A method for manufacturing custom fit therapeutic footwear such as shoes and inserts includes the step of measuring a patient's foot and forming an imprint of a patient's foot to identify the patient's footprint and any high pressure areas on the bottom of the foot. The method also includes the step of making a mold of a lower portion of the patient's foot and subsequently making a plaster cast of the lower portion of the patient's foot. A multidensity sheet of insert material is provided and formed into a shape that corresponds to the lower portion of a patient's foot as for example by vacuum forming. The method also includes the step of providing a second insert material that is softer than the first insert material. The imprint of the patient's foot is then used to position any needed accommodations. The area to be accommodated is then punched out through the entire thickness of the insert and filled with a sheet of softer insert material. The final product may then be covered with a top coat or sheet of moldable polyethylene.