A little adjustable. I wear a narrow, and this medium adjusted almost to that narrow width. It wouldn't have adjusted enough if I had been between an AA and a AAA width without having the straps curling up past the end of the Velcro. As far as the footpad, it's great! I put these on, & forgot I had new shoes on. Very, very comfortable. I has a great footpad support especially under the arch. These were my first Earth brand shoes, & it won't be my last.