footwear?

It is very important that you move from the very supportive pneumatic boot or cast to your new footwear very slowly and very carefully so as to protect your foot, which can still be vulnerable.

We usually recommend around a six-week transition period into your footwear. When not in your special footwear, you should be wearing your pneumatic boot/or cast. No other footwear including slippers should be worn during this time.

Week 1: Wear footwear for ½ hr in the morning and ½ hr in the afternoon/evening
Week 2: Wear footwear for 1 hr in the morning and 1 hr in the afternoon/evening
Week 3: Wear footwear for 2 hrs in the morning and 2 hrs in the afternoon/evening
Week 4: Wear footwear for 3 hrs in the morning and 3 hrs in the afternoon/evening
Week 5: Wear footwear for 4 hrs in the morning and 4 hrs in the afternoon/evening
Week 6: Wear footwear for 5 hrs in the morning/early afternoon and 5 hrs in the late afternoon/evening
Week 7: Wear footwear all day

Usually at three and six weeks, you will have a review appointment with the orthotist to check your footwear and temperatures.

If, while breaking in your footwear, you notice any sudden redness, swelling, temperature increase or pain, please immediately return to wearing your cast or pneumatic boot and contact the Orthotic Department to arrange an urgent appointment.

Additional instructions

To be completed by your orthotist.

About this leaflet

Author: Nicola Green, Orthotist
Written: June 2020
Updated and approved: November 2021
Review date: November 2024
Edition: v2

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk