Shoes can be used as is. Ordered one that turned out to be too big, it was ok. I kept it instead of sending it back but didn't use it. I have ordered a second one in a smaller size. Fits as expected. However, the upper part of the shoe, which is on the little toe or big toe side (depending on which foot the shoe is used on), is not properly attached to the shoe. There is about 1 inch and 1/2 of separation and the back of the shoe doesn't fit well and doesn't fit as snugly into the heel/achilles on the back as it should. I will be repairing the side of the shoe myself as I need it for medical reasons and I can't wait for another one to come. I have had the same shoe from the same company in the past but it was not defective as I got it insured from a prosthesis shop. He didn't have these flaws, nor did the "too big" shoe that I recently bought. Overall, if this shoe had been put together the same way as the other two, it would have received 4 stars. The shoes get 3 stars because of the quality of the respective shoe.
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